How to avoid bad decisions that can ruin your career
BMJ 2024; 386 doi: https://doi.org/10.1136/bmj.q1584 (Published 18 July 2024) Cite this as: BMJ 2024;386:q1584
About once a fortnight I deliver a day long, one-to-one ethics course to a medical student, doctor, or dentist. These clients, usually referred to me by their concerned legal advisers, are undergoing disciplinary proceedings and are fighting for their professional lives.
The allegations against them are varied. Some have had sex with patients; some have harassed or bullied colleagues; some have breached patient privacy by looking at acquaintances’ medical records; some have lied to the coroner about the clinical care provided to patients; some have committed violent crimes (or done lesser crimes but failed to notify their regulator about them); some have defrauded the NHS by claiming payment for fictitious work or have left an NHS shift early to attend their private practice; and some have forged signatures, made up feedback forms, or misused social media.
Having conducted around 100 of these intensive “remedial ethics” sessions, I’ve asked myself this question: what single intervention could have helped my clients avoid making these errors?
The answer is not more teaching of ethics at medical school. When I ask my clients how much of ethics they studied at medical school some vaguely recollect a few sessions, while others claim, probably wrongly, that there was nothing at all. No one can remember anything about their ethics teaching. And very few recall any ethics education after qualification, which might be more effective.
Neither does the answer lie in swearing an oath. Doctors who swear the Hippocratic oath, for example, promise to “use treatments for the benefit of the ill” according to their ability and judgment and to keep patients from “harm and injustice.” They also promise to act morally in their private and professional lives. The problem is that several of my clients swore the Hippocratic oath at the start of their careers, and it made no jot of difference to their conduct. There’s a world of difference between making promises and fulfilling them.
Furthermore, clinical ethicists wouldn’t have prevented the errors. In 2005 I wrote an editorial in The BMJ calling for the introduction of clinical ethicists in hospitals.1 I argued that these specially trained ethicists, common in large North American hospitals, could help doctors resolve ethical dilemmas and contribute to their continuing education through lectures and private consultations. Yet I doubt whether any of my clients would have approached a clinical ethicist, let alone an ethics committee.
Trusted third party
The answer to my question is simple: seek advice from those close to you, be they colleagues, friends, or family. This may sound obvious, but none of my clients had asked anyone for advice before their life changing decisions.
My clients committed serious errors of judgment, most of which would probably have been avoided had they confided in a trusted third party. They were too deeply involved, too conflicted, too emotional, to see the situation clearly. They were blinded by the heat of the moment. If they had paused to seek the views of another person, the confidant would likely have pointed out the dangers missed by the doctor or identified the flawed rationalisation. They would have posed the awkward questions that might have led my clients to the right answer. If a colleague asked you if they should fabricate patient feedback for their portfolio, or do private work when on call, or go on a date with a recent patient—what would you tell them?
As the biggest obstacle to seeking help is ourselves, we should be humble about the correctness of our ethical judgments in times of crisis. If your ethical antennae pick up something troubling, however inchoate, or however confident you are that you can cope with it alone, ask someone else for their take on the situation. It may demand a few minutes of your time and theirs, and it may be embarrassing, but it could save you from a career ending blunder.
Footnotes
Competing interests: Daniel Sokol is a medical ethicist and barrister. He is founder of the Centre for Remedial Ethics (www.remedialethics.co.uk) and coauthor of the forthcoming A Young Person’s Guide to Law and Justice (Book Guild, 2024).
Provenance and peer review: Commissioned, not peer reviewed.