Background

Anju arranged a clinical elective in a remote, resource-limited healthcare facility in a third-world country where state-funded healthcare was very limited. During her placement in the emergency department, part of her role involved checking whether patients had the necessary insurance or sufficient funds to receive ongoing care. This responsibility included declining assistance and turning away patients who lacked adequate financial coverage.

Allegations

Although Anju found the experience educational, concerns were raised by her university mentor back home about her professional and ethical position. Questions started to be raised about whether her actions were in line with the General Medical Council’s (GMC) professional and ethical guidelines, including the Hippocratic oath to “do no harm.” The concerns were focused on whether a medical student should be making decisions that could then potentially deny patients from getting the necessary care they needed due to financial reasons, and whether this was in her scope of practice.

How Medical Protection helped

As a student member, Anju called the Medical Protection advice line as soon as the concerns were raised. A dedicated team of medicolegal experts and advisers listened to what had happened and gave her advice on what professional standards were expected and what might happen next.

A medicolegal consultant then worked closely with her to ensure she fully understood the appropriate professional boundaries, and an adviser helped her gather evidence of all her reflections and learning. Unfortunately, the matter was escalated to a formal GMC complaint, but Anju was reassured that a panel would be available to support her and help protect both her future career and her fitness to practise.

Outcome

The GMC acknowledged the difficult circumstances and Anju’s good intentions in the role she had been assigned during her elective. No further action was taken, but the GMC urged Anju to be careful in future when getting involved in decisions that could result in care being denied and to always seek support and guidance in any ethically challenging situations.

Learning points

• Medical students should always make sure that they act within their competence levels, particularly when working in settings with limited resources and ethical dilemmas.
• All decisions that affect patient access to care on financial grounds should be carefully considered, as they may conflict with the GMC’s guidelines and medical ethics.
• Medical indemnity is essential for elective placements overseas to protect students against any potential complaints or legal claims.
• Early advice and support from Medical Protection can help members understand professional boundaries and navigate complicated ethical situations when working abroad.