Faisel Alam blogs for us about being a medical student and the professional responsibility this brings both in and out of the workplace.
I am a graduate student (3rd year) at GKT School of Medical Education, King’s College London. I work as an Education Associate for the General Medical Council which involves visiting medical schools as part of a quality assurance team. I am also involved with the CQC as a Specialist Advisor where I provide specialist advice and input into their inspections and investigations activity.
Honesty, integrity and patient safety
As medical students, in a community of over 40,000, we are not just the future doctors of tomorrow, we are also the eyes and ears of the NHS today. In light of the widespread failings highlighted by the Francis Report in Mid Staffordshire that led to hundreds of hospital patient deaths, this highlights more than ever the need for honesty and integrity to lie at the heart of everything we do. These values of professionalism have significant implications for patient safety.
The Lessons Learned Report [PDF] of the Mid Staffordshire NHS Foundation Trust Public Inquiry directly quotes the Health & Care Professions Council (HCPC):“You must behave with honesty and integrity and make sure that your behaviour does not damage the public’s confidence in you or your profession.”
Doctors – the ‘most trusted profession’
Doctors hold a position of power and responsibility that demands trust when carrying out professional duties. While doctors are often rated by the public as the ‘most trusted profession’, we have seen in the past the irrevocable damage that is caused to the entire profession – and the danger to patient safety – when medical professionals have been dishonest. A notable example can be seen in the case of former surgeon and medical researcher Andrew Wakefield, known for his fraudulent research paper suggesting a link between the measles, mumps and rubella (MMR) vaccine, and the appearance of autism and bowel disease. The impact this has had on public health still continues today; with hundreds of thousands of children in the UK currently remaining unprotected in the absence of vaccination as a result of the scare, while the battle to restore parents trust in the vaccine remains ongoing.
In my view, honesty and integrity are core values of professionalism that we must all embody. As medical students, we see patients across all levels of their care pathway. This includes in hospital, at the GP surgery, in care homes, as well as in the privacy of their own homes. Our patients share with us some of the most difficult and intimate experiences of their lives. There have been occasions where I’ve accompanied healthcare staff to a patient’s home the day after an attempted suicide following a drug overdose. These experiences can be very overwhelming. Maintaining honesty and integrity, and not acting beyond one’s limitations is absolutely crucial both for us, and for the safety of our patients.
As medical students in particular, we are placed in a somewhat unique position. Unlike many other disciplines of study we are scrutinised even before entry to university through extensive DBS checks. We are also particularly vulnerable in that we are accountable for our actions and behaviors both in and out of the clinical environment.
GMC student professional values survey
The results of the GMC survey showed that most medical students have an understanding of professionalism that is in line with what is expected from future doctors. I wanted to reflect on some of the findings with some of my own examples.
I remember during the first few weeks of my Psychiatry rotation where my colleagues and I were waiting for our consultant near his office. In that time, we began reflecting on our experiences of the day. Another consultant walked past and overheard some of our conversation. We were then called into a side-room where we were told in detail about how careful we must be when talking in open areas, particularly about patient cases, even whilst maintaining anonymity.
While the majority of responses in the GMC survey stated that discussing details of a patient examination in public is mostly unacceptable, it is interesting that almost a fifth considered it to be mostly acceptable. The best thing to come out of that experience is that I now try to be vigilant about when, where, and to whom I communicate my experiences from the clinical environment.
Another pertinent area where the boundaries of professionalism can blur is across social media. In my view, I don’t think we receive enough training in this area, and that which we do receive I would question its effectiveness. I know of many colleagues whom either opt to not partake in, or maintain a very low-key profile, or even delete their social media accounts such as Facebook and Twitter. And one of the overwhelming reasons seems to always be related to the risks associated with the nature of social media, including the fear of any professionalism-related repercussions outside of the clinical environment. Simply producing guidance that so often gets shelved and gathers dust can be limiting. The GMC should invest in timely and innovative ways to engage and educate students to become astute across social media when it comes to professionalism.
Sometimes we get it wrong. Sometimes we just need to be advised. Or perhaps sometimes we err too much on the side of caution. Ultimately, we try our best to act with honesty and integrity, in the provision of safe, effective, high quality, compassionate patient-centred care.
This week the GMC has published a report showing the results of a recent student survey we undertook on professionalism. The results will help us to review the guidance we give to medical schools and students on professionalism and fitness to practise.
Faisel Alam is a graduate student (3rd year) at GKT School of Medical Education, King’s College London.