By Dr Deborah Bowman

New doctors who begin practising will be well-versed in their ethical responsibilities. Preparation for finals and applications for early year jobs require students to engage with, and demonstrate, their ethical knowledge and how they apply that knowledge in practice. Yet, until graduation, students have few formal responsibilities. 

Once the celebrations of finals and the novelty of introducing oneself as “doctor” have passed, the realities of medical practice can be a shock. For many, survival rather than ethical sophistication are the order of the day. Duty of care narrows to the list of tasks accumulated at the behest of seniors.

Responsibility becomes burdensome rather than a privilege. To be ethical is easy in the abstract: ethical dilemmas in the lecture theatre and seminar room often appear to be deftly resolvable. However, the realities of ethical practice are more demanding, which is why some doctors make poor ethical decisions. 

For most junior doctors, ethical questions do not relate to the life and death crises that often dominate ethics teaching. The issues are more mundane. Yet, it is their very ordinariness that makes those challenges fundamental to, and at the heart of, what it means to be an ethical doctor.

In a properly organised intern post, the boundaries of appropriate and inappropriate work, both in terms of content and load, will be defined and regulated. However, it is possible that even the best-run intern post will bring ethical challenges relating to the shift in responsibility and the particular features of the clinical teams with whom one is working.

Our advice

• The pressure of the clinical workload means that mistakes are inevitable, but a distinction needs to be made between matters of personal conduct and poor performance, and where a doctor’s performance may be affected by a health issue (eg. depression, substance abuse etc.).

• Medical Council guidance says you should support colleagues who have problems with performance, conduct or health, but action should be taken if this compromises patient care. The Medical Council recommends that you must take appropriate steps to notify the relevant authority about your concern as soon as possible¹. If you are not sure who you should report your concern to, ask a senior colleague for advice or contact your medical defence organisation.

• Challenging a senior colleague is probably one of the hardest things you may have to do in your career, so if you have concerns, contact Medical Protection as soon as possible and a dedicated medicolegal adviser will support you through the process.