Raising concerns
Elsewhere in this series (Ethics Module 4, Duty of care), a professional duty of care is explained and the broader aspects of professional responsibility are discussed. Your first duty is to the patient and this extends beyond a particular patient under your immediate care, to patients and potential patients in the wider community. If, in the course of your professional life, you see or hear something that leads you to believe that patients could be placed at risk or the quality of their care compromised by the actions or performance of a professional colleague, then you have an ethical duty to take reasonable and appropriate steps to:
- Raise your concerns with the colleague directly, if this is appropriate to the situation
- Deal with the problem yourself (if this is within your power)
- Report your concerns to a higher authority (if you cannot resolve the matter yourself)
- Take advice as to how best to manage the situation.
Making others (particularly those in authority) aware of your concerns is sometimes referred to as “whistleblowing”, and historically the tendency was to keep these concerns to yourself. Unfortunately, this approach can sometimes leave patients exposed to continuing risk. There is an increasing awareness that, in order to discharge our ethical duty to protect the public, it will sometimes be necessary to raise concerns with a body that can investigate the situation more fully, such as a medical board or council.
This will rarely be the first step, however. In the first instance it is usually more appropriate to discuss your concerns with other professional colleagues, a practice owner or immediate manager, or with higher authorities in a corporate institution or hospital setting. Medical associations, protection or indemnity organisations and other professional groups can all be useful sources of advice. It is also unwise to act upon “hearsay” rumours about a professional colleague, or to jump to conclusions without trying to find out both sides of the story for yourself.
On the other hand, it would be imprudent to automatically dismiss such concerns without giving them some thought and consideration. There are many past examples of patients suffering serious consequences which could have been avoided, if the appropriate action been taken by other healthcare professionals who were well placed to appreciate the risk.
It is also worth remembering that you may actually be helping a professional colleague to come to terms with a problem that previously they might not even have acknowledged. Dealing with a problem at a lower level, however awkward at the time, can prevent it from escalating into a situation where the stakes (and the professional consequences) are higher. The way in which such concerns are raised certainly has an important ethical dimension. It is usually not too difficult to distinguish a genuine concern to protect patients while trying to support a professional colleague, from a vexatious attempt to cause problems for the colleague in question.