Home » Episode 3

Episode 3

The one where Jane’s surgery is at risk of going wrong…..

On the day of the surgery, Jane is checked in to the hospital and waits to be prepared for the procedure. A very senior and skillful surgeon, Mr Jones, infamous in the hospital for his authoritative manner and sometimes foul temper is scheduled to perform the operation.

 

 

 

 

 

 

 

A young F2 named Dr Patel will be observing and assisting the procedure. A team of nurses and an anaesthetist begin the surgical preparations, and an X is marked on the bandage on Jane’s left ankle to mark the correct surgical site.

 

 

 

 

 

 

The previous case has run on later than was expected and so the morning’s theatre list is now under pressure. Immediately prior to the surgery, in the haste to move quickly on to Jane’s case however, a member of the preparation team takes off the bandage, unknowingly removing the ‘X’ with it. The nurses are busy with the final preparations for the surgery, and Mr Jones is becoming increasingly impatient and is eager to being the procedure due to the now tight theatre schedule. Because of this, the step of verifying the correct surgical site is overlooked and Mr Jones mistakenly makes preparations to operate on the right ankle, instead of the left. The left leg is draped and covered while the right leg is exposed.

Dr Patel scrubs up and gowns and comes to the side of the operating table.

 

 

 

 

 

 

She looks at the drapes and notices that the right leg is exposed. Having been the doctor who admitted Jane on to the ward, Dr Patel has a nagging feeling that it was actually the other leg. She tries to remember her examination of Jane and which leg was the problem. She admitted Jane to the ward at the end of a very busy 12 hour shift in which she had no break and convinces herself that it probably was the right leg; after all the team and Mr Jones would be very unlikely to make such a mistake. Dr Patel briefly considers speaking up to clarify the site, but hesitates as Mr Jones seems a tad irritated and is starting to get impatient and also she remembers what happened the previous week when she questioned another surgeon regarding a potential error which resulted in the surgeon snapping at her.

 

She is also worried about challenging the authority of a senior surgeon in case she scapegoats herself among the rest of the hospital staff, particularly as she has only started working at that hospital. Mr Jones has already scolded and spoken harshly to several of the nurses that day, and Dr Patel does not want to be snapped at again.

ep3 - wrong

However, she is also concerned for Jane’s safety on the operating table, and is aware of the serious implications that could result from a botched surgical procedure. Unsure of what to do, she silently debates with herself for several seconds.

ep3 - what should I do

 

 

Questions for Student Comment:

1. The decision of whether or not to challenge the authority of senior colleagues is always difficult. Please comment on the reasons for and against Dr Patel challenging the authority of those in control of this procedure?

2. What steps could be put in place to prevent this potential error from happening?

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  24. Anonymous says:

    1. The decision of whether or not to challenge the authority of senior colleagues is always difficult. Please comment on the reasons for and against Dr Patel challenging the authority of those in control of this procedure?

    For: The first priority of any healthcare professional should be the safety and wellbeing of the patient. The patient is in an incredibly vulnerable position here, they are anesthetised and therefore unable to protect/defend themselves in any way. They have placed their trust in the surgical team as professionals that they feel they can trust with their lives. For Dr Patel not to do anything about this is a serious breach of trust between herself and the patient. She should not be putting her own comfort and reputation above the safety and wellbeing of the patient. It is also a breach of trust between herself and the multi disciplinary surgical team. The other healthcare workers rely on the team as a whole to be constantly checking and revising the work in hand. Dr Patel has a responsibility to the other members of the team to be open with her concerns in a professional manner.

    Against: The senior colleague here has created a extremely uncomfortable environment for the multi disciplinary team to work in here. His attitude is very unprofessional as his co-workers don’t feel able to express their professional opinion to him out of fear of him having a go at them. Dr Patel is understandably very hesitant to raise concerns over a possible mistake. Not only could he react badly to her concerns but he may also treat her worse as they continue to work together and this could greatly impede on her learning.

    2. What steps could be put in place to prevent this potential error from happening?

    Writing the X on the skin not the bandage, double checking the notes with all the MDT present and making sure everyone is happy and can raise sensible concerns in a professional and non-judgemental manner.

  25. Anonymous says:

    I think patient safety is always top priority and therefore Dr Patel should have spoken up. It is also paramount that more senior doctors take into consideration that trainee doctors are there to learn. Therefore, senior doctors require to be approachable and understanding so the junior doctors feel encouraged to speak up when needed. The surgical site should have been marked with a black marker on the patient’s leg not on the bandage to avoid such mistakes. The pre- theatre checklist should have been completed appropriately by the nurse no matter how busy the ward or the theatre was. All the above aspects had put Janes health and life at risk.

  26. Anonymous says:

    Dr Patel is not working in a psychologically safe working environment which means that more accidents (such as operating on the wrong ankle) can occur and put patient safety at risk. Dr Patel feels inferior to the surgeon because of his observations and his previous experience with another surgeon. This harms teamworking. Therefore, Dr Patel should not shy away from voicing his concerns in theatre. Though the surgeon would most likely at first be irritated- he/she will learn to appreciate that he/she would be saved from an immense clinical negligence case and a series of reoperations needed to fix the mistake. If the situation makes Dr Patel anxious, uncomfortable or Mr Jones makes him feel unsafe, then a conversation must be had in order fix this problem before communication within the operating room worsen. In this case, Dr Patel should still voice his concern maybe to a more senior colleague in theatre so that documentation can be checked before the operation begins.

    • Doctors could complete IHI modules so that they do not lose sight of their core values in moments of stress
    • Minimise the number of people in theatre so that everyone is aware of every step taken in build up to and during the operation
    • Mark skin with X before bandage removed
    • Patient files relevant to operation read before operation starts

  27. Anonymous says:

    1. The decision of whether or not to challenge the authority of senior colleagues is always difficult. Please comment on the reasons for and against Dr Patel challenging the authority of those in control of this procedure?
    A patient’s health is of utmost importance in an operation theatre or any other medical situation as it is important that the best medical care is provided for the patient to ensure proper treatment and recovery. Therefore, it is important that Dr Patel raises awareness on the confusion with which leg is to undergo surgery, to ensure that Jane’s best interest is in mind. If Dr Patel does not check on the right leg, the surgery will be performed on the wrong leg, which will be detrimental to Jane’s health resulting in a second surgery. Jane will have to undergo a second surgery while simultaneously nursing her other leg back to health, this will result in a lack of faith in the medical profession; preventing Jane from seeking medical help in the future. This is not only a waste of time and resources but could result in a malpractice suit and issues with the hospital’s administration for both Dr Patel and Mr Jones. While it is understandable why Dr Patel may be hesitant on raising concern about the leg, it is vital that she does so to ensure that Jane receives proper medical help and to save Mr Jones and herself from legal trouble.
    However, raising concerns could result in some adverse effects. As Mr Jones is already irritated and angry, the questioning of his medical skills may result in further aggravation of his anger causing him to perform the surgery angry and in haste which is not ideal for Jane. Dr Patel might feel as though she is overstepping her boundaries by questioning the many authorities in charge of this surgery and this could affect their teachings in the future. Moreover, if she is wrong, this could result in embarrassment and could affect the opportunities she is given the next time around as she could be considered incompetent as she would have wasted precious time. It is important however to mentions the smallest concerns she may have to ensure the patient receives the best care possible, but it is equally important to relay these concerns in a polite and respectful manner. This could cause the surgical team to lose faith in the surgeon’s judgement and therefore could jeopardize this and further procedures. It is important for a surgical team to have trust and faith but also comfort in offering criticism.

    2. What steps could be put in place to prevent this potential error from happening?
    To prevent errors like this, it is vital that there is efficient and thorough communication between the surgical teams preparing and performing the procedure. The surgical team should be briefed before the surgery on the patient’s history and the process of the particular surgery being performed. Moreover, before the surgery begins the surgical site should be re-checked to ensure that it is the right one. In fact, to decrease the potential for error, the surgical site should be marked on the skin and should consist of more than an ‘x’ to clearly indicate that it is the surgical site. Most importantly, it is important for senoirs such as Mr Jones to create an environment where his juniors are comfortable enough to question him by being more respectful and accommodating.

  28. Anonymous says:

    1. The decision of whether or not to challenge the authority of senior colleagues is always difficult. Please comment on the reasons for and against Dr Patel challenging the authority of those in control of this procedure?
    Raising concerns protect patients and allow the best care to be provided. It is important to always check, as no matter how high up a colleague is, everybody makes mistakes. Of course, raising concerns should be done respectfully, as working in a team is extremely important and so staff need to be able to get along with eachother.
    2. What steps could be put in place to prevent this potential error from happening?
    Better communication with the preparation team would avoid the X being removed, and Dr Jones should be more respectful of other members of staff so that steps aren’t skipped to avoid upsetting him. The care of the patient should be the first concern.

  29. Anonymous says:

    1. Patient safety must be priority. If they do operate on the wrong leg, Jane will suffer unnecessary pain and distress. Thus, Dr Patel should re-check with Mr Jone’s if it is the correct leg. However, Dr Patel may not want to do so as doing so could irritate Mr Jones even more causing a risk to Jane as irritated doctors will not perform at their best. Despite this, patient safety must be put first.

    2. Firstly, the surgical team must ensure to thoroughly complete all checks, even when tight for time. Secondly, perhaps the X could be marked directly onto the skin. And lastly, senior members of staff must ensure to treat everyone with respect and be open to being challenged.

  30. Anonymous says:

    The decision of whether or not to challenge the authority of senior colleagues is always difficult. Please comment on the reasons for and against Dr Patel challenging the authority of those in control of this procedure?
    For
    • Surgery being performed on the wrong leg is a waste of time for everyone involved as well as resources.
    • Jane will lose even more faith in the medical profession if the procedure is done wrong.
    • Mr Jones will only be more irritated if the procedure goes wrong
    • Dr Patel is having doubts for a reason, she might as well put her mind at rest.
    Against
    • Mr Jones may punish her for asking stupid questions
    • It may waste time in an already time pressured environment

    What steps could be put in place to prevent this potential error from happening?
    Marking the leg on the skin rather than the bandage will prevent the mix up in which leg must be operated on. Also putting a system of checking everything is in order before the surgery begins will act as a safety net for the surgical team. All members of the team should be informed of the exact specifications of the operation before entering the surgical suite.

  31. Anonymous says:

    Doctor Patel should speak up on behalf of Mr Jones to ensure there are no medical malpractice suits against Mr Jones if he were to operate on the wrong leg. This would be beneficial to Mr Jones and would help strengthen team dynamics as Mr Jones may be grateful for Dr Patel spotting something that he may have overlooked. However, as stated Mr Jones is already irate so speaking up may just result in agitating him further so could cause friction between the two colleagues.

    To prevent this occurring again perhaps Mr Jones he himself should directly mark the leg they will be operating on rather than on the bandage. Even something as simple as clarifying amongst the surgical team and theatre nurses who the patient is, why they require surgery and the site of surgery is always a good option to ensure everyone is on the same page.

  32. Anonymous says:

    1)Dr Patel has a duty to protect the patient regardless of the fear of annoying her senior colleague. If she has any doubts about the surgery she should raise them in the best interest of the patient and also to ensure that they are providing the best quality of care. Even in pressured situations, patient safety is a priority which is highlighted by one of the domains of Good Medical Practice set out by the GMS, ‘Safety and Quality.’ If not, then this would lead to multiple mistakes within the healthcare setting. However, when working with a senior doctor it may be daunting and as Mr Jones has a reputation for having an authoritative manner and foul temper, she may feel embarrassed if she is wrong about which leg needs operated. In addition, she may feel that if she was wrong then she would be adding more pressure on the limited time already established in the surgical ward.
    2)The WHO Surgical Safety Checklist was developed after extensive consultation aiming to decrease errors and adverse events, and increase teamwork and communication in surgery. Therefore, to prevent the error in this situation, the preparation team should have followed this checklist rigorously. In the healthcare setting teamwork and communication are key. There should be a more comfortable environment established so that people can speak up when they have a concern regarding the patients safety. Notes should be double checked before surgery even when timing is becoming an issue. If not this will lead to detrimental consequences.

  33. Anonymous says:

    1 – It can be very daunting for any junior doctor, let alone the F2 Dr Patel to challenge the authority and indirectly the competency of a senior colleague, particular Mr Jones who has been described as a very skilful and senior physician. There are many reasons why Dr Patel should challenge Mr Jones as it directly relates to patient safety and in medicine, the patient’s safety is of the most important concern. In the Duties of a Doctor as laid out by the regulating GMC body, paragraphs 22-30 relate to ‘Safety and Quality’. Paragraph 25 clearly states ‘You must take prompt action if you think that patient safety, dignity or comfort is or may be seriously compromised’. Jane’s safety is being seriously compromised as the surgical team are about to operate on the incorrect ankle. Dr Patel therefore has a professional responsibility to overlook the potential embarrassment and humiliation Mr Jones (the foul tempered surgeon) may subject him to if she thinks that Jane’s safety is being seriously compromised. However, it’s also due to the reasons described above that may deter Dr Patel from challenging Mr Jones. Feelings of embarrassment, nervousness and humiliation are all things that may cause Dr Patel from speaking up and challenging Mr Jones’ authority.

    2 – To prevent this potential monumental error from occurring in the surgical theatre, there must be a widely accepted and shared opinion that any member of a multidisciplinary surgical team, no matter how junior or senior, can feel safe and confident in raising any issues they might have if they believe that patient safety might be compromised which places the patient in direct risk fo harm. Certain hospital protocols within a surgical theatre should be enforced to ensure that mistakes do not happen, and surgical notes should be routinely checked prior to the start of any operation.

  34. Anonymous says:

    Dr Patel’s first priority must always be the patient. Practically, this means she is obligated to minimise any risk of harm to Jane by ensuring the correct leg is operated on. By taking the simple corrective steps, inappropriate treatment and associated complications will be avoided, theatre time will not be wasted and Jane’s trust in the profession will be maintained. Jane may be reprimanded for questioning her superior, however this is outweighed by the priority of Jane’s wellbeing.

    It appears the theatre schedule is very full, leaving little room for potential complications and delays. Putting less pressure on staff by anticipating for disruptions in the theatre schedule. Mr Jones appears to be creating a culture that opposes patient safety by belittling junior colleagues, this should be addressed. More simply, the ‘X’ should be drawn on the skin, instead of on the removeable bandage. Finally Dr Patel is responsible for raising concerns and prioritising patient safety where at all possible.

  35. Anonymous says:

    1. Although speaking up to Mr. Jones may seem challenging for Dr. Patel, it is certainly the right thing to do in this situation for a number of reasons. It ensures that Jane is definitely going to receive surgery on the correct ankle, even if Jane is incorrect. The clarification would eliminate Dr. Patel’s fears of carrying out incorrect surgery. Inquiring with Mr. Jones would demonstrate Dr. Patel’s effective communication skills and desire to ensure patient safety, which is critically important. Even if Mr. Jones responds negatively, Dr. Patel should reassure herself that double checking and ensuring patient safety is always the correct thing to do.

    Some reasons against raising concerns may be embarrassing for Dr. Patel if she is incorrect in suggesting it is the other leg and it may cause her to refrain from seeking clarification for future reference. It may cause Mr. Jones to become very impatient and angry towards Dr. Patel, which as a F2 doctor, may knock her confidence and elevate her anxiety surrounding communicating with doctors at a senior level.

    2. The steps that should be put in place to prevent this potential error happening include making sure the location of X is clearly known just before surgery rather than presuming it’s original location, if it has been removed already. The senior doctors should ideally be very welcoming to inquiries from other colleagues, including junior doctors, about a potential error like this and seek to leave no possibility of incorrect location of surgery. Detailed records of the surgery should be written down and filed for easy access if any clarification need to be sought at any time.

  36. Anonymous says:

    1.
    It can be exceedingly difficult to speak up against a more senior authoritative figure for many reasons and I do empathise with Dr Patel. However, in this, and any other, medical situation it is critical that the safety of the patient is of utmost importance. One of the key duties of a doctor is to ensure patient safety is not compromised, so this should be Dr Patel’s main concern when considering how to approach the situation, regardless of her rank or experience. Speaking up against Mr Jones would be quite daunting, given his reputation for both his skill and short temper. A younger F2 doctor, such as Dr Patel, may fear coming off as disrespectful by challenging and undermining their experience. As they are only at the beginning of their careers, they have much to gain from the teaching of more experienced healthcare staff so there may be a worry that upstaging a senior surgeon may cause resent, making their future relationship strained.
    It is always better to raise concerns and check rather than risking patient safety. Even if Dr Patel was wrong, the chance or such a preventable error is eliminated. By not expressing her doubts, the situation could backfire on Dr Patel who would get in more trouble with Mr Jones (especially as she was the doctor who admitted Jane), than if she spoke up and was incorrect.
    By not speaking up and allowing the operation to go ahead will firstly cause Jane even more unnecessary suffering, with no actual further progress in her treatment. It would be a great inconvenience to Jane who would likely lose function in her good foot as she waits for the surgical incision to heal, making her daily life even more difficult if she could not use crutches. Jane’s operation would be rescheduled putting further strain on the operation waiting list. The operation list for that day, which was already delayed, would be held up further for no reason. It would be a waste of staff time and hospital supplies.

    I can understand why Dr Patel would be hesitant. Raising a concern may throw off the surgeon’s focus. The confidence of the surgeon may be lowered, or even the rest of the surgical team may lose trust in the Mr Jones in this case, which could jeopardise the procedure. Speaking up in a polite, judgement-free manner is crucial in situations like this.
    As Dr Patel is an F2, she may be cautious about overstepping her boundaries. However, she would likely gain more respect from preventing such an issue from occurring and making her opinion more trusted in the future.
    The long waiting list would be on Dr Patel’s mind. Due to the previous operation that went on longer than anticipated she may be uncertain about delaying another procedure further. Although, it is much better to hold up the operation for a few minutes to check notes than for it to be rescheduled entirely.
    Mr Jones’s attitude in the operating theatre towards other staff may deter Dr Patel from speaking up. He had already snapped at several nurses earlier that day. However, this may be more of a reflection of Mr Jones’s current mood as if he scolded Dr Patel, he would not be singling her out. Also, it is almost certain that his mood would worsen if he was allowed to go ahead with the operation on the wrong leg.
    Dr Patel admitted Jane at the end of a non-stop 12-hour shift. She would therefore be doubtful of her recollection of events. She would not want to embarrass herself by being wrong about Jane’s leg. This may lead to future anxiety when it comes to raising patient safety issues.

    2.
    The main issue in this scenario is that the marked bandage indicating the leg to be operated on was removed. If a bandage is to be marked, it should be done so in an obvious manner with a large, unmissable X. An X is quite ambiguous, as a staff member may assume it means, for example, that the bandage needs changed. Perhaps even writing ‘this leg’ or ‘leg to be operated on’ on the bandage may give clearer instructions for healthcare providers. Ideally, the marking should be made on the leg itself so as the marking cannot be removed. There should be a good level of communication between staff who are made aware of this in case they are washing the patients. Prior to the operation, a doctor or nurse should visit the patient and ensure the leg is still adequately marked.
    All the members of the surgical team should be briefed on the procedure beforehand and made aware of what leg is to be operated on, so the chance of error is thoroughly reduced. A system of checking should be maintained throughout the procedure, with the notes being checked immediately before hand to ensure the correct leg will be treated.

    It is vital in a clinical setting to have an environment in which all staff are considered equals. Everyone in a surgical theatre, from the head surgeon to technician, should feel comfortable and confident to express doubts. There should be a mutual respect of opinions and no sense of a hierarchy for the benefit of the patient.

  37. Anonymous says:

    1. If Dr Patel doesn’t challenge Mr Jones, the wrong leg will be operated on. This will further damage Jane’s trust in the medical profession. From a practical point of view, it would also be a waste of time and resources. However, if Dr Patel does speak up, the right leg will be operated on allowing Jane to recover faster. However, when she raises her concern there is a risk that she is incorrect. Mr Jones will be angry with her and this may give her a bad reputation in the hospital where she has just begun to work in. Speaking up has a risk of short-term negative consequences such as Mr Jones yelling at her whilst not speaking up has a risk of long-term negative consequences. When patient safety is at risk, the reasons for speaking up will always outweigh the reasons against speaking up.
    2. Dr Patel is scared to challenge Mr Jones because he’s a senior colleague and has a reputation for snapping at other staff. Creating a culture where speaking up about potential errors is encouraged would be beneficial to patient safety. The importance of common procedures such as verifying the correct surgical site and the negative implications that skipping these procedures can have, even when under time pressure, should be stressed. The permanency of the marking made way for errors as it was on the bandage rather than on the skin. A visual check list could be placed in the operating theatre to remind doctors of the importance of these basic checks.2.

  38. Anonymous says:

    Being able to speak up when patient safety is at risk is, to me, a vital part of medical training and the medical profession as a whole. The professional relationship between Dr. Patel and the senior surgeon could potential become strained if the concerns are raised in a disrespectful or derogatory manor. However, if the concern proves to be correct then this slight interruption will be more than worth it. Patient safety should always be the priority.

    The x should be marked on the skin, not the bandage. There should be a more open surgery where those with concerns are not intimidated to speak their concerns. The notes should be double checked before the surgery begins, regardless of time constraints.

  39. Anonymous says:

    I think that patient safety should always be top priority and therefore any concerns should always be raised. However, they should be raised in a respectful manner so that it does not come across as being offensive or disrespectful to the senior members of staff. I understand why Dr. Patel may be worried about voicing her concerns as if the senior doctor is known for his foul temper, she may be worried about his reaction. But the consequences of not bringing up these concerns are more severe than if she doesn’t.

    I think this could have been avoided if the skin was marked instead of the bandage and I think that there should always be time set aside for discussing the patient and reading the notes before the surgery begins. I also think that the surgeon should work on being more approachable and encourage people to be open and confident in talking to him in order to promote better team work with the work environment and improve patient safety.

  40. Anonymous says:

    1. Dr Patel should raise a concern as it would contribute to the safety of the patient. If the concern is not addressed the pain in Jane’s leg will persist and it will further contribute to the distrust in the profession. If concerns are raised in a respectful manner than it shouldn’t undermine colleagues’ relationships. However, Dr Patel is unsure if she is correct with her concern and may be afraid of negative implications to the professional relationship
    2. This could be avoided by placing the X on the skin rather than the bandage so it isn’t as easily removed. Although the surgeon is rushed as he is behind schedule, time should be taken to consult notes as in the long run this could save more time. Moreover, a professional relationship with more open lines for communication could be worked upon to ensure all members of the multi disciplinary team can raise concerns.

  41. Anonymous says:

    Patient safety should always take priority it is the duty of a doctor. If Dr Patel raises her concerns promptly she will save patient distress and discomfort and ensure the correct procedure goes ahead. If she decides against raising her concern this will put the patient at unnecessary risk and require more hospital time and resources in the long run. However, it is understandable that Dr Patel clearly feels uncomfortable and nervous speaking up to her senior colleague. The best approach would be to check with the other surgical staff the details of the procedure and if confirmed raise the concern respectfully to Mr Jones.

    A run through the important details of the operation with the staff involved in the operation before beginning will prevent any doubts of those involved and promote an open and engaging work environment so that concerns can be raised and relieves any doubts. This will ultimately ensure patient safety.

  42. Anonymous says:

    1. The benefit of Dr. Patel challenging Mr. Jones is that patient safety is guaranteed whereby harm towards patient can be avoided. If there’s any doubt, health care professionals should clarify any information in order to avoid any mistake which may cost patients’ life. Moreover, health care professionals should always put patients as their priority in any situation. However, challenging a senior authority might take a wrong turn whereby Dr. Patel might be criticized by doing so as if she was being disrespectful. This might also affect the whole team’s performance in carrying the relevant surgery.

    2. Mr. Jones should always clarify by looking through the notes as well as confirming the relevant information for the procedure with the whole team. Mr. Jones should not reprimand his team members for speaking up if there’s any doubt. Health care professionals should be encouraged to voice out any concerns so that patient safety is not compromised.

  43. Anonymous says:

    1. Whilst Dr Patel is afraid that challenging the senior surgeon may cause her embarrassment if she is wrong or even worse prevent her from progressing, patient safety should remain her priority. By raising her concerns with the senior surgeon she would be adhering to the safety and quality aspect of the Good Medical Practice document and thus ensuring a good outcome for the patient. Furthermore correcting the surgeons mistake at the beginning may prompt other safety checks being carried out before the operation

    2. In order to prevent such a mistake happening her bare skin should have been marked with an X, rather than the bandage which was removed in this case. Furthermore before beginning the surgery, the surgical team should consult both the patient’s X-ray and medical notes.

  44. Anonymous says:

    Challenging the authority of a senior colleague is undoubtedly a nerve-racking process for Dr Patel. There are may reasons which would encourage Dr Patel challenging her senior colleague and most importantly to ensure patient safety and put the patient first in every situation. This is clearly laid out and demanded in the GMCs ‘Good medical practice’ in domains 2 ‘Safety and Quality’ and 3 ‘communication partnership and teamwork’. To ensure good medical practice these guidelines must be followed and by checking with the other staff that the correct ankle s being operated on would definitely be in line with these policy’s. Another reason why she should not hesitate in challenging her senior colleague is that he may even be impressed by her confidence and understand her competent checking and it may not negatively impact her reputation with him regardless of whether she was correct or not. Reasons to not challenge her senior may include being nervous of embarrassing herself or being conscious of the busy schedule that day.

    To prevent potential error for occurring in the theatre a change in culture must occur in which all staff feel like they can speak up and raise their concerns. Procedures to ensure that mistakes do not occur should be followed and the surgical notes should be checked before the operation by a designated member of staff.

  45. Anonymous says:

    1. The decision of whether or not to challenge the authority of senior colleagues is always difficult. Please comment on the reasons for and against Dr Patel challenging the authority of those in control of this procedure?
    It is escential to uphold patient safety and health above that of upsetting the surgeon or facing a telling off. However, it could perhaps be condescending to comment on every procedure and slow down the process.

    2. What steps could be put in place to prevent this potential error from happening?
    That the mark would be put on the leg rather than a bandage, and that proper procedures to check this all are observed just like confirming the patients date of birth and name

  46. Anonymous says:

    There are various ‘pros’ and ‘cons’ to Dr Patel raising the issue. Firstly, raising the issue with a senior colleague may protect the patient as it will cause the senior to stop and check the leg to resolve the issue. It may also ensure that other needed pre operation checks are carried out, as raising the issue creates a pause to consider safety. Her confidence to raise the issue may also help to create an atmosphere of honesty in the team, preventing future patient safety issues. However, I understand why she is worried about raising the issue, as her own tiredness makes her unsure of her own memories and raising the issue when there is no problem may lead to embarrassment and worsen the mood of the senior surgeon. Raising the issue and the resulting time it takes to sort it out may also cause worries about the later operations in the day being able to proceed. Challenging the authority of the surgeon may also put the future learning opportunities of Dr Patel at risk as she is still early in her career. Regardless of personal concerns here though, patient safety should be paramount as she makes her decision in this situation.

    There are several steps to be put in place to prevent this issue. Firstly, drawing the ‘X’ on Jane’s bare skin will ensure it is less likely to be removed, stopping confusion. Consulting the X-ray images of the legs as they prepare for the operation may also make things more clear. Making sure that the pre surgical pause is fully observed and that there is a culture of openness within the hospital will also give a space for any concerns to be raised before a procedure begins.

  47. Anonymous says:

    As Dr Patel is a relatively new member of the team at this hospital, she may feel as if she doesn’t yet have the authority to challenge her senior colleagues. Whilst challenging Mr Jones may result in embarrassment for Dr Patel, the safety of the patient, Jane, must be the priority and as a result Dr Patel must carry out the appropriate steps to address her concerns that a mistake has been made in the preparation for the surgery.

    Perhaps run through the notes with the entire operating team just prior to the procedure to ensure that the correct plans are in place. As is the case in this situation however, pressure due to a push for time has meant that certain procedures have been left out and the preparation has been rushed.

  48. Anonymous says:

    Challenging authority in any circumstance can be very difficult for anyone, not least a junior team member. I can empathize with Dr Patel that is may feel daunting to question a very senior colleague, especially as she is not 100% confident on the details following her 12 hour shift in which she assessed Jane. Additionally, if Dr Patel was mistaken, and the correct leg was prepared, this could lead to a feeling of embarrassment and subsequent anxiety regarding her reputation and career progression.
    However, patient safety is paramount within the health service. Amongst a team that works safely and effectively doubt of any size is more than enough justification for any member – medical or not – within a team to raise a concern. The team should respect all points made from every member equally and react to concerns in a non-judgemental manner without criticising. All healthcare professionals will make errors. Regardless of Mr Jones feeling grumpy on this particular day, it is reasonable to expect that Mr Jones would be grateful for keeping his patient safe and protecting his own reputation. Mr Jones would be a lot more grumpy if he were to know that he had operated on the wrong limb while another of his team had doubts but did not raise them.
    A few methods to prevent this potential mistake could be implemented prior to anaesthetic. Writing directly on to skin on the correct limb, covering the healthy limb while patient is conscious as well as confirming directly with patient the limb and procedure. Once anaesthetised thorough use of the Pre-Operative Theatre checklist would provide prompting for any member of the team to notice any discrepancies between planned procedure and current preparations while also providing clear opportunity for all members of the team to raise any doubts. This check could include referring to imaging to check the same limb is exposed.
    Potentially, submitting a ‘Near Miss Incident Report’ would allow a multi-disciplinary debriefing to establish any other potential methods to prevent this error occurring. A subsequent Safety, Quality and Experience Project could develop a safe, unique and effective method for this specific hospital. Overall however, a culture of no fear in raising concerns could be promoted hospital-wide to alleviate fears of judgement among all staff.

  49. Anonymous says:

    1. The decision of whether or not to challenge the authority of senior colleagues is always difficult. Please comment on the reasons for and against Dr Patel challenging the authority of those in control of this procedure?
    It may be difficult to rais concerns because of fear of repercussions however your responsibility as a doctor is to the patient first and then consider everything else. in this case, it would be paramount for Dr. Patel to challenge the surgeon. A negative of this would be causing mistrust or friction within the working environment.

    2. What steps could be put in place to prevent this potential error from happening?
    Never allow surgery to be started without a paper indicating the site of surgery along with marking the patient with the correct site on their skin. with regard to the potential mistake. with regards to raising concerns: a more friendly work environment would definitely improve this and make superiours more approachable. Thus this would make it easier to raise concerns to them.

  50. Anonymous says:

    Although raising concerns to a more senior colleague can be difficult as so not to offend them, the patients safety is always at the centre of all clinical contact and therefore is always one of the most important aspects to consider when carrying out any procedure, due to the detrimental effects that can result from overlooking a concern someone may have. I can relate to the fact that Dr Patel finds it hard to raise his concerns to a more senior colleague-Mr Jones as he doesn’t know how he we will react to the interruption, however as it was Dr Patel himself who admitted Jane onto the ward he has had a greater amount of time with Jane and so is not surprisingly more likely to know her case better and there for should trust her instincts and raise her concerns to the surgeon, however it should be done in a discrete and thoughtful manner as to not potentially embarrass or anger her senior colleague which could be a result if harshly alerted to the whole team. In addition the raising of the concern could potentially cause some of the MDT to loose trust in Mr Jones, firstly for not noticing himself but also if he were to actually operate on the wrong leg a greater mistrust would be brought about highlighting the importance for Dr Patel to communicate her doubt, as inevitably whether she raises her concern or not there could be greater effects for Mr Jones and Jane herself if she were not to, bring back around the importance patient safety plays, as it will be asker to check the notes one last time before the surgery, than realising part-way through the surgery that the wrong leg is being operated on and then having to tell Jane this and therefore she will have to undergo another operation.
    Rather than marking the X on only the bandages covering Jane’s leg it could be marked onto both Jane’s bandages and her skin itself using and arrow pointing to he actual site around where the operation should be taking place to further highlight the location of the expected surgery. Further to this, prior to going into surgery there should be a conversation with the patient to ensure that they are clear with what area and which side is bing operated on, so that they are sure as to what they are going in for. The notes should then be checked and before the surgery begins the MDT should have a quick briefing to ensure everyone is on the same page and are 100% confident in what surgery is being carried out and where it is being carried out.

  51. Anonymous says:

    The main argument for would be that by challenging Mr Jones, Dr Patel would be ensuring patient safety through preventing the wrong operation happening. Moreover, others in the room may have noticed the mistake and may support Dr Patel’s concern. By raising the mistake, Dr Patel would also prevent further damage to Jane’s trust in the healthcare profession. This would have resulted from the botched procedure. The argument against, however, could be that by pointing out the mistake, Dr Patel could cause the rest of the team to lose some faith in Mr Jones’ ability as a surgeon. Overall as patient safety is a doctor’s main concern, Dr. Patel should speak up if it is at risk.
    A number of steps could be taken. Firstly, the entire multidisciplinary team could discuss the patient prior to the operation, including what procedure is to be carried out and some basic details about the patient (for example, a female in her mid 60s). At this point the team members could be asked if they believe that sounds right or if they have any particular concerns about the procedure. Another step that could be taken would be to make a mark directly onto Jane’s leg, rather than onto the sheet. Finally, what seems to be a key problem with the scenario, an environment where each team member feels empowered to speak up should be cultured.

  52. Anonymous says:

    1. Patient safety should always be the main priority, regardless of the circumstances. However, I do understand why Dr Patel was reluctant to speak up in this scenario. The advantages of Dr Patel challenging the authority of those in control of this procedure are that Jane would be operated on the correct leg, preventing her from undergoing a pointless surgery. Also, Dr Patel would feel better as she would have peace of mind since her gut instinct was correct. The reasons against her speaking up would be that it could make Mr Jones feel embarrassed since he made a mistake, damaging her relationship with him. However, the benefits of Jane’s safety outweigh the drawbacks and so Dr Patel should most definitely challenge his authority in this case.
    This error could be prevented by having better communication amongst the surgical team and a more efficient marking technique, for example – markings could be placed directly onto the skin rather than on a bandage

  53. Anonymous says:

    1. The primary concern for a medical professional is ensuring patient safety. It is vital to raise any concerns if you feel like patient safety may be infringed upon. Raising a concern will reduce the risk of harm to the patient and ensure a high quality of care. However, as the lead surgeon is quite intimidating, it may be difficult for Dr. Patel to raise her concerns due to fear of ruining her relationship with the surgeon and may cause issues regarding her assisting in the future. Despite this, raising a concern is vitally important for the protection of the patient and this outweighs the worries of Dr. Patel but the method of raising the concern must be respectful and professional. The near misses must also be noted as all members of the team can learn from this experience. Overall, a concern should be raised to ensure the patient’s safety despite perceived implications to the individual raising the concern.

    2. This error could be prevented by a more effective marking technique of the correct ankle in relation to Jane’s case. Also, the surgical team should review the notes to make sure that the entire team is fully aware of what will happen in the operating theatre. Furthermore, more steps could be put in place to make the hospital environment more open for raising concerns and the idea of raising concerns should be encouraged and praised.

  54. Anonymous says:

    1. Raising a concern if you believe that the patient’s safety may be at risk should always be your priority, regardless of the situation. However, I can appreciate that some situations may create a more difficult environment to speak up in than others. In Dr Patel’s case, she is scared of being snapped at by the senior surgeon, or perhaps damaging her new work environment and relationships with her colleagues. Whereas these are indeed important, the consequences of putting a patient at risk are much worse. There are ways to go about raising a concern which mightn’t make Mr Jones as irritated, such as politely and respectfully mentioning a gut instinct or doubt that Dr Patel has – and asking that it would be checked for her own peace of mind, instead of outright accusing Mr Jones of being wrong. The GMC guidelines state that doctors must promote and encourage a culture that allows all staff the raise concerns safely and openly, so Dr Patel should be reassured by this and Mr Jones should work on promoting equality and teamwork amongst colleagues, instead of taking the authoritarian approach.
    2. More communication between team members was needed here, though I can appreciate how it may be difficult under a time constraint and in a busy ward. Markings for surgery should always be placed on the skin, so as to eliminate the risk of this situation happening.

  55. Anonymous says:

    1. Challenging a more senior colleague is always going to be difficult, and I can understand why Dr Patel would be hesitant, due to the mood of Mr Jones throughout the day. As an F2, it is likely that Dr Patel wants to learn as much as they can and most likely fears that if she speaks up and is shot down, her learning will be compromised throughout the remainder of her time there. She may also feel as if she is inferior to her colleagues, solely because she is less trained, however it is important to note that every member of the MDT is just as important as the next. Dr Patel should speak up, however in a respectful manner, if she fears the surgeon will be rude to her, not to tell him that he is wrong, but to double check in the interest of Jane’s safety. Dr Patel Jane when she was admitted to hospital, when Mr Jones didn’t and should therefore trust her instinct. If she is wrong, there are no consequences to patient safety, however if she doesn’t speak up, Jane’s safety is severely compromised.

    2. The surgeon should overview the condition and procedure before beginning, and ensure all staff are in agreement and have no worries or concerns about the procedure. This in turn would create a healthier working environment. Moreover, the mark on the patient should be on the skin, where it cannot be removed, and the notes should be in a more convenient place so that there is less trouble or hassle if they needed to be consulted.

  56. Anonymous says:

    Effective communication between members of the surgical team is essential in order to achieve the best outcome for the patient. Dr Patel has a duty of care towards the patient and not informing the surgeon of a potential error could cause major repercussions, by causing further harm to the patient as well as not actually solving the problem that the patient is actually meant to be receiving surgery for. On the other hand, as the doctor has only begun work in this hospital confronting the surgeon could lead to a break down of communication. Dr Patel may also feel that confronting the surgeon may affect her chances on assisting in subsequent cases.
    In order to prevent these sorts of mistakes the whole surgical team should be informed of the details of the case before surgery begins. As well as this the skin of the patient could be marked, rather than marking a bandage which can be easily removed.

  57. Anonymous says:

    1. It is important for patient safety for doctors to raise concerns if they believe there is risk involved. Conversely, if the authority of Mr Jones is challenged, then that may result in him being more irritable which could lead to a break down of communication. Both options put the patient at risk, so it is important to think on the decision.

    2. All staff involved should undergo the correct pre-surgical review to make sure that nothing is overlooked and this mistake is not made.

  58. Anonymous says:

    There are many benefits and drawbacks of challenging the authority of those in control of the procedure. Focussing on the benefits, it is clear that challenging their authority may identify an error (such as the wrong limb being prpered for surgery) and ensure monitored, safe clinical practice. Also, as a doctor of any quailification level you owe a duty of care to the patient. By not raising patient safety concerns with senior medical staff, you may be undermining patient wellbeing and so it is vital that all issues are made clear. On the contrary, there are several clear reasons why Dr. Patel is hesitant to challenge the authority of the staff in control of the surgery. Firstly, if her doubts were uneccessary, then she may be wasting valuabe theatre time on irrelevant issues. Also, other medical staff may feel they are being undermined if they were alerted of a possible flaw in their work.

    There are many procedures that could be adopted to prevent this type of medical error. The skin of the correct limb should be marked, rather than a bandage, thus eliminating the need to remeber which limb is being operated on. In addition, medical staff should have the notes present at the surgery so that they can confirm it is the right body part being operated on. Finally, doctors and nurses be taught to have the courage to raise any concern reguarding potential mecical error, irrespective of their age or qualification level.

  59. Anonymous says:

    1. Raising a concern is a tough thing to do and requires courage and integrity. Drawbacks include Mr Jones being offended and snapping at Dr Patel and then Dr Patel doesn’t learn in the surgery as she is too on edge and looking incompetent if you are incorrect. However, the risk of staying quiet far outweighed this as the surgery could be performed on the wrong leg meaning another surgery for Jane who has already been through enough and also an increased hospital stay and prolonged time under anaesthesia. So, you should always raise a concern whether or not you’re confident in it as patient safety should always be critical and the first consideration.
    2. Mr. Jones should create a more encouraging environment in which staff feel they can openly address concerns without fear of repercussions. Before putting Jane under, the should check such details with her and confirm via her notes and care record.

  60. Anonymous says:

    1. The decision of whether or not to challenge the authority of senior colleagues is always difficult. Please comment on the reasons for and against Dr Patel challenging the authority of those in control of this procedure?
    For: Jane will get surgery on the wrong leg if not checked. Highlights that she is paying attention to her patients since she previously examined Jane.
    Against: If she is wrong she would further delay the theatre which is already running behind and would likely feel undermined by the consultant’s response which may also go towards affecting the team’s dynamic in a negative way.

    2. What steps could be put in place to prevent this potential error from happening?
    A final check procedure should be put in place whereby the notes are checked before the surgery is started and verified by 2 team members. The mark could be placed on using a more permanent technique and not one which is so easily removed. Also the consultant should be more approachable, which would allow a more open working environment without barriers, making junior staff more likely to raise concerns which is very important when it comes to patient safety.

  61. Anonymous says:

    1) Dr Patel might feel scared to raise an issue with a person like Mr. Jones because of his temper and rudeness . As Dr Patel has just started working in the hospital , feelings of insecurity might prevent Dr Patel from raising an issue about Jane to Mr.Jones . Furthermore, Dr Patel has already being scolded once for trying raise an issue with one of the other doctors and therefore might feel as though she doesn’t want to be in that position again . However , patient safety is absolutely vital and hence certain aspects that are uncertain should be addressed there and then to prevent confusion .It would have been better if Dr Patel would have raised her concerns to any other members of the multidisciplinary team , just to make sure that Jane’s safety was not in jeopardy .

    2) it would be better if the team had a ‘final check ‘ policy before the actual surgery to be absolutely sure of what they are going to do and where the surgery is going to be performed . This may take a little bit more time and might be difficult in tight situations , however this check need not be too long , it can be very brief and implementing simple things like this could dramatically improve patient safety .

  62. Anonymous says:

    1) Although it is sometimes uncomfortable and difficult to challenge those of a higher authority, Dr Patel must remember that patient safety is a priority in this instance. If she fails to challenge Mr Jones, the surgery may go ahead on the wrong leg, causing multiple complications. It may also result in the patients losing trust with the hospital and staff, as well as contentment with their competency to provide care. There are relatively much fewer reasons why Dr Patel may want to avoid mentioning her concerns to the surgeon. She may feel that she is being disrespectful to his intelligent by querying this or may feel that it will damage her relationship with her colleagues, particularly as she is new to the hospital. She may want to not draw attention to herself or be seen negatively by the surgeon. However, as patient care is the most important aspect here, any doubts of this manner should be addressed as soon as possible and clarification for all members of staff achieved, prior to surgery.

    2) Multiple steps could have been put in place to avoid this occurrence. For example, the mark could have been placed on the skin of the patient to avoid removal. Also, communication among the staff could have been improved significantly. It would be beneficial for the notes to be double checked prior to surgery and the details of the procedure explained to all members of staff to ensure that everyone is aware of what will be happening and has the opportunity to raise any concerns. Keeping the patients’ notes in close proximity would ease this process.

  63. Anonymous says:

    1. The decision of whether or not to challenge the authority of senior colleagues is always difficult. Please comment on the reasons for and against Dr Patel challenging the authority of those in control of this procedure?

    Although there are hardly any good reasons for not challenging authority – I suppose it could be distracting and time consuming if it’s a false alarm meaning that the already tight schedule that the surgeon had would become more stressful. Additionally, this may leave the team with a bad relationship. However, this is not a big enough deal to put a patient in unnecessary risk and checks should be done no matter what.

    2. What steps could be put in place to prevent this potential error from happening?

    Perhaps marking the skin rather than the bandage? Furthermore, it should be made easier for staff to raise concerns and perhaps the surgeon should be spoken to as its not healthy to work in such a closed environment.

  64. Anonymous says:

    1. The decision of whether or not to challenge the authority of senior colleagues is always difficult. Please comment on the reasons for and against Dr Patel challenging the authority of those in control of this procedure?

    The reasons for Dr Patel to challenge the authority of the surgeon include: the doctor’s first concern is towards the patient and by not addressing her concerns this could have major implications on the health, well-being and safety of Jane. The surgeon could operate on Jane’s wrong leg resulting in devastating consequences. If Dr Patel raises her concerns the clinical notes can be verified and the operation can be performed on the correct leg. This should not majorly impact the theater schedule and will mitigate the risks of the wrong procedure occurring.

    A reason against Dr Patel raising her concerns would be that this could impact the team dynamic; thus, negatively affecting the communication between the surgical staff and consequently diminishing the efficiency and safety of the procedure. Nevertheless, the risk of performing the incorrect operation means that Dr Patel should address the surgeon.

    2. What steps could be put in place to prevent this potential error from happening?
    The mark made on Jane’s leg to indicate the correct limb should be made in a semi-permanent form that will prevent the mark easily being removed.
    Protocols should be put in place whereby two members of staff verify that the correct procedure will take place prior to it commencing.
    Addressing the work culture whereby Dr Patel is intimidated by senior colleagues to address concerns. Removing barriers between senior and junior staff to encourage a relationship whereby staff can learn from each other.

  65. Anonymous says:

    1) If there are concerns surrounding patient safety, if is important that doctors feel comfortable approaching senior colleagues. In this instance the obvious reason for Dr Patel to challenge the surgeon would be to protect the patient. Some reasons why Dr Patel would decide not to challenge the surgeon would be for fear of discipline against him if he was wrong. They may feel that if they question the surgeon they will not be allowed to scrub in on subsequent surgeries. Another reason could be that the schedule was tight and they didn’t want to further disrupt the day, especially when the surgeon was already irritated.
    2) A work environment should be created where concerns can be raised without fear of retribution. This should stem from the lead surgeon who should respect the views of everyone involved and genuinely take aboard any questions surrounding their practice. Also a pre-operative checklist could be employed for use before every procedure, no matter the delay, to ensure that mistakes such as these are not made.

  66. Anonymous says:

    1.Reasons for: protecting the patient, speaking up when they feel there is something wrong, sticking to the GMC guidelines, making sure the surgery takes place as it should, with no harm to the patient;
    Reasons against getting into a fight with the more senior doctor, not being listened to, being regarded as the ‘black sheep’ of the team or being yelled at.
    2. Double checking with the patient notes before the surgery, designating a special team member to make sure the surgery will take place without a flaw.

  67. Anonymous says:

    1. Arguments against:
    • Mr. Jones might get angry as he feels his authority and position are questioned by a junior doctor
    • Mr. Jones might snap at Dr Patel and diminish her learning opportunities during the surgery
    • Dr Patel might end-up feeling uncomfortable, in case she is wrong, and might loose the faith in herself
    • Dr Patel might feel very uncomfortable insinuating that a senior and respected surgeon might be wrong and challenge his authority
    2. Arguments for:
    • This is a case of patient safety and it is important to put patient safety first at any time, therefore Dr Patel should put aside her personal feelings and also Mr Jones’ and respectfully raise her concern
    • By this issue it may also help prevent future mistakes such as this one
    • It would prevent a future lawsuit against the hospital, which will save both time and money of both the doctors and patient
    • It will prevent Jane from being put through further stress and time spent in the hospital
    To prevent such an error from happening the World Health Organisation surgical checklist should be used, the notes of the patient should be re-verified while preparing her for surgery, the X could be marked on the skin of the patient, not on something that can be removed, such as a bandage and finally, younger doctors should be encouraged to speak up while senior doctors should be asked not to take the raising of the concern as a challenge of their authority.

  68. Anonymous says:

    its important to confront and raise awareness on the mistake no matter what, because patient safety is the most important things in case, so its important to not put the patients health and life at risk.
    confronting the reminded the doctor before the operation its not a harmful thing, and it should be done professionally because a mistake like this can be harmful to all patents and doctors.

    maintaining a safe and open work environment is very crucial to help assist patients and provide the best care there is.

  69. Anonymous says:

    1. Reasons for- Patient safety should always be the priority and if Dr.Patel does not challenge Mr Jones in this scenario it will put Jane’s safety at risk and will result in horrible consequences for her including a lot of unnecessary pain, inability to walk for a few weeks and a further breakdown of trust in the medical profession. If Dr.Patel speaks up it will prevent all these negative outcomes.
    Reasons against- Dr. Patel isn’t completely certain that it was Jane’s left foot and she could be wrong because she saw Jane at the end of a 12 hour shift with no break so her memory may have been impaired. Mr Jones could get very angry at Dr. Patel and possibly not even listen to her and go on with the surgery on the wrong ankle. Mr. Jones may even take a dislike towards Dr. Patel because of his foul temper and restrict her learning opportunities. It could also mean the surgery takes longer to complete meaning other patients have to wait longer for their surgeries.
    2. The preparation team could have drawn the X on the ankle instead of the bandage. All steps should be followed, including verifying the surgical position, even under time pressures. There should be better communication within the team and possibly a team briefing so that everyone knows what has to happen and where the surgery is taking place, i.e. which ankle. It should also be made easier to raise concerns like Dr. Patel’s concern, an environment like the one in this scenario makes it very hard for staff to raise concerns without being afraid of getting shouted at or punished, this endangers patient safety.

  70. Anonymous says:

    Even if it may be uncomfortable at times, raising concerns is vital if the patient may be at risk of a medical error. In this case, Dr Patel should speak up to prevent undue patient harm as he is unsure of whether this was the correct ankle to be operated on. Concerns should always be raised in a professional and respectful way to avoid negative reactions and to maintain a good working relationship. Although it is understandable that Dr Patel doesn’t want to be snapped at by a more senior colleague, the care of the patient must always be the doctors first and main priority.
    Mr Jones should complete the WHO surgical checklist, and the team should work together to ensure all details are correct. The X could be marked on the leg, not bandage. Staff members should be encouraged to raise any concerns.

  71. Anonymous says:

    Dr Patel’s reluctance to speak up and clarify the surgical site is likely due to differences in the medical hierarchy between herself and the senior surgeon, Mr Jones, compounded by the fact the entire surgical team is under stress which is clearly impacting Mr Jones’ mood. Speaking up could result in her being snapped at and made to feel like an inconvenience, particularly if the correct leg was about to be operated on. Dr Patel does not want to feel inadequate or appear as a nuisance in front of her colleagues, especially in front of a senior colleague.
    However, in this case, Dr Patel speaking up will call to attention the mistake and prevent an error before it happens. This will save time and avoid additional stress to the surgical team but also prevent the anger, sadness and uncertainty the patient will experience should this error occur. Although speaking up is an understandably uncomfortable thing to do, particularly while challenging the authority of senior colleagues, the care of the patient should always be put before the comfort of the health professional even if in the end, the patient’s wellbeing was never endangered in the first place.

    The World Health Organisation Surgical Safety Checklist should be used to try and minimise potentially avoidable errors like operating on the wrong patient or the wrong side of the body. Any actions taken should be intentional and thorough in order to detect any safety measures in place (such as the X on the bandage) and prioritise the patient’s safety. An open culture should be established so that concerns and uncertainties can be voiced without individuals feeling confronted or challenged. This is particularly important during operations where insufficient communication, unspoken concerns and ideas could, in the worst-case scenario, cost the patient their life.

  72. Anonymous says:

    Question 1
    Arguments for challenging the authority:
    1. Patient safety should always come first. Despite Dr Jones having a lot of experience, mistakes can still happen and surgery should be performed only when there is certainty of the site of surgery.
    2. Dr Jones might reflect on the mistake that almost happened and reconsider his approach to treating patients and colleagues.
    3. An even longer and more painful recovery, as well as putting Jane in the position of doubting the medical profession even more, can be avoided.
    4. In case of Dr Patel being correct, the costs and time spent on redoing the surgery can be eliminated.

    Arguments against challenging the authority:
    1. Dr Jones could feel like Dr Patel is trying to diminish his authority, ultimately leading to a more tense relationship between them.
    2. Dr Jones snapping at Dr Patel could result in both being distracted by their feelings and not being able to focus on surgery.
    3. If Dr Patel turns out to be incorrect, her opinions might not be taken seriously as this could result in decreased perception of her trustworthiness and competence.
    4. In this scenario, Jane’s surgery might take longer if notes are to be re-checked, meaning she would have to be anesthetized for longer and the theatre list will be affected even more severely.

    Question 2
    The hospital staff need better communication and to feel safe when expressing opinions or concerns. If Dr Patel felt comfortable with talking to Dr Jones they could have talked it over and clarified the leg that has to be operated on. Additionally, someone should have informed the preparation team to leave the bandage on, further highlighting the need for good communication and teamwork. All staff members involved in the surgery and preparation should have full knowledge of the case to ensure good care of patients.

  73. Anonymous says:

    Dr Patel is obviously hesitant in speaking up as Mr Jones is an authoritative figure and she herself is unsure of whether it really is the left leg is injured and if she were to speak up and if she were wrong, Mr Jones’ mood would worsen and she could possibly face some repercussions for questioning authority, however patient safety should always come first and the fact that she has doubts about it being the wrong side is good enough, for consequences of a mistake like that would be more detrimental. It is always better to be safe than sorry. Furthermore, if the surgeon were to operate on the wrong side of Jane’s leg, her faith in the medical profession will decrease further and she will be more reluctant to see doctors
    Steps to prevent something like this from happening would be to put precautionary measures in place, like checkpoints, where a certain criteria has to be met before being prepped for an operation. Maybe putting multiple people to check if the correct side is being operated on. Another issue is the fact that Dr Patel is afraid to voice her concerns because she is hesitant of being reprimanded. Communication between surgeon, doctors, nurses and other staff should be improved and if anybody has doubts, they should be able to voice it freely without the fear of being reprimanded.

  74. Anonymous says:

    Dr Patel should challenge the authority of those in control of this procedure because Jane’s safety and welfare should be her first priority. Therefore, because Dr Patel has a duty of care towards Jane, she should speak up in order to prevent a catastrophic and avoidable error occurring, regardless of what the doctors and nurses say or think of her as a result. However, if Dr Patel is incorrect, she may be reprimanded for wasting valuable time and feel like she can not speak up again if something isn’t in accordance with the notes.

    The steps that should be put in place to prevent this potential error from happening include Mr Jones and his staff checking the details of the procedure more thoroughly to begin with and having a much more approachable manner, so the staff feel comfortable learning and speaking up if something isn’t the way it should be. The X mark could also have been placed on the leg instead of being attached to the bandage.

  75. Anonymous says:

    1. I understand the problem Dr Patel is in, as he/she feels hesitant to speak up, however, by not doing this you are compromising patient safety, which goes against the duties of a doctor outlined by the GMC. It it essential that Dr Patel brings this up to Mr Jones as the wrong leg may be operated on if he/she doesn’t. This will result in the need to reschedule a second operation to rectify the mistake, and perhaps Jane may be hesitant to undergo surgery again due a lack of faith in the profession. This will make the problem of time pressures within the operating theatre even worse. In addition, it will cost the NHS more – with regards to the second operation, management and care of the wrongly operated foot and further management and care of the correct foot that was supposed to be operated on. Furthermore, the NHS could be sued for negligence, costing a considerable amount of money.
    While saying all this, I do understand why Dr Patel may not feel confident in bringing up the issue as it is challenging someone in higher authority and it could come across as you’re doubting their intelligence. In addition, Mr Jones attitude makes it much more difficult for someone to query something as he seems very scary and unapproachable. In addition, Dr Patel has the fear that he may be wrong as he is not 100% certain. However in any case, you shouldn’t be performing surgery unless you’re 100% certain of every detail.

    2. It is essential that precautionary measures are put into place before any operation to avoid this happening. The whole team should be brought together prior to the procedure and briefed on the details of the operation, allowing everyone to get clarity. Also, there should be no compromise on the safety of the patient, regardless of the time pressures. All staff should be encouraged to speak up and voice any concerns. If Dr Patel were to have done this, a potential harmful, costly problem could have been avoided.

  76. Anonymous says:

    1. The main reason for challenging Mr Jones is to prevent any potential harm to Jane, as patient safety is paramount. By not intervening and allowing the procedure to take place on the wrong ankle could have an adverse impact on Jane’s health and well-being. This could cause a longer recovery time for Jane and increase surgical risks associated with the procedure. Another reason for Dr Patel to challenge the authority is that it would prevent the team having to re-operate on Jane and alleviate some of the pressure put on the team. It would also save the costs of a second procedure to take place and may prevent the added cost of Jane’s rehabilitation. However, the main reason against challenging Mr Jones is the response she will receive if she is incorrect and then consequently delay the operation through this confrontation. Overall, Dr Patel must way up the pros and cons of challenging Mr Jones and understand although Mr Jones has a reputation for being very skilful in surgery, mistakes can still happen, and patient safety comes first.

    2. There are many steps that could be taken to prevent such an error from taking place. Firstly, Mr Jones temper and how he communicates with other members of staff should be addressed so that a more pleasant, positive working environment is created so that staff members feel comfortable to approach Mr Jones if they have query. Also, before the operation takes place, all members of the surgical team should be present when discussing what the procedure involves and how it is going to take place. This will prevent any confusion and error during the procedure.

  77. Anonymous says:

    1. It is understandable that Dr Patel may feel conscious about the reaction of the surgeon as he is known for his foul temper. By challenging Mr Jones on this issue Dr Patel is prioritising patient safety as well as reducing the potential harm on the patient if Mr Jones was to go ahead and operate on the right ankle. This would alleviate potential surgical complications and risks that accompany any surgical procedure. It is important to note that the consequences of not speaking out are greater than consequences of speaking out as Dr Patel could be in legal difficulty if the incorrect ankle was operated on. On the other hand, if Dr Patel challenged Mr Jones this may affect the chemistry of the multi-disciplinary team in future situations. Dr Patel also has no proof that the wrong leg is going to be operated on and is not 100% confident in this. Finally, challenging Mr Jones may demonstrate a lack of respect for the consultant if it was not carrier out in a polite manner.
    2. To prevent an error like this happening again better communication between Mr Jones and his team would be essential. Before the surgical procedure begins Mr Jones should explain his plan to the rest of the team which would allow the opportunity for any concerns to be addressed at this stage. This encourages a more open work environment ensuring that each member of staff feels comfortable relaying their concerns to more senior members of staff. Despite the theatre waiting list being long, care should be taken at this stage which may save time in future if any mistakes where to be made. Rushing will cause more negative impacts. In addition, the pre-surgery markings should have been drawn onto the patient’s skin reducing the potential risk of the marking being removed.

  78. Anonymous says:

    Arguments for challenging the consultant- There is a duty of care to Jane and her safety may be compromised if the wrong leg is worked on first. There would be a longer recovery time and a lot more pain. Jane’s trust in healthcare professionals may drop even further and it would save the hospital from going through malpractice procedures. The operation would take a lot longer placing more pressure on the team as they run further behind schedule. With more impatience and haste from the team the operation may not be performed as well as it should be. This could also cause longer waiting times for patients waiting to be operated on, these patients are already anxious and hungry and thirsty as they will have had ‘nil by mouth’ in preparation for surgery. Challenging can be done in a polite and respectable way and Dr Patel may be encouraged by speaking out but also encourage and lead others to do the same in future situations.
    Against – Challenging may show a lack of respect for the consultant especially if not done politely and feelings in the operating theatre may get more tense.
    2. To prevent an error like this happening, clarifying all the important details and checking the notes before starting should have been done. Good communication between the team should be established and the consultant could work to establish a better work relationship with the rest of the team. Practically the ‘X’ could have been drawn on in a more lasting way.

  79. Anonymous says:

    1. Arguments for Dr Patel challenging the authority of those in control of this procedure would be;
    – A major risk to Jane undergoing anaesthetic for surgery to operate on the wrong leg
    – Jane will get worse if correct leg not operated
    – Harm to patient avoided if Dr Patel speaks out
    – The consequence of not speaking out is greater than the consequence of speaking out
    Arguments against Dr Patel challenging the authority of those in control of/ the procedure would be:
    – Risk of damaging relationship with colleagues, if the head surgeon feels challenged
    – Lost of confidences in which leg and Dr Patel may feel embarrassed
    – No proof that the wrong leg is going to be operated on – gut feeling

    2. Steps that could have been put in place to prevent this potential error from happening is that Mr Jones needs to able to communicate better with his team and build better relationships, so they are not afraid to challenge or question his decisions. Medicine is a multi-disciplinary field, meaning that no matter who you are, your voice is important, especially when it comes to patient safety. Potential errors could have been avoided practically by placing the ‘X’ on the actual leg rather than a bandage, which could and did get lost. Checking the patient’s note and details before, during and after the operation would also have allowed for the identification of the correct leg. A checklist system should able to be placed and followed accordingly.

  80. Anonymous says:

    1. The primary reason Dr Patel should challenge authority of senior colleagues is to ensure that patient safety is prioritised. Operating on the incorrect leg could have detrimental consequences, both to Jane’s physical and mental health. Furthermore, unnecessary surgeries place a huge financial burden on NHS and Jane will have to return to hospital to undergo the correct procedure. Having a duty of care to the patient, it is vital that Dr Patel raises her concerns and ideally should feel comfortable discussing issues with senior members of staff. However, this is easier said than done. Dr Patel may feel reluctant to speak with Dr Jones in fear of humiliation in front of the rest of the team. In addition, she may feel like she is damaging potential career prospects or is at risk of being exposed to an episode of his “foul temper”.
    2. Clarifying important details with the patient before undergoing anaesthetic (for example, their procedure and site) can help prevent avoidable mistakes. The skin should also be directly marked using a marker to ensure that the appropriate site has been identified – this would prevent the mark being removed with the bandage. Discussions between multidisciplinary team members at these stages would allow any concerns to be raised regarding potential errors which could be rectified before surgery begins.

  81. Anonymous says:

    1) For: Challenging the consultant could help avoid operating on the wrong leg, and avoid risks of potential surgical complications and risks that accompany any surgical procedure. If the wrong leg was operated on, challenging the consultant before the procedure could save the team and the hospital from going through significant incident and malpractice procedures. Even if you were wrong, challenging the consultant politely may encourage other members of the team to speak-up going forward if they see a colleague practising unsafely or without giving due diligence before a procedure.
    Against: Challenging the consultant could risk a negative response from the more senior member of the team, and affect the chemistry of the multi-disciplinary team going forward. If you approached delicately enough, challenging him could negatively affect his likelihood to support you and go out of his way to help you going forward. You could also be in legal difficulty if the wrong ankle was operated on whilst you believed there was an error and did nothing.

    2) The whole team could be briefed on how the correct body part was going to be marked, and all could made aware of the issue they are trying to rectify with the surgery. A culture of good communication could also be encouraged so people feel comfortable to raise concerns when they feel a mistake is about to be made.

  82. Anonymous says:

    Dr Patel should challenge the authority of those in control as the patients safety and treatment is at risk. There could be serious consequences for both the patient and staff if a mistake occurred.
    However, it may show a lack of respect if Dr Patel challenges his superiors as he is only in a junior position. Also, it is understandable if Dr Patel is worried about Mr Jones’ reaction. In the grand scheme of things, the patient comes first and it also is a good sign of integrity and team work if the team is corrected from making a horrible mistake.

    Mr Jones should double check all details about the patient and the procedure and be more approachable. Staff should also be encouraged to share their concerns and worries about things with senior staff and an open work environment should be promoted.

  83. Anonymous says:

    1) Challenging the authority of senior colleagues in this case could mean that they may go back and check the notes again after Dr. Patel has raised her concerns and this would mean that they would realize their error and fix it before operating on the wrong ankle. This in itself would mean that there would be less consequences in the future for all those involved in the preparation and performance of this procedure as of they did continue to perform the operation on the wrong ankle then there could potentially be a law suit against the surgeon or the hospital but also the case could be looked into by the GMC and this could result in serious consequences for all those involved, including Dr. Patel herself but also Mr. Jones, because he is the senior surgeon in charge. It would also get Dr. Patel a bit of credit for her watchful eye and ensuring that a major error was not avoided.
    Reasons against challenging the authority of Mr. Jones could be that she may get shouted at and taken off the case, as he is already in a bad mood and he may think the she is trying to undermine him which he will not like. Obviously it is difficult to tell a senior surgeon about a potential mistake and so chances are high that he will not take it well.

    2) If the previous case ran on longer than expected then it may be wise to consider postponing the surgery so as to avoid mistakes caused by rushing to prepare the patient. This could also mean that Mr. Jones would be less irritated in the build up to the surgery and so would decrease the chances of an error by him during the procedure due to being annoyed. It could also be avoided by everyone taking their time and taking care in the preparation of the patient despite being under pressure of time as it is still important to not make mistakes that could sabotage the procedure, regardless of under what circumstances it is being done.

  84. Anonymous says:

    1. The hesitation from the junior doctor is understandable as it would be an intimidating position to be despite these complications. Although there is many reasons for voicing her concerns to the surgeon. Firstly, the implications of operating on the wrong leg could be fatal for the patient or cause unnecessary significant trauma both physically and mentally. Patient safety should always be at the top of any clinicians mind and therefore concerns should be voiced as the implications for not voicing them and the issue occurring is worse than being proved wrong about a voiced concern. Although, the senior surgeon does not give off the impression that concerns can be freely voiced due to his hostile and authoritative manner as described. Voicing or challenging a concern can be very difficult but must be done to ensure that the patient is put out of harms way. There is also a waste of time and resources that comes from this potential mistake.

    2. Certain steps such as creating a more pleasant work environment and ensuring that all of the colleagues respect each other no matter what role or level they are practicing at is vital. Practical things such as making a mark on the skin instead of the bandage, checking notes over and taking more time to prepare could all prevent this potential mistake.

  85. Anonymous says:

    1) Dr Patel is in a junior position and therefore feels inferior and unable to voice her concerns. In hospitals an environment should be fostered wherein concerns can easily be raised by any member of staff. Dr Patel feels as though Dr Jones anger is not worth getting involved and therefore she has not addressed the concerns about operating on the wrong leg. She is considering in her head and is weighing up the benefits of speaking. In reality the issue is the environment of the hospital and the communication skills between staff, lacks effectiveness and also the MDT is a potential risk to patient safety. If senior staff were more accommodating to the younger doctors they would feel able to address concerns. Dr Patel should address her concerns in a respectful manner, as the patients safety is of the ingests concern. The senior doctor must ensure that the culture of fear in the younger less experienced doctors is eradicated, in order to make sure that the care patients receive is the best and safest possible.
    2) The marking should be directly on the skin if possible in order to make sure that it is not removed at any point.
    The hospital environment should be more nurturing of staff and should include all staff and treat them with equal respect regardless of position/ seniority.
    Multi-disciplinary meetings should be conducted before operations in order to allow any member of staff address any concerns.
    The attitude of the senior doctor (Dr Jones) must change as he is expected to be a mentor to the trainee staff and therefore should treat them with the respect they deserve as he expects himself to be treated.

  86. Anonymous says:

    Dr Patel would have wanted voice concerns about the operation due to the potential risk to patient safety of needlessly operating on the wrong ankle and not actually fixing the injured ankle. However, it was more likely Dr Patel was reluctant to raise concerns due to feeling intimidated by the surgeon and their notorious temper and feeling too inferior so that these concerns wouldn’t have been acknowledged. By delaying surgery further to check the mistake, Dr Patel risked irritating the surgeon further, which could have been detrimental to the rest of their training with the surgeon.
    More time between surgeries would be useful to make sure all the preparations were completed thoroughly, as well as ensuring all the surgical team knew which ankle was being operated on definitely before starting.

  87. Anonymous says:

    1) The main reason for Dr Patel to raise her concern is for the safety of the patient and to ensure that the operation is given the best chance of being successful, she has a duty of care to the patient and to her colleagues so if she feels there is an issue she should communicate that with the team. I believe the reason for Dr Patel’s hesitance is due to the fact that she is concerned about offending her senior colleague by questioning his practice, perhaps his reputation of having a ‘foul temper’ has also added to this as she may fear being humiliated if she is wrong in front of other colleagues.
    2) Before starting the surgery Mr Jones should communicate his plan with the rest of the team, this allows an opportunity for concerns to be expressed or for any questions to be addressed. The mark made on the bandage should have been made on the skin so that it is not as easily removed and there should be a ‘double check’ before the surgery begins. In the future, Mr Jones should make a conscious effort to engage with other staff members junior to him, so that they feel more comfortable with raising any concerns they may have.

  88. Anonymous says:

    1. Dr Patel should confront Mr Jones as the safety of the patient (Jane) should be her main concern. If she decides to check the notes outside of theatre, it may be too late and the procedure may have been underway. Further, if she decided to ask the theatre sister to check, the same could have happened. Even if Dr Patel’s concerns were unwarranted, then she should be commended for her bravery to put herself out there and make her opinion known; Dr Patel should not be worried about speaking her mind when the patient’s safety is her priority.
    2. Staff in the hospital who feel Dr Jones abuses his position should have an anonymous outlet to express their views and raise any issues regarding other members of staff. An X written on a bandage, which may become loose or be taken off (like in Jane’s case), should not be allowed as a method of informing the surgical staff; written word could be used or a more permanent, physical method of presenting the area could be used (marking the patient’s skin with the marker for example). Leaving gaps between surgeries so there is less pressure on staff and more time can be taken to ensure proper safety precautions are taken.

  89. Anonymous says:

    1. The hesitation of Dr Patel is understandable. Numerous reports have highlighted the fear associated with confronting senior members of staff in the medical profession, including worry of creating conflict and damaging future career progression. However, the repercussions of failing to challenge those in authority when there is belief an error has occurred can be immense, an example of which being the Gosport War Memorial Hospital deaths. The patient’s safety should always be paramount, Dr Patel must speak out and clarify the surgical site to protect Jane from unnecessary surgery and possible complications. In addition, unnecessary surgery will cost the NHS resources and time as Jane will have to return to have the correct procedure. As long as Dr Patel approaches this situation with respect for her senior colleagues, clarification will not cause any harm and in this case will protect Jane. Should Mr Jones snap at Dr Patel, that would be a question of his professional conduct.

    2. In 2008 the World Health Organisation launched the Surgical Safety Checklist aimed to improve communication between surgeons, nurses and anaesthetists and ensure patient safety. Several aspects of this checklist include confirming the correct surgical site. Before induction of anaesthesia the patient must confirm their identity, site, procedure and consent – if this had been done Jane herself could have clarified the mistake. The site must also be marked, with an arrow where possible, on the skin using a marker sufficiently permanent to remain visible after skin preparation. This would have prevented the mark being removed with the bandage and prevented any error. Before an incision is made the patient’s name, procedure and incision site must be confirmed again. This step ensures the correct site will be operated on and allows communication between team members, providing the opportunity for any individual to voice concern If they believe an error has been made. Any of these steps would have prevented this error in Jane’s surgery.

  90. Anonymous says:

    Speaking up and raising concerns can be perceived as an accusation or ’lecture’ by the addressed. Nobody wants to make mistakes and facing your faults is sometimes extremely difficult. People might therefore be reserved and refusing when facing these issues. Challenging the authority of someone who is far more experienced than you can be particularly difficult. Nevertheless, it is extremely important to raise concerns whenever the patents’ safety could be in danger. Everyone can make mistakes and preventing those mistakes of causing harm is pivotal.

    In this case, many minor errors – which could have been detected and corrected easily – summed up and lead to a situation which could potentially cause a lot of harm. Always being thoughtful while handling a patient, thorough cross-checking as well as an environment in which concerns can be raised without any fear can prevent errors like this.

  91. Anonymous says:

    For – It would rectify an error before the surgery begins. This would be beneficial for all parties: the operating staff as it would save them wasting their time opening Jane’s other ankle to find nothing wrong, and Jane herself as she would be anesthetised for less time, would have a more minor surgery, would potentially recover sooner, and would leave her in less danger of complications opening the wrong ankle. Furthermore, this would help the theatre schedule; as they are already running behind opening and examining the wrong ankle would only be further detrimental to the timings. Against – It would potentially anger the surgeon. This would leave Dr Patel feeling deflated and unconfident if Mr Jones snapped back at her. This could potentially generate some anxiety. A more irate surgeon may not perform the surgery to the best of his ability due to his distraction, and this would negatively impact on Jane’s recovery.

    Ensure that all pre-surgical checks are carried out fully before the surgery regardless of how little time there is. This should be standard to ensure patient safety in theatre, and to ensure safety in the recovery ward also. This could be done, even verbally, quickly before the surgery and it would not be detrimental to the theatre operating list schedule. Also, markings in the future should be made directly onto the skin, and therefore there will be no risk of losing a bandage and thus the confusion before the surgery as described. It would also benefit younger and more inexperienced doctors in future, as it removes the risk of them being ‘snapped at’ by more senior consultants. Finally, the surgeon should be reminded that his sharp and inconsiderate behaviour is not the fault of any of his medical staff and team, and therefore he should relax for the benefit of the staff and patients.

  92. Anonymous says:

    1. Dr Patel should have the patient’s safety at the forefront of her mind, therefore, if she is in any doubt regarding the procedure she has a duty to challenge the authority. In challenging the authority she could save Jane from an unnecessary surgery and further complications. By challenging the view and having the patient as the priority, this will maintain the patient-doctor relationship. Dr Patel may not wish to aggravate the surgeon more and have his frustrations taken out on her and also potentially create a bad impression on the senior surgeon when she is unsure which leg it is that needs operated.

    2 .Place the X on the skin instead of the bandage to ensure that it can not be remove.Ensure each patient receives sufficient time prior to surgery as it is better to finish the surgery rota later than cause patient’s unnecessary pain. There should be an open environment on the team ensuring everyone can voice their opinions.

  93. Anonymous says:

    1. Dr Patel should not sit quietly while she is in doubt that the wrong leg is about to be operated on. She should check the notes or speak up and ask Dr Jones about this, since it could be detrimental for Jane. While she is understandably nervous and uncomfortable confronting a senior surgeon like Dr Jones, since he is infamous for his temper and she is scared this may give her a bad reputation, it is her duty to be sure that the patient is getting the correct surgery. The patient’s health and safety should be a priority. Dr Patel should bring it up with Dr Jones in a respectful manner.
    2. Even though the operation theater waiting list is long, care should be taken that each patient is given the right amount of time and care and that there is no room for errors. Checks should be made at various points leading up to the surgery that the correct procedure is being carried out. Also, the hospital environment should be more open so that each staff member is comfortable and confident enough to raise concerns without feeling as though they will get in trouble for it.

  94. Anonymous says:

    1. In my opinion you can challenge anything if you do it in the right manner, maybe here it is necessary to directly challenge the surgeon as the surgery seems relatively imminent and otherwise the error may have been made before the appropriate corrective action has been taken. Dr Patel should briefly explain that she admitted Jane and believes that her fracture is on her other leg as to bring the concept of doubt into play. Thus someone will have to check Jane’s notes to verify. There is a concern for Dr Patel that since she is in a position where she is seen as relatively inexperienced by the other members of the surgical team, that by raising concerns she may seem disrespectful to the senior staff. She doesn’t want to be seen to step out of line or to possibly damage the relationship within the team, which in turn could harm Jane’s surgery.
    2. The team should be made to feel that their concerns are worthy, regardless of how big or small they are. This should be promoted by the surgeon who in effect is the leader of the team, rather than the condescending and fear-mongering attitude taken here. Possibly the skin of where is to be operated should be marked somehow, something which could not be removed as easily as a bandage during preparation. Additionally, the steps (such as checking the surgical site is the correct one) in the lead up to a surgery should never be skipped, regardless of how insignificant they may seem or how much time constraint is placed on the surgical team.

  95. Anonymous says:

    1. Dr Patel should question Mr Jones to ensure the patient is being operated on on the injured leg. This is to ensure the patient does not go under any unnecessary anaesthetic as if they open the uninjuried leg, they won’t be doing any good to the patients health but only causing them increased risk of e.g. infection from the hospital to the opened wound. However I do understand how it may be difficult to say to Mr.Jones due to past experiences with him as he has a tendency to “snap” with other doctors. However, I still think she should question him as the safety of the patient is above all this. It may be better to question him in a respectful manner as then she may get a better response.

    2. The steps which could be put in place to prevent this from happening are: they could have marked her actual leg with the “X” instead of the bandages – however this may pose a problem with infectious control. Another alternative to preventing this from happening is by enforcing before each surgery take place someone must read the patients notes to ensure they are operating on the correct site of the body and read it out to the medical staff in the theatre. If they don’t they put the patient at risk as they have created an open wound which could be infected. Lastly, another way to prevent this from happening is by ensuring communication between doctors is kept professional and for Mr.Jones to understand he is not above the questions of any other member of staff if it is for the best interest of the patient, a communication class could be useful between the staff to ensure that no member of staff is afraid to speak out to their superiors if they are in the wrong or they think they may be in the wrong.

  96. Anonymous says:

    1. I understand that challenging the authority of a senior member staff is difficult, however the patient’s safety must always come first. If Dr Patel had any doubts about the surgery then she should question this. Mr Jones has a very bad attitude towards his colleagues to the point where they are scared to question him. This is not the attitude a doctor, particularly a senior doctor should have.
    2. To prevent an error like this happening again the senior surgeon should promote a more positive work environment, instead of snapping at staff he should react more calmly, then if any staff did have a concern about an error in the surgery they will be confident to speak up about it and preventing it. As well as this, the ‘X’ to mark the correct surgical site was marked on Jane’s bandage which was then removed. In future the mark should be put on her skin so that there is less risk of anyone missing it.

  97. Anonymous says:

    1. Patients must always come first, even if it means challenging authority. If there is any doubt from any member of staff, it should be taken with the utmost care and attention and should be double-checked to try to prevent incidents from occurring. Challenging the authority of senior colleagues in this situation should prevent the wrong leg from being operated on, shows that Dr. Patel has initiative, has been paying close due care and attention to their patient, and show Mr. Jones that he has a good team around him. However, challenging senior colleagues is not difficult. There is very much a hierarchy still in healthcare where instead, teamwork should be a priority. Senior colleagues have a lot of respect due to their knowledge, experience and job position, and a younger, less experienced colleague may find it difficult to point out mistakes or discuss certain things with their superiors. As Mr. Jones has a reputation, his less senior colleagues may be less willing to challenge his authority for fear of repercussions such as shouted at and belittled, being told they cannot help with the surgery or being given unwanted tasks. There is already some pressure on the surgical staff to keep to an already behind schedule, so Dr. Patel is concerned that checking notes again and raising a concern could further delay the schedule and affecting even more patients.
    2. Steps should be taken so that before surgery, any markings should be made on the skin rather than bandages which could easily be removed. If markings are placed on the skin, it is harder for anyone to remove these. There should be a checking system in place so that all members of the team have checked the notes several times at different points before the procedure and discussed the correct surgical site together based on recorded information rather than from memory.

  98. Anonymous says:

    1. The reasons for challenging the senior team would be because you must always put the patient first even if you feel it might put your relationship with your senior doctor under strain. Also the damage done by not checking the patient’s notes is much greater then possibly annoying the surgeon.
    The argument against not challenging the authority of the surgeon in control of the procedure is that it might put the surgeon in a bad mindset if the concern turns out to be incorrect, in doing so it may make the theatre run behind even more. This may cause the surgeon to rush the procedure possible causing him to make mistakes during the surgery and throughout the rest of the day.
    2. Steps that could be put in place could be marking an X on the skin of the patient not on the bandage so it cannot be removed. Furthermore, the notes of the patient should always be checked to prep the surgeon before the patient enters the theatre.

  99. Anonymous says:

    Dr Patel should challenge the authority of those in control of the procedure in order to ensure the correct leg is operated on. If Jane was operated on the wrong leg, it would negatively affect Janes trust in the medical profession and she could potentially sue the hospital. Jane would end up having both legs opened up so she would be twice as likely to get an infection and her recovery would be more difficult. Dr Patel has previously examined Jane so she has more experience with Jane than the surgeon does, hence she has a duty to speak up. If Dr Patel didn’t speak up it could negatively affect her confidence in the future as she would regret not saying something.
    On the other hand, there are reasons against Dr Patel challenging the authority of those in control – they may get angry if Dr Patel does not display her concern in a respectful and polite manner. This could negatively affect the working of the surgical team.
    In order to prevent this error from happening the X could be marked on Janes skin instead of the bandage. Additionally, the surgeon should double check on the notes which leg is being operated on and check with his staff that they are all happy to proceed with the procedure. Instead of being bossy and angry, he should try create an open working environment in which people of a lower authority feel comfortable to speak up.

  100. Anonymous says:

    The decision of whether or not to challenge the authority of senior colleagues is always difficult. Please comment on the reasons for and against Dr Patel challenging the authority of those in control of this procedure?
    A reason for challenging authority could be to place patient safety as the highest priority. In this case, by challenging Mr Jones, the surgery on the wrong ankle may be avoided and therefore might save Jane from the unnecessary physical and psychological trauma of incorrect surgery. This might also save the hospital time and money associated with rectifying the incorrect surgery, as well as costs associated with medical claims. In addition, by challenging Mr Jones, Dr Patel may save his reputation as a skilled surgeon by preventing the senior surgeon from making this serious mistake, reducing the risk of the public losing trust in the medical profession. By having the confidence to challenge authority, Dr Patel may also encourage her colleagues in the hospital to do the same if they suspect that something is wrong, creating a safer and more efficient work environment for both the patients and the staff.
    A reason against challenging may be that Dr Patel may be wrong and this may waste time in an already tight schedule, potentially reducing the number of patients that can be operated on that day. Dr Patel may also be worried that challenging Mr Jones may lead to the senior surgeon having negative emotions towards Dr Patel and may potentially make the work environment hostile as a result.
    2. What steps could be put in place to prevent this potential error from happening?
    The hospital could introduce steps that must be completed and signed off before surgery can take place, such as checking the patient’s notes and verifying the correct surgical site. In addition, there could be a zero-tolerance policy to “snapping” at other staff members for challenging authority. This may encourage staff to not be afraid and speak up when they believe that patient safety may be at risk, reducing the risk of potential errors occurring. Also, by educating staff members on the importance of challenging authority and giving them opportunities to improve their team work and communication skills e.g. through social team-building events outside of the work environment, the staff may feel more comfortable working together to deliver a high standard of patient care.

  101. Anonymous says:

    Dr Patel needs to put the patient’s safety above all else, and if there is risk of the surgery going wrong then she should speak up to try and avoid mistakes. Everyone involved in that patient’s surgery should have the patient’s best interests at heart and therefore should all feel open to anyone coming forward with concerns that could compromise this. However, it can feel daunting to question the knowledge of someone much more experienced and the possibility of damaging relations with colleagues is also a major issue since this could compromise teamwork for future operations. Overall concerns should always be raised if patient safety is compromised.

    An error like this could be avoided by having the surgery notes double checked when the patient is brought into theatre, so that everyone involved is properly informed about the procedure. Better communication could have also avoided this situation, for example the person who removed the bandage should have informed the theatre staff that they have done that. The pre-surgery markings should have been drawn directly onto the patient’s skin in surgical pen so that it wouldn’t have been lost when the bandages were removed and would be obvious to the people in the operating theatre.

  102. Anonymous says:

    1.The advantage of challenging an authority in this case would prevent the patient from harm and would prevent a variety of issues from arising such as : complaints against the surgeon, doctors (Patel herself) and other staff and help in maintenance of a good view of the medical profession (trust).
    The disadvantage of challenging authority would be subjecting yourself to a hostile work environment as unprofessional surgeon and other staff could take it personally and hold a grudge against Dr Patel. It might also appear that Dr Patel is trying to damage the leadership of the team.

    2. Double-checking all notes before commencing surgery.The surgeon should also give other members of the team a chance to ask questions or express any concerns before beginning the surgery.

  103. Anonymous says:

    1. The decision of whether or not to challenge the authority of senior colleagues is always difficult. Please comment on the reasons for and against Dr Patel challenging the authority of those in control of this procedure?
    Dr Patel has been confronted with a very serious situation and must act in Jane’s best interest. The reasons for Dr Patel to challenge the authority of those in control of this procedure would be to prevent unnecessary damage to Jane’s perfectly healthy right leg. The implications of surgery on the wrong leg could cause unnecessary pain, increased recovery time, further surgery and possibly more complications. The surgeon may be having a bad day however he is likely to be more irritated and angry if Dr Patel didn’t speak up before they surgery. The reasons against speaking up are that the surgeon may feel his authority is being undermined and could become aggravated and he could take this out on Dr Patel. However this is greatly outweighed by the fact that Jane will come to more harm.
    2. What steps could be put in place to prevent this potential error from happening?
    Clarification of surgical sites should be made clearer with an permanent marker on the patients skin or even multiple marks. Everyone on the surgical team should read the patients notes reducing the chance that this potential error could happen. A more open environment should be promoted to allow everyone on that team to feel that they can speak up if they think something is not right or another professional is doing something wrong. This should be done in a constructive way and every member of the team should feel that their opinion is equally valid.

  104. Anonymous says:

    1. Reasons for: Jane has already been through a rather difficult experience in regards to her treatment so far and as a consequence has been in pain for an extended period of time, therefore by not double checking that this the correct leg, could mean that she will undergo an unnecessary surgery; leading to an extra surgery, increased recovery time, increase complications e.g. infection. Furthermore although the surgeon may be irritated by having his judgement questioned, he will likely be more frustrated by the F2 doctor not speaking up and possibly preventing the mistake. Not only will the mistake take a great cost on Jane, it will also take cost on the hospital and hospital staff, meaning the operation time will take longer or even another one will need to be scheduled. This will have a domino effect on other operations and patients who need operations.
    Reasons against: questioning the surgeon may have aggregated the surgeon, further increasing his irritation, which he may take out on the F2 doctor. However the costs of not speaking up could be sever and hence outweigh the reasons against speaking up.

    2. When conducting a surgery such as this , having all members of the surgical team check over the patient’s notes and clarifying what the procedure is and where it needs to be carried out prior to the operations, could avoid mistakes like this in the future. Furthermore if more people are aware of the mistake that’s been made, then they may be more likely to speak up about when in situations with people they don’t feel comfortable approaching. Furthermore, creating a stronger team work environment, where people feel that their opinion is equally valid is crucial in order to create opportunities for people to speak up.

  105. Anonymous says:

    1)The reasons for Dr Patel challenging the surgeon in this instance is patient safety. The reasons against raising the issue is the potential reaction of the surgeon. Dr Patel should be raise the concern in a professional and respectful way however it is also the surgeons responsibility to receive feedback in a professional, calm manner despite who raised the concern.
    2) To prevent this issue from occurring, and effort should be made to read the patients notes to double check the correct procedure on the correct leg is occurring. In addition the surgeon should promote a more open working environment in which staff should feel confident raising any concerns they may of had.

  106. Anonymous says:

    1. Dr. Patel should raise her concerns with Mr. Jones, after checking the patient notes to back up her concerns, as it would be necessary to ensure patient safety. Should the surgery proceed as planned without Dr. Patel’s intervention, an unnecessary surgery would be performed on Jane’s right leg which would leave her recovering from an invasive and needless procedure on her right leg, whilst still having pain on her left leg. Furthermore, the realisation of such an error may reinforce to Mr. Jones the importance of checking patient notes and not rushing through surgeries.
    However, there is a likelihood that through voicing her concerns, Dr. Patel may damage her relationship with Mr. Jones, as he may view her legitimate worries as an attempt to undermine his authority.
    2. To prevent such a potential error from occurring in the future, it is essential that all members of the surgical team read over the patient notes once more before beginning the surgery to ensure that the details about the patient are correct. Additionally, Dr. Patel would have been much more comfortable with raising her concerns to Mr. Jones if Mr Jones promoted a more open work environment with effective communication instead of rising to anger when questioned on his decision making.

  107. Anonymous says:

    Although Dr Patel may feel worried about the response from the surgeon upon challenging him, ultimately, he has a role of responsibility to care for the patient and their safety. Failing to confront the surgeon and ensure the correct leg is to be operated on will put the patient at risk a clear reason for challenging the authority of the surgeon. However, it is understandable that Dr Patel does not want to waste any time in the already stretched surgery schedule and would be afraid to be incorrect in challenging the surgeon and seeming unqualified to the other members of the team.
    The cross should be marked on to the skin in order to prevent another case like this. Also, all members of the multi-disciplinary team should feel comfortable to raise any concerns regarding patient safety, training could be provided for more senior teaching staff especially to ensure everyone feels happy raising concerns.

  108. Anonymous says:

    1. For: Dr Patel needs to challenge the surgeon in order to ensure the safety of the patient, as if the surgery were to continue wrongly it could end up causing Jane harm as well as unnecessary pain. By challenging the surgeon, it will also ensure the surgery is correct the first time around which will save time in the long run as a singular surgery is better than multiple surgeries and the surgery itself will take a shorter time if performed correctly at first.
    Against: Dr Patel may not want to raise the concern for fear of embarrassment or being snapped at by the surgeon. Raising the concern could also lead to a worsening of the relationship between herself and the surgeon. If the concern is correct, raising it will damage the reputation of the surgeon and may lessen patients trust in this surgeon or medical professionals in future.
    2. This could be prevented if the notes were double checked by the surgeon before beginning the surgery, not just by those involved in preparation. The surgeon could also try to have a less sharp manner and more mild attitude to improve communication within the team so concerns can be raised easily and surgery can run smoothly. Improving communication in this way will also make doctors more likely to raise concerns in future, preventing these mistakes in other situations.

  109. Anonymous says:

    1.

    For challenging the authority: Dr Patel must maintain patient safety. If she challenges the senior colleague, the consequence she faces is less severe than performing the wrong surgery and facing complications. If Dr Patel can justify her opinion, and give evidence for this, then she should challenge Mr Jones. Dr Patel has a responsibility to challenge assumptions, and not just accept information without verifying it.

    Against challenging authority: In doing this, however, she might likely damage her relationship with the rest of the staff and become a scapegoat. This will lead to feelings of rejection and give her a negative first impression. Still, one of the duties of a doctor is to keep the patient’s safety, so this should override her judgement on what to do.

    2.

    1) Do not overlook significant details.
    2) Double-checking information before the procedure.
    3) Having the doctors verify Jane’s notes together before starting the procedure.
    4) Preventing feelings of intimidation in the workplace by asking for opinions.

  110. Anonymous says:

    1. Dr Patel should raise concerns if there is any uncertainty before the operation begins. Moreover Dr Patel should feel comfortable enough within the team to be able to raise concerns which is something that needs to be addressed. Ultimately concerns must be raised in order to ensure good patient outcome and patient safety, in this instance that the correct ankle is operated on. However it is understandably difficult to raise concerns in times of stress when many things appear to already be “going wrong” on the day, and it is important to raise concerns if you are certain that it needs to be raised and that you have also thought of a way to resolve said concerns.
    2. Better communication between the preparation team and the operating team would eliminate would help to prevent situations like this. If the dressing was removed early then a similar marking should have been used (potentially on the skin) in order to avoid any confusion and also simple communication and documentation of the removal of the dressing to make sure all parties are clear on what has happened to Jane from preparation all the way to the operating theatre.

  111. Anonymous says:

    1. For: As a doctor patient safety should be priority and if Dr Patel had any concerns about the procedure, she should have clarified these with her senior colleagues regardless of her fear of their reaction. Furthermore, by Dr Patel speaking up she could have prevented a botched surgical procedure and her colleagues’ reaction would have been very different to that of her expectations. By Dr Patel speaking up and preventing the error, she would have maintained the patients trust in the NHS and prevented the risk of claims or bad publicity and complaints. It would also have prevented unnecessary pain to the patient and the need for further surgery to correct the real problem, which would be a waste of NHS funding which is already under pressure.

    Against: Dr Patel is not certain that it is the wrong leg and may feel that she would be wasting even more time if she was to question the surgeon unnecessarily. Also, Dr Patel may not want to come across as being disrespectful towards the surgeon by questioning his work, especially at a time when he is already agitated. She may fear that raising her concern could ruin the relationship with her colleagues and somewhat embarrass the surgeon in front of the team.

    2. More efficient teamwork and communication would have played a big part in preventing this situation. The surgeon should encourage the team to raise any concerns they may have for the benefit of both the staff and patient, as well as have a more friendly and respectful approach towards his fellow colleagues so that they would not be hesitant to speak up. The patient notes should also be thoroughly checked before carrying out the surgery. When removing the bandage, the staff should have taken time to ensure that the X mark remained on the ankle, and if not it should have been redrawn to prevent error in surgery.

  112. Anonymous says:

    1. For: it is essential that Dr Patel raises the concern as the safety of the patient must come first because if the surgery takes place on the wrong leg, it would lead to more harm to the patient as well as further eroding Jane’s already potentially damaged trust in the healthcare system. Also, raising the concern prevents the need for Jane to be readmitted for a second surgery which would put pressure on the NHS and potentially delay other patients from having an operation due to longer waiting times.

    Against: raising a concern may lead to the surgery being delayed which puts pressure on the staff due to the tightness for time in the theatre list due to the earlier surgery running over. Moreover, Dr Patel may not feel comfortable questioning a senior doctor and may be lacking the confidence to do so. Furthermore, Dr Patel may be worried that he is wrong in raising these concerns and with his lack of experience, is perhaps more likely to doubt himself. However, in my opinion I feel that Dr Patel should raise his concerns as the patient’s safety must come first.

    2. Better teamwork and communication may have helped to prevent this error. If the senior surgeon was more understanding or less abrasive, then other staff may feel more comfortable raising concerns and there would also be a more positive working environment for the team. The team could also have read through the notes together to make sure everyone in the operating theatre knew what was going on. Moreover, the X should’ve been marked on the skin where Jane was to be operated on, instead of the bandage and regardless of the time pressures, the patient notes and check list should have been followed in order to maintain patient safety.

  113. Anonymous says:

    The main reason for challenging authority is to ensure the patient’s safety and this must come above all else. If the wrong leg is operated on this will mean Jane will go through unnecessary pain, risk of infection and recovery. She will end up with a longer hospital stay as she awaits another operation on the correct ankle. Operating on the leg also wastes the time of the theatre staff and resources.
    The reasons Dr Patel might not challenge authority are that she fears angering Mr Jones, especially since he seems irritated and impatient, and if she is incorrect she could end up unnecessarily delaying the surgery further. This could damage her working relationship with Mr Jones and the other members of the theatre staff and make working together in the future harder.

    To prevent this potential error the surgeon scheduled to perform the operation should talk to the patient not long before the operation to discuss the procedure and mark the surgical site themselves. The surgical site could be marked directly onto the skin. The job of verifying the correct surgical site from the notes should be given to one of the team members. Furthermore, senior team members should try to create an environment where more junior team members feel comfortable raising concerns, as this is crucial in looking after a patient’s safety.

  114. Anonymous says:

    1.In the best interest and safety of the patient, Dr Patel should have intervened and challenged the authority of senior colleagues to prevent doing harm to the patient. Intervening and highlighting the error would save operative time and costs through care and compensation for the possible patient claim.
    Dr Patel would obviously like to avoid confronting those with more authority incase this may negatively impact other’s opinions of her. She recognizes the risk of embarrassment with causing further delays in theatre.
    2. Use the WHO surgical safety checklist; mark the X on the patient’s skin rathe than on a dressing; maintain good communication within the peri-operative team and ensure that each member feels confident and comfortable to raise concerns

  115. Anonymous says:

    1: Ensuring patient safety should always be the first priority. By voicing her concerns over whether the correct leg has been identified to be operated on, Dr Patel will prevent the prolonging of Jane’s suffering – operating on the incorrect leg will have been a waste of time, and could possibly lead to further complications for Jane in the future. Communication between members of the team is key, and no individual should feel they cannot share their opinions or concerns. However, Dr Patel may feel that she is not experienced enough to challenge Mr Jones. If her concerns prove to be unfounded, they may cause an unnecessary delay when the surgical team is already behind schedule for the day, which may have a knock-on effect on the safety of other patients due to receive surgery. Furthermore, Dr Patel challenging her colleague may cause offence, leading to a breakdown in communication and effective teamwork which is not easily remedied.

    2: The error could have been prevented by more effective communication and teamworking skills – for example, if the member of the team who removed the bandages from Jane’s leg had communicated this to the rest of the team, the correct leg would have been identified. Fostering a more supportive working environment, where each member of the team feels comfortable to voice their opinions and raise concerns over potential breaches in patient safety could also prevent situations like these.

  116. Anonymous says:

    1. Dr Patel should raise the concern to Mr Jones as patient safety is at risk. Patient safety should always be first and foremost and therefore it is always acceptable to raise any concerns or queries with other staff members.
    The reasons why Jane may not wish to raise concerns with Mr Jones would be due to personally feeling uncomfortable and due to fear of being ostracised by her new colleagues.

    2. The cross on the leg could be placed on the skin instead of the bandage. Also there should be a more comfortable working environment put in place where staff members are not scared to speak up. Furthermore, there should be a more thorough pre operation check system put in place so that mistakes like this don’t happen again.

  117. Anonymous says:

    1.Reasons for- if Dr Patel doesn’t challenge the authority of the senior doctor then it will put the patients health and safety at risk. Furthermore it could cause long lasting physical effects on Jane as she could be exposed to hospital bacteria and put her at risk of infection in her healthy leg. In addition it would make jane lose confidence in medical professionals and may not want to comeback for other issues which would result in her health being at risk.
    Reasons against- -Dr Patel isn’t confident that its the wrong leg and also might not want to talk against the consultant and damage their relationship and her relationships with her other colleagues.
    2.They could instead of drawing the X onto a removable bandage they could use a marker to draw it onto the patients skin. Furthermore they could make sure more people check the patients charts to remove these sorts of errors

  118. Anonymous says:

    1. Arguments for
    -Not raising the concern will put Jane’s safety at major risk as she will end up having to go through and recover from an operation which will be of no benefit to her condition
    -The pain in Jane’s damaged left ankle could become worse if it is not operated on which would cause her extra and unnecessary harm. She may also have to wait for another time slot to have the correct surgery to become available, which will be very frustrating.
    -Jane will loose trust in the healthcare system if the wrong leg is operated on, meaning that if she is unwell or injured in the future she may be less likely to visit the doctor
    -Everyone in the multidisciplinary team should fell comfortable with raising concerns in a respectful way

    Arguments against
    -Dr Patel is not sure that it is the wrong leg and may feel that she should be certain before raising concern
    -She may not want to come across as disrespectful to the consultant, which could damage their professional relationship
    However, it is important that she raise her concerns because her first priority as a doctor should be her patient’s wellbeing

    2. The error could be prevented if the surgeon checked Jane’s information with other members of the team who have been more involved with her care up until this point. He could also encourage the surgical team to raise concerns, and check that the other members of staff are happy with the surgery taking place before it goes ahead. The error could also have been prevented if the preparation team had taken more time to check the bandages they were removing as they may have discovered the ‘X’ marking the surgical site, despite being under a lot of stress as they were running behind.

  119. Anonymous says:

    1. For – An operation on the wrong leg would be horrific for the patient. They would have a much longer healing time, it does not solve the problem in the leg that actually needs surgery and the patient will lose trust in the NHS. It also would harm the careers of the doctors involved as the patient is well within their rights to take legal action. Therefore, it would be wise for Dr Patel to raise her concerns. Moreover, the NHS is structured in a horizontal hierarchy whereby anyone who notices an error as severe as the one described can raise the issue with a more senior member of staff therefore, in theory, Dr Patel should feel comfortable raising this issue with the surgeon. It is also Dr Patel’s duty as a doctor to protect the patient from harm regardless of how the senior surgeon may react.
    Against – Dr Patel may not want to question the surgeon as he has much more experience than her and is much more senior. He is also already agitated. She also does not want him to react angrily towards her, especially as he has snapped at nurses earlier in the day, however the patient must always come first if there is any doubt.
    2. Better teamwork and communication could prevent this error. If the senior surgeon had a better attitude, staff may feel more comfortable raising concerns and discussing their roles in the operation. Moreover, the team could read through the notes together and this would make sure everyone in the operating theatre was on the same page. For this to work, the atmosphere should be more open and the surgeon would need to have more respect for his colleagues. All procedures must be done with maximum care so the step of verifying the correct surgical site should not have been skipped.

  120. Anonymous says:

    Episode 3

    1. The decision of whether or not to challenge the authority of senior colleagues is always difficult. Please comment on the reasons for and against Dr Patel challenging the authority of those in control of this procedure?

    For: Putting patient safety first to avoid Jane going through unnecessary distress and harm, it would severely affect Janes view of the healthcare system and could very lead the doctors being liable for a lawsuit which would put strain on the NHS staff and ethical team to handle this. Also, there would be extra costs to perform the correct surgery eventually and it would be an insufficient division of medical time and resources. Ultimately though the most important aspect is patient safety and to think of how stressful and traumatising it would be for Jane to have the wrong leg operated on.

    Against: Dr Patel isn’t 100% sure it is the wrong leg and his lack of confidence in if he is sure could lead to a waste of resources and time which could affect the moral in the surgical team and lead to more mistakes being made during the surgery. This could also embarrass Dr Jones and could damage Dr Patel’s relationship with a senior doctor whom he would like to have a good rapport with as they will be working together a lot. However all of these are not as important as patient safety in my opinion and if Dr Patel has any doubts whatsoever he should not feel afraid to speak up.

    2. What steps could be put in place to prevent this potential error from happening?
    The patient could have the ‘X’ (surgical mark) placed their skin to avoid future problems as there are so many people involved in the surgical prep and there are many chances for miscommunication between the team. The hospital should also enforce a supportive environment where all colleagues feel comfortable to raise concerns no matter what level of seniority they are, whether you’re a junior doctor or consultant specialist. This could be done through available workshops on teamwork and being confident too speak up if you believe there is a slight chance of something affecting patient safety.A thorough checklist could be referred to before surgery to ensure the team is confident in what surgery is about to take place and their various roles.

  121. Anonymous says:

    1. For:
    The safety of the patient should always come first, regardless of what the circumstances are. In speaking up and challenging the authority of this senior medical colleague, Dr Patel can explain that they maybe operating on the wrong leg and help to rectify this before the surgery progresses any further. This will be of benefit to the patient Jane, as her leg after surgery will begin to improve in function and the operation won’t be performed on her other leg, which would cause her more pain and grieve. Additionally, she won’t have to be readmitted for a second attempt at the surgery, which puts pressure on the NHS in terms of time, waiting lists, costs, staff and equipment as well as herself.

    Against:
    Speaking up in this case and having the medical team revise Jane’s notes would mean that they are set back in time again with them already under tight time regulations. Also, challenging the surgeon could possibly cause an uncomfortable atmosphere in the operating room and possibly trigger him to snap at the staff involved again, as he seems irritated and frustrated to begin with. This could lead to a breakdown in communication and a dip in moral between the staff in the room as they as feeling upset and embarrassed, which can lead to complications in the surgery also. Additionally, if the notes suggested that they were operating on the correct leg, Dr Patel could be accused of wasting time.

    2. All staff involved could take a few moments before the surgery consulting and double checking the patients notes and clarifying that they are performing the operation on the correct leg. A copy could always also be brought into the operating room to keep them on track as well. Prior to this, the X which marked which leg was to be operated on should have been redrawn when the bandage removed it or drawn with a more permanent marker or made more apparent and clearer beforehand. Additionally, everyone in the room should be aware of what is about to occur during the surgery and an idea of what the patient wants to obtain from it. There should also be a strong work environment and good communication links established between all members of staff, including junior doctors and nurses, so that nobody will be embarrassed or nervous to speak up if they have a concern.

  122. Anonymous says:

    1.
    Arguments for raising the concern:
    It is essential that Dr Patel raises some concern that the leg about to be operated on may not be the correct one. This is essential for patient safety as evidently it would lead to extreme harm and detrimental effects for the patient if the procedure continued incorrectly. As well as, this by raising the concern, Dr Patel is saving the multidisciplinary team from possible litigation and legal action by the patient. It is crucial that the entire team communicate effectively with one another especially for big procedures such as surgery. It Is better that the concern is raised and be wrong rather than not saying anything and the patient’s safety being jeopardized.
    Arguments against raising the concern:
    In an already high pressure environment which is behind the time schedule it may be seen as a waste of time consulting the notes and disrupting the momentum of the team before the surgery. As well as this, disrupting the Senior surgeon before he operates may lead to him becoming agitated or tense which may affect the procedure being carried out as he is already stressed. However, despite these things the concern should most definitely be raised for the patient’s own safety

    2. A way of reducing these mistakes being made again is by marking the skin of the patient rather than the bandage to ensure that the marker can’t get removed or lost through the process. As well as this a environment should be obtained in which each member of the multidisciplinary team should feel as though they can speak up about any concerns or issues without fear or worry that they may be wrong.

  123. Anonymous says:

    Challenging the authority of senior colleagues when you hold a relatively junior position is a multi-layered issue and so there is points for and against the idea. In a medical setting such as in a theatre the relationship between the various team members that make up the multidisciplinary team is extremely important. Therefore, Dr Patel may be pensive to bring up the doubts she has over which leg is being operated on as she does not want to disrupt this team dynamic just before a surgery is going to take place. Another reason against bringing up her concerns is that the team is already behind schedule and so she may feel that if she is incorrect it will be a waste of time in an already time pressured situation. She may think that an error like this will lead to a degree of frustration and resentment against herself which would damage the team dynamic and make a positive result for the Jane less likely. However, the most important point to remember in situations like this is to ensure patient safety and that the best outcome for the patient is reached. In this case that means that Dr Patel should certainly mention to one of the members of the team that she has doubts over whether the team is going to be operating on the correct leg. This would result in the correct leg being operated on and so Jane would have a much better outcome. It would also help to protect the other medical personnel involved from possible litigation as a result of a mistake being made in Jane’s surgery.
    There are several procedures which could be put in place in order to reduce the risk of this potential error in the future. One such procedure would be to have all markings of the correct surgical site be made on the skin when possible rather than on bandages which can very easily be removed before the procedure takes place. Another way in which this risk can be reduced is by having a designated member of the team who ensures that the correct surgical site is being used as part of their duties.

  124. Anonymous says:

    Dr. Patel has a duty of care to the patient and should put that at the forefront of her mind before her own personal feelings of being shouted at by a senior doctor. These concerns can be raised in a respectful manner, the worst outcome of raising this concern is that she is wrong. It is important to remember that no one is invincible and everybody makes mistakes regardless of their position or years of experience.

    However, the other outcome of saying nothing and being right proves to be extremely detrimental to this patient. Raising concerns with this extremely unapproachable doctor could contribute to negatively damaging the work environment between the colleagues. Dr. Patel raising concerns would also delay the surgery even further. However, in this case it is necessary to raise concerns.

    An open work environment should be put in place where staff feel they can voice any concerns they may have in a safe way. It is a team effort and everybody has a responsibility to speak up if they feel a mistake has been made. Initially, the correct leg should have been marked in permanent marker and double-checked before operating, regardless of how busy surgery is, as this is a vital step.

  125. Anonymous says:

    1. For
    Patient safety should always come first. Dr Patel has a duty to have the patients best interests in mind and so this should take priority over her fears. Although it is understandable that it would be difficult to challenge the authority of senior colleagues, in cases where the concern turns out to be valid doing this is essential. The outcome of not raising a concern and making a detrimental mistake is far worse for the doctors and the patient than raising the concern in the first place. So raising concerns decreases the chances of making mistakes which would cost the patients safety. Raising concerns also would’ve prevented Jane the pain and suffering of the unnecessary surgery of the wrong leg. The mistake in this case wasted time and money in treating Janes ankle which was perfectly well. If the mistake was avoided in the first place costs would’ve been lower and Jane wouldn’t had to have had a second operation which she would’ve been frustrated with. Dr Patel obviously respects Mr Jones due to his skill and experience however this doesn’t mean he never makes mistakes and with Dr Patel challenging which leg is to be operated on would’ve prevented Mr Jones from making this mistake.

    Against
    They are under time pressure and so confirming the right leg would take time on a schedule which was already behind. In cases where the concern is invalid the delay probably would cause frustration for the medical team. However of course it is always essential to confirm any concerns regardless of their outcome. It is also understandable why Dr Patel would feel intimidated by Mr Jones due to his experience and as a result trusted that he wasn’t making this mistake. She also wouldn’t want to frustrate Mr Jones further and get snapped at.

    2. Firstly the X should’ve been marked on the skin of the leg which is to be operated on, instead of the bandage. Although the nurses were busy and Mr Jones was becoming impatient the step of verifying the correct surgical site should never be overlooked as it was in this case. Regardless of the time pressures and stress the patient notes and check list should be strictly adhered to in order to maintain patient safety. Finally everyone in the team should feel confident to raise any concerns openly without fear of being snapped at. Humans are going to make mistakes so if there wasn’t a stigma or fear surrounding raising concerns then patient safety would be better protected. There would also there would be a more positive working environment for all the multi-disciplinary team.

  126. Anonymous says:

    For: Put patient safety at the forefront of any procedure; avoiding surgery to wrong leg, which creates and prolongs unnecessary suffering, costs both time and resources as well as creating a liability to the NHS. An open culture where doctors can freely be challenged by their peers is crucial, as even the most renowned and senior of consultants can make simple mistakes.
    Against: opportunity for potential embarrassment, worsen relationship between Dr.Patel and the consultant, Damage reputation, hold up surgery which is already running late.

    Mark the skin with an indelible marker, if impossible a mark should be made which clearly states where the surgery should take place i.e. an arrow further from surgery site. Open communication is essential between the surgery team and the preoperatory team , in cases like this the notes should always be checked, but more than this an open environment should be fostered.

  127. Anonymous says:

    1. For:- Ensures the establishment of accurate patient safety procedures which, in turn, could result in the avoidance of a colossal medical mistake. The possibility of a wrong operation involves the affliction of unnecessary harm and distress to Jane, who has already suffered at the hands of an over-worked hospital staff. Not only this but it also makes the hospital and its doctors liable to a lawsuit, thereby putting strain on the NHS itself. This, coupled with the time and costs of performing a second surgery, makes the whole situation undesirable in terms of the distribution of medical resources.

    Against:- There is a clear power dynamic issue visible in the scenario, which is often the case with young doctors (especially when they are new to a particular job). Dr. Patel is struggling with voicing his opinions confidently and tries to convince herself that she is making the mistake due to her inexperience. She is also unsure about her memory and all the details of Jane’s case, which constitutes as reasonable doubt. Ideally, Dr Patel should clarify these aforementioned suspicions and ensure that Jane’s safety is the top priority.

    2. Physically, its possible to draw the mark directly on the patient’s skin in an attempt to avoid the possibility of such an occurrence. However, most importantly, it’s crucial to create a healthy work environment which encourages intellectual curiosity and allows all healthcare professionals to voice their concerns. Perhaps, the staff should undergo a series of workshops that educate them on the importance of developing a responsive demeanor, especially with respect to younger doctors and nurses questioning an aspect of a clinical procedure. Similarly, conducting a small pre-op meeting with all the relevant staff could prove to be a small platform for raising associated concerns. Also, educating doctors on understanding the bigger picture associated with scenarios like these could help them in realizing what’s really at stake here – the ultimate goal of treating a patient efficiently.

  128. Anonymous says:

    3) 1. For: Patient safety is always the first priority and Dr Patel has a duty of care towards Jane, so Jane’s safety should come before Dr Patel’s fears of being reprimanded. Checking the notes would be quick to do and if Dr Patel is correct about a mistake being made it would prevent repeating the procedure and would mean a better outcome for Jane.
    Against: Dr Patel isn’t entirely confident that a mistake has been made and maybe fears being seen as incompetent by her colleagues. Another reprimand from Mr Jones, during an already stressful procedure due to the time constraints, may lower team moral further, leading to a breakdown in teamwork and therefore more errors could occur.
    2. The X could have been marked directly on Jane’s skin. A pre-operative checklist would also be beneficial as it would have allowed the team to identify the error without having to worry about confronting a senior colleague. A supportive environment should be established where all members of the team feel comfortable enough to raise concerns.

  129. Anonymous says:

    For
    – corrects the mistake and avoids surgery being performed on the wrong site
    – increases safety and trust concerning the patient
    – avoids unnecessary pain and suffering from the wrong leg
    – decreases costs and anxiety experienced to re-operate at a later date

    Against
    -anxiety of speaking out against those in authority
    -embarrassment
    -damage to the relationship between Dr Patel and Mr Jones
    -poor teamwork and communication

    To prevent this happening again, there could be open communication prior to surgery between all members of the team. The team should be able to raise issue/concerns openly and in a positive way- avoiding embarrassment or confrontation. Before surgery begins they could run through the logistics of the surgery double checking the site. Increasing communication and teamwork skills allows people to speak up when they are unsure.

  130. Anonymous says:

    For:
    – ensures that the patient’s safety is not compromised
    – beneficence and non-maleficence pillars have to be maintained as duties of doctors
    – encourages other doctors/nurses/staff to raise their concerns in a similar situation
    Against
    – he does not feel comfortable on questioning a senior doctor
    – he has less experience and he is worried that he might be wrong and as a result the operation will be delayed
    – low confidence
    However, in my opinion, even if I understand the reasons that might put her off of saying something, none of them is more important than the patient’s safety.

    2. – X could be put directly on patient’s skin
    – a system that encourages people to talk and raise their concerns at anytime
    – an environment that makes people feel comfortable to talk and communicate with each other
    – teamwork debrief before an operation

  131. Anonymous says:

    1. Dr Patel should challenge Mr Jone’s behaviour as it reduces the risk of an error being made which could harm the patient. If she raised this in a professional manner it would not matter if her suspicion was incorrect as it would have been quick to clarify in the notes. I can see why Dr Patel would be afraid to speak up in this situation to the irritated Mr Jones as she is perhaps worried about being given a bad reference, or being seen as incompetent by the team if her theory was wrong.
    2. The mark should have been made on skin instead of the bandage which could be easily removed by accident. Mr Jones should also have consulted the team before the surgery started in order to identify worries or concerns in a supportive manner.

  132. Anonymous says:

    For – Patient safety should always come first in any scenario. If Dr Patel is harboring doubts regarding Jane’s safety they should be acted upon. Even the most experienced doctors, clinicians or surgeons are prone to human error especially if their skill has made them complacent. Fear of reprimand is not a valid excuse for not raising concerns especially if you believe patients may come to harm.
    Against – Dr Patel’s concerns may be invalid, she isn’t completely sure a mistake has been made and raising concerns may unnecessarily delay the operation and incur the anger of Mr Jones the performing surgeon.

    A pre-operative checklist could be put in place to ensure the correct procedure is being carried out. The X marker could have been made on the Jane’s skin so it is not lost when the bandages were changed and details left in the patient’s notes. The lead surgeon, in this case Mr Jones, should have adopted a less hostile approach to his medical team, encouraging questions and seeking the advice and comments of the whole multidisciplinary team. Junior doctors should be encouraged to raise concerns and ask questions without any fear of reprimand as this will ultimately result in fewer errors

  133. Anonymous says:

    My Views on Jane’s Story Episode 3
    Mr Jones is clearly a very good doctor but as it is stated he is infamous for being a bad person to work with, being an amazing doctor means very little if you can’t work with others. Our healthcare system functions on being a multidisciplinary team environment and if this system breaks down the ability to deliver good care to patients goes away also. Everyone in the surgical room should be aware of what is happening i.e. the patient, what the operation is etc. which means in times like these mistakes can be seen by any person within the team and not left to the chance of the doctor.
    The initial breakdown in the system was the prep team, once the bandage was removed, they should have drawn a new marker on Jane’s skin. Even if you are not the doctor or not going to be in the surgery your role may be the most important and being observant here would have saved this from even being an issue. In Jane’s story Episode 2 we were told that Jane’s ankle had become swollen and bruised which jane’s right ankle would not have been. Surely anyone in the room could very easily see there was a mistake if they are told they would be working on this ankle but the ankle they see in surgery looks undamaged. Sometimes every problem does not require a medical solution or even a complicated one a bit of observation and common sense would have helped this situation.

    The decision of whether to challenge the authority of senior colleagues is always difficult. Please comment on the reasons for and against Dr Patel challenging the authority of those in control of this procedure.
    For
    The most important thing to remember in this scenario and every scenario is patient safety. Even the most skilled doctors can miss things and make mistakes and its important for the patient and the doctor that they have someone pointing that out so they can learn from this and the patient doesn’t come to any unnecessary harm. The last thing Jane needs is another mistake that require her to not only be put at risk but also to make her lose her faith in the healthcare system all together.
    The thing even as medical students that we must remember is that the patient’s safety comes first no matter what and even an inkling of doubt is worth investigating. Dr Patel being uncomfortable for a few minutes doesn’t outweigh the risks to Jane. It’s better to be safe than sorry.

    Against
    Dr Patel has clearly lost her confidence and is doubting her instincts due to the previous incidence where she was shouted at for highlighting another potential error. She has also already witnessed Mr Jones snap at the other members of the team. She feels as though she will be made uncomfortable with the rest of the hospital staff if she stands up and probably thinks no one will take her seriously if she is wrong.
    Dr Patel isn’t even completely sure herself if a mistake has been made so she probably feels like what’s the point in saying anything and making a big fuss over nothing. This is understandable as it must be extremely hard to stand up to someone who is such an amazing doctor and is far more senior than you. She probably feels as if she will hold up the whole surgery over potentially nothing.

    What steps could be put in place to prevent this potential error from happening?
    There should be several systems put in place to prevent this from happening:
    • Notes should be double checked before going into surgery
    • The prep team being more observant (putting an x on Jane’s skin when the bandage was removed)
    • Senior doctors learning to cultivate good working relationships with every member of the multidisciplinary team. If it is noticed that certain doctors are not doing that, they need to be pulled up on it and maybe be taught how to.
    • Teaching undergraduates or foundation year doctors about how to correctly stand up when they believe something is wrong in a professional manner. This will give them more confidence when they must do it
    • Having a checklist before surgery and using it
    • Everyone in room should be aware of the patient’s concern and what they will be doing that day son there are multiple barriers in place along the healthcare system to stop mistakes

  134. Anonymous says:

    1) Reasons for challenging authority:
    Patient safety and care should always be first priority for doctors, therefore by speaking up and confirming which leg is to be operated on will avoid a major mistake being made. Furthermore, if Jane’s other leg is operated on, she will be more likely to lose all faith in the medical profession as this would be another mistake made that could have been avoided.
    Reasons against challenging authority:
    The F2 doctor obviously finds the surgeon Mr Jones intimidating and considering his temper when challenged in previous situations it is understandable that Dr Patel is apprehensive about raising her concerns. Also, considering the tight time schedule for the operation, Dr Patel may not want to be a hindrance and slow the operation.

    2) There are steps that could be put in place to prevent this error from happening. Firstly, regarding the bandage marked with an X, I think that a mark could be placed directly on the skin of the patient to be operated on so that there will never be confusion as to which body part will be operated on. Secondly, a checklist could be implemented before surgery to reduce the chances of something similar occurring. Finally, I think that there is a stigma surrounding junior doctors challenging senior colleagues but we must acknowledge that everyone is human and makes mistakes, therefore, the opinions and views of junior doctors must be welcomed.

  135. Anonymous says:

    1. Dr Patel should confront Mr Jones about the situation because although she may feel uncomfortable, Jane should be her first priority, which is also stated by the GMC as a doctor’s first concern in Good Medical Practice. If Dr Patel does not say anything she is compromising Jane’s safety. Bearing in mind everything else Jane has already been through with the misdiagnosis and wrong medication, operating on the wrong leg would completely destroy any trust Jane has left in the medical profession. However, it is understandable why Dr Patel does not want to raise concerns incase she is wrong and is shouted at by the consultant. But patient safety overrides this and it is better to be safe than sorry.
    2. There needs to be much more emphasis on the importance of a multi-disciplinary team; not just the consultants and doctors, but nurses, porters, students, midwives, pharmacists and anyone involved with a patient’s care plan should feel they are able to speak up if something doesn’t feel right. It also shouldn’t be the case that consultants feel their position of authority is being threatened if it’s suggested a mistake has been made. It should be used as an opportunity where everyone in the team can learn from it. Regarding Jane’s case, there should have been more checks and double checks to ensure the correct leg was being operated on e.g. record in Jane’s notes which leg is being operated on, mark the X on her skin and recheck before beginning the operation.

  136. Anonymous says:

    1. The decision of whether or not to challenge the authority of senior colleagues is always difficult. Please comment on the reasons for and against Dr Patel challenging the authority of those in control of this procedure?

    AGAINST – Dr Patel feels she is young and inexperienced in comparison to Mr Jones. Whilst he in a very senior and skilful surgeon, he’s also authoritative and snappy towards staff , and wouldn’t appreciate being questioned if he was correct or not. Dr Patel doesn’t want to be snapped at again, and has had bad experiences before when questioning a senior doctor. She has perhaps lost her confidence.

    FOR – perhaps other staff have also noticed the mistake, and are too afraid to say. Dr Patel however is the only other Doctor in the room, and should maybe feel she has a greater responsibility to speak up about her concerns over Jane’s leg. If she questions it, the leg can be corrected and the procedure won’t have to be repeated. If Dr Patel puts patient safety as her first concern, not her reputation, Jane will have a much better outcome and won’t go through unnecessary suffering.

    2. What steps could be put in place to prevent this potential error from happening?
    The consultant should use his position to empower other staff in the room to have a voice, rather than use his power to be authoritative, or the only voice which matters in the room. By going through a pre-surgical checklist, errors can be avoided and questions can be raised to minimise errors in surgery. Dr Jones should be nicer to other staff, practise patience and more self control in his demeanour to staff, so that other staff don’t fear questioning him.
    The Case just prior to surgery should be summarised, all staff should introduce themselves by name quickly, and the floor should be open to questions to ensure that all checks are made and errors minimised. Because the root of the problem comes from Dr Jones attitude, staff should feel supported to make a complaint if they feel they are disrespected by another member of staff. Appropriate actions should be taken in light of complaints and Dr Jones should try his best to adopt a better attitude in work.

  137. Anonymous says:

    1. According to the GMC’s ‘Good Medical Practice’, a doctor’s first concern should always be the care of their patient. Following this guideline, the risk of being scolded by the senior surgeon or developing other poor working relationships should not prevent the doctor from speaking up about their concerns. If patient safety is at risk, a doctor should always speak up and either resolve the situation or find someone who can. It is, however, understandable that the F2 doctor may feel intimidated by a senior colleague and does not want to get on his bad side. This fear has been amplified by the surgeon’s attitude towards other staff members that day.
    Speaking up in this situation would prevent a very serious mistake being made and the care of a patient being compromised. Even if it ended up the young doctor was wrong about her concerns, it’s better to be safe than sorry. A mistake such as operating on the wrong leg will only add to the trauma Jane has already experienced throughout her treatment. An operation gone wrong would destroy any remaining trust she has in the medical profession and the hospital.

    2. There appears to be a culture in the hospital were senior staff do not like to be questioned by more junior colleagues. This attitude means situations like Jane’s in the operating room are more likely to occur as there is a fear of speaking up about concerns. This should be addressed and an environment should be established where any worries regarding patient safety can be discussed, without fear.
    An ‘X’ was marked onto the bandage around Jane’s leg to indicate which leg was to be operated on. This was removed by a nurse who was trying to quickly prepare Jane for surgery. To prevent this error happening again, the ‘X’ could be written directly onto the patient’s skin to make it clear which area of the body is being operated on.
    Additionally, a system where it is always double-checked before the surgery begins would highlight any errors such as the wrong leg being prepared for the operation.

  138. Anonymous says:

    1. Dr Patel should challenge Mr Jones’ authority as she has a duty of care to Jane and so is partially responsible, along with Mr Jones and the other theatre staff, to make sure that Jane’s surgery goes as it should. Speaking up and raising her concerns would have ensured that the mistake was noticed and therefore the correct ankle would have been operated on. This would mean much less pain and stress for Jane. Even if there had been no mistake, there would have been no harm done had Dr Patel confirmed which ankle was to be operated on. However, Dr Patel’s fears are understandable; if she spoke up and this irritated Mr Jones, this could lead to poor working relations in the future, which would also affect patient care. It may also affect Dr Patel’s own training, as she would not get the most out of her time with Mr Jones if he was hostile towards her.

    2. This potential error could have been avoided if Mr Jones had previously worked to cultivate good relations with those he works with so that they felt comfortable raising any concerns with him. It could also have been avoided by putting in place a system of checks before each procedure to ensure that things such as confirming the procedure to be performed and the operation site are done before every surgery as standard.

  139. Anonymous says:

    1. One of the duties of a doctor is to take prompt action if you believe that patient safety, comfort and dignity may be seriously compromised, and so Dr Patel should raise the concern to Mr Jones no matter what the repercussions. However, I can understand why this would be a difficult and scary decision. As stated, the theatre where already behind in there lists, and so by raising the concern she will be delaying the lists even more and if she wasn’t correct she could be blamed for it. I also think that by challenging a higher authority there is also the risk of hindering your own career and learning as there is a chance of the surgeon not giving you the attention you require or even refusing to work with you. Nonetheless, the safety of the patient is the number one priority of the doctor and so should also be upheld no matter what the situation. The GMC states that Doctors must promote and encourage a culture that allows all staff the raise concerns safely and openly, and so it would be wrong to not act on this impulse out of fear of reprisal.
    2. The main surgeon should go through a checklist of the patients condition and the surgery procedure that is to be done. A second check should then be done to ensure the correct procedure is being done on the correct patient and that all staff are happy to proceed. I think it is also important to promote and environment where concerns can be raised openly and are actively discussed.

  140. Anonymous says:

    1. Reasons to challenge the authority in this situation are to ensure the success of the operation by ensuring that the correct ankle is operated on and ultimately so that the patient’s safety is protected, whilst reasons against challenging authority may include the fear of being wrong and slowing the procedure, thereby making other patients wait. However patient safety should always be at the centre of every decision, so reasons to challenge authority outweigh the reasons not to. The is bigger risk in staying quiet and potentially allowing the patient to be harmed than to challenge authority and be wrong.
    2. The final checks before an operation should always be made and the mark to indicate the limb to be operated on should be made on the skin, where it cant be removed by accident, rather than the bandage. In addition, the surgeon should ask if anyone has any concerns before they begin the procedure.

  141. Anonymous says:

    1. Dr Patel should challenge Mr Jones in order to ensure that the patient is safe and the procedure is performed as it should be. Nevertheless, it is understandable that Dr Patel is worried about Mr Jones’s reaction. The most important thing would be to raise the concerns in a respectful manner which would not undermine Mr Jones’s authority. Overall, the consequences of not raising the concerns and putting patient at risk would be worse than the consequences of challenging the senior colleague as doctors should always make the well being and safe of the patients their priority.
    2. Mr Jones should check with the rest of the staff if the details of the procedure he is about to begin are correct. Moreover, all of the staff members should be encouraged to raise any concerns by the hospital authorities.

  142. Anonymous says:

    Raising concern is essential if patient safety is at risk. However, if worries are raised in a disrespectful manner, or in a way that undermines the more senior staffs’ authority this can have negative implications on teamwork and professional relationships. Concerns should always be raised if patient safety is at risk.
    The senior surgeon could promote a more open work environment, in which concerns such as this could be raised without fear. The preparation could additionally be double-checked before the surgery is started by talking through the procedure and notes to ensure all staff present are aware of the surgery presently happening.

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