Video: Commitment to Professional Responsibilities | Commentaries

A Medical Student Perspective

Grades, respect of peers and residents, a future in surgery; all seem at risk by simply considering the consequences of reporting the incident. Fortunately, I am yet to face this dilemma in real life, but each year up to 75% of graduating students state they have personally witnessed medical errors¹. Disappointingly, but not surprisingly, less than half of these errors are reported.

From the reading of the Hippocratic Oath on the first day of class, students understand professionalism: competently caring for patients, maintaining accountability, humility, and an altruistic attitude all while respecting collegial relationships and the academic atmosphere².

The student role in the hospital, though, is often ill defined³. Not quite a doctor but more than a passive observer, contributions are difficult to measure. SOAP notes are often discarded presentations ignored, and attempts to "help" frequently seem burdensome. Is it your role to be an active patient advocate? Do the same rules of professionalism govern students, residents, and attendings?

Society, as Arnold points out, tends to frown at whistle blowers⁴. In general, remaining quiet is preferred to questioning a peer. Formal, anonymous, methods of incident reporting exist, but are often written off as too severe a penalty, leaving simple avoidance as the most commonly chosen alternative.

From a selfish point of view, avoidance is easily justified. Third year students lack confidence in our knowledge and place supreme importance on grades and evaluations. With minimal stress, it is easy to assume the patient will be cared for properly; but what if they aren't?

As students, we strive to embody the ideals of medicine; we are eager to show empathy, professional ethicality, and maintain an absolute desire to help others⁴. Every missed opportunity for professional behavior, though, serves as justification to repeat the infringement in the future. Doing the right thing is always difficult but is part of what defines professionalism, and if approached appropriately can maintain our ideals while limiting adverse consequences.

Personally, I am best suited to a subtle approach. I would avoid confronting the resident in the presence of others, as embarrassment and lost trust can irreparably damage relationships and opinions. As students, we follow a fraction of the patients covered by house staff, providing ample opportunity to complete the history and physical and discern the patient's true issues. Briefly presenting all new and pertinent findings to the resident will draw attention to previous misrepresentations. Further, I would take advantage of my status as a student to ask the resident to repeat and teach troubling parts of the patient's exam and history.

These cautious approaches provide the opportunity to correct mistakes without blatantly challenging the resident. I believe most mistakes are products of fatigue and stress rather than true shortcomings in ethical fiber. A tired resident will always appreciate help in averting disaster, and in the end the patient will receive appropriate care.

In the rare case of an un-responsive resident, buckle your seat belt and stick to your professional values. The character of all involved will be exposed and everyone will be better for it.

References:

1. Madigosky WS, Headrick CA, Nelson K, et al. Changing and sustaining medical students’ knowledge, skills, and attitudes about patient safety and medical fallibility. Academic Medicine 2006;81:94-101.
   
   
2. Chard D, Elshakawy A, Newbery N. Medical professionalism: the trainees’ views. Clinical Medicine 2006;6:68-71.
   
   
3. Park J, Woodrow S, et al. Patient care is a collective responsibility: perceptions of professional responsibility in surgery. Surgery 2007; 142:111-118.
   
   
4. Arnold L. Assessing professional behavior: yesterday, today, and tomorrow. Academic Medicine 2002; 77: 502-515.

Chris Yingling
Medical Student, Jefferson Medical College