This blog is the transcript of a speech Phil Riddell was asked to give at Central Manchester FT in May 2017. Since then Phil has graduated and is now a Junior Doctor.
Hi, my name is Phil, I’m a final year student down at Cambridge and I’m interested in patient safety. I know that medical students, interested and patient safety are not commonly said in the same sentence, but bear with me.
I know many students who are interested in ‘cool’ things, like being a neurosurgeon or a cardiologist. In Cambridge, we have student societies for pretty much any specialty you can name that advertise careers in these exciting fields. None of these consider patient safety as part of their remit. This is compounded by more senior staff omitting, albeit subconsciously, that patient safety is part of their work because it may not be as cool as a coronary artery bypass graft. So, how did I come to be interested in patient safety?
Well, things were happening on my clinical placements that I just couldn’t get my head around. In my first week as a clinical student, I was shadowing one of the pharmacists and she found three errors on a single drug chart. Errors kept happening in my clinical placements, the majority of them were near misses. But that didn’t stop me thinking about what could have happened to that patient, or a future patient. Some would say I’m a bit of a worrier, but because the consequences of errors can alter the whole patient experience, I feel that it is not worrying- its just trying to learn from every opportunity I can.
So with this interest, I decided that I needed to know more about keeping my patients safer- and my wishes were granted with some teaching from the clinical school.
Patient safety is a topic of teaching that is relatively new in medical education. From my limited knowledge, it is taught to varying degrees at different medical schools, with even more variation in the impact of that teaching. In Cambridge, we have Professionalism days, where we sit down and have a set of lectures on various topics. We’ve had a single day on patient safety and human factors- it is a great start, but it was not enough for me. My problem was that it was too didactic- I needed to think about things myself.
So I started to talk to other students about safety, except that when I talked to my colleagues about my interest in patient safety, I was met with looks of bewilderment. “Why are you interested in that?” “It’s all about finding someone to blame.”
It’s not hard to see why they say things like this. Our Patient Safety day turned into an exercise where we were told about big errors that had happened. As students, we discussed them at length, but ended up laying the blame at someone’s feet. This just didn’t seem right to me- I knew people who had been involved in near misses before and they weren’t incompetent, they had just made an honest mistake.
Very few of my colleagues seem to acknowledge that safety will be a big part of whatever career we chose as healthcare workers. Take the recent NPSA alert about medical air valves on wards- that affects every patient that comes into hospital, regardless of which team they are admitted under. As an organisation we are constantly learning about potential, or actual safety incidents and reacting to try and prevent them from happening in the future. What we learn as an organisation impacts on the experience of so many of our patients.
As you can tell, I still wasn’t satisfied. As a result, I’ve had to look elsewhere for some experience of what it is truly like to work in Patient Safety. I managed to get a week with the Clinical Governance lead in Papworth hospital, which was a good taster. More importantly, that’s when I was introduced to Sign Up To Safety.
‘Great’, I thought. Here is a group of people who are willing to help me get a glimpse of what patient safety is really like. I had a list of questions ready- what can I read, who should I be listening to and so on. But then what happened was they asked me to talk about life as a medical student from a safety perspective.
This time, it was my face that looked bewildered. Who was going to listen to me? I was just some Graduate-entry medical student who could regurgitate lots of facts under exam pressure. I have thoughts, but no one will be interested in them, because they simply cannot help.
Regardless of my doubts, Sign Up To Safety were keen to get my views online and out into the wider world. Cat Harrison worked tirelessly with me to make sure the thoughts that I came up with were distilled into something that was readable. That in itself was a feat, as my science degree and upbringing in Salford did it’s best to ruin any form of narrative.
My first post centred around the role of medical students in safety. Cat encouraged me to really think about what I was experiencing, how it made me feel and what that meant for me going forward as a medical student and future doctor. In essence, she was getting me to narrate my reflections.
Reflective writing, eurrrghh. Some of my student friends hate that phrase. It’s code word for another piece of work that no one is going to read and comment upon. But I had faith in Cat and Sign Up to Safety- they had a vision… “we want to help people to share what they know about keeping people safe”…. and they definitely had more experience than I did.
Over the next few months, Cat encouraged me to write more. She read each piece and made comments on how I might further unpick what I had seen. She suggested other things that I might be able read to help me gain some clarity. Then she put them online.
The first few were simple posts that went out and may or may not have been read by the wider audience that followed the work of Sign Up To Safety. That suited me- I was only just starting out in the massive world of patient safety. I think I would have panicked if someone sent me a message. I still felt like I didn’t really belong in the world of safety.
Then, after a few posts, I got a comment from someone who had read my posts and liked what I had said. They wanted to share it with their colleagues because something within it had resonated with them.
Since then I’ve gone on to write about various experiences that I have had. As I’ve written more, I’ve come to the realisation that we all have something important to contribute to safety, we just need to find a way to distill these experiences into a coherent form. I’ve managed to do that through my reflective writing.
We all take time to reflect on things that happen to us during the day, I’ve just taken a leap of faith and given others an opportunity to know how my experiences have made me feel and how they will shape my future practice. You don’t need to be willing to write yourself to help others learn. You just need to be willing to listen and discuss.
The key ingredient in my writing is not me. It is those who have listened to what I have said and discussed what I’ve written who have enabled me to take my work further. It’s people like Cat, and later Dane Wiig from Sign Up To Safety, that have taken the time to read what I have to say and offer what I would say is ‘constructive encouragement’.
This key ingredient became clear to me a few weeks ago when I received a notification that feedback is now available on a palliative care essay that I submitted to the clinical school over four months ago. Usual comments are short and sweet, limited to ‘Good essay’, or “Satisfactory work”. I was expecting the same sort of comments this time, but I was pleasantly surprised by what I found instead.
The full feedback was no more than a paragraph, but here are the key things for me:
“Thank you Philip…”
Wow, someone was grateful that I had made the effort to reflect upon my experiences. They instantly made me feel that my perspective was valuable to not only myself, but to them as well…
“Have you looked at the…”
My jaw was on the floor again. Not only was what I said appreciated by my ‘marker’, but they had taken the time to think about how I might be able to develop my ideas further after this essay was consigned to the depths of the medical school archives. Sufficed to say I have now followed up on each of her suggestions and am grateful that she pointed me in the direction of those resources.
I think this applies across all the work we do. If you really want to engage someone and help them develop further, you thank them for their current contributions and suggest how they can improve in the future. We do it all the time in our specialties- we will look at what we are currently doing well and then suggest areas for further reflection. I don’t think Patient Safety should be any different- we should be thanking people for being confident enough to share their thoughts, and suggesting what they can do to build on that. These discussions will help us all to improve the safety of our patients.
I know that some in the audience will still be sceptical about sharing their thoughts in a public domain as large as the internet. Once your thoughts are out there, you can’t take them back. Everyone will be able to see them. That is something that scares a lot of people, and heavy guidance from the GMC, NMC and other professional bodies can feed this fear.
However, I disagree that this guidance should prevent us from sharing our experiences.
“The standards expected of doctors do not change because they are communicating through social media rather than face to face or through other traditional media”. (GMC)
“Use all forms of spoken, written and digital communication (including social media and networking sites), responsibly. ” (NMC)
Both of these sets of guidance clearly state that any communication online should not bring the profession into disrepute, but this does not stop us sharing what we think, as long as we do this in a responsible way. I agree with the GMC- our standards do not change, but these standards do not stop us from sharing what we know verbally with our local colleagues. Why should they stop us from sharing with our colleagues around the world? Why share and discuss with just a few, when you can do the same with so many? The potential impact could be far greater, for both you and others.
Committed reflection has really helped me to develop my patient safety skills and knowledge, and the discussions I’ve had with people about my reflections, both on- and off-line, have only served to whet my appetite for Patient Safety and my future career. I hope it can for you and your colleagues too. Thank you.