Whistleblowers: promises of protection are repeatedly broken, meeting hearsBMJ 2019; 364 doi: https://doi.org/10.1136/bmj.l1482 (Published 28 March 2019) Cite this as: BMJ 2019;364:l1482
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As medical students from Imperial College London, we read this article with great interest. The story of Peter Duffy from early 2018 has sparked much conversation and debate within our peer group. The details of the story have been reported with similarities and differences to other cases, yet the ‘Whistleblower’s Catch 22’ is a common theme: the idea that coming forward to try to protect patients can lead to ostracization of the whistle-blower in question.
As fifth year medical students, our real-life experiences in terms of ‘whistleblowing’ are unsurprisingly limited. Regardless, it is a topic we have discussed in many ethical scenarios and teaching sessions. Before beginning our first placements in hospital, case scenarios were acted out and we discussed the responsibility as team members of holding people accountable when necessary. We have always been taught that whistle-blowing is needed for patient safety which is the overarching purpose of our role (or future roles) as doctors, but the logistics of it have often not been thoroughly explored. Following teaching sessions, many of us muttered to each other how horrendous this would be in reality. We understood that it may be too difficult to proceed with for many people, exacerbated further if you were alone and not supported by your colleagues.
Prior to becoming medical students, some of us had ethical questions posed to us during our interviews, which included this topic. The ‘right’ answer was, of course, making a decision that promoted the safety of patients above all else. Yet, like many things in life, it appears the reality may be difficult – if not at least, with many more consequences. It is daunting to see headlines circulating across the news including doctors losing their jobs or being threatened as a result of their words.
In an independent review on the reporting culture in the NHS done by senior barrister, Robert Francis QC, it was recommended that changes be made within the NHS to promote an open, honest reporting culture . As steps are taken to tackle this, it is important that it is reported back to students to ensure they can recognise poor care and feel confident in reporting it. An article in the BMJ, 2015, outlined the plea of a Foundation Year One doctor to include “mandatory whistleblowing training for medical students” . Including this in the UK medical curriculum would help ensure students all start foundation training on the right foot.
As numerous cases have been reported in the news, and likely many more behind the scenes, we believe it is vital to encourage teaching that explores how to approach and handle scenarios like this. It is a reality that as medical students, what we are taught now will shape the doctors and team players we become in the future. Whilst we do not expect to discuss cases as they develop in the public eye, we believe that having a safe space to talk about, discuss in detail and reflect upon these cases could help our personal development and confidence. As the article quotes, “there has never been a more dangerous time for frontline NHS staff to consider speaking up in defence of our patients”, we feel concerned that this is a harsh reality we may come face to face with in the future. Whilst we are not in a position to demand change in terms of legal protection for those who whistle-blow, we believe that education regarding this topic is vital for the future generation of doctors.
1. Francis R. Freedom to speak up: an independent review into creating an open and honest reporting culture in the NHS. 11 February 2015
2. Limb Matthew. Whistleblowing training should be mandatory for medical students, BMA says BMJ 2015;350 :h2848
Competing interests: No competing interests