Setting the scene

Think about the above while considering the following scenario:

You've just qualified as an FY1, and are shadowing an FY2 in a surgical department. The FY2 is being supervised by a senior trainee, who has a reputation for being unapproachable.

One patient, who had recently undergone surgery, develops acute chest pain and the FY2 is very concerned. He is capable but anxious about the patient and asks you to contact the senior trainee.

When the senior trainee answers your bleep, you explain that the patient has deteriorated, describe his signs and symptoms, and clearly state the FY2 needs urgent assistance. The senior trainee is very dismissive and suggests the FY2 gives the patient 10mg of intravenous morphine to treat his pain and get the medical on call doctor to review the patient.

The FY2 knows the patient has very low blood pressure and respiratory difficulties, but gives the morphine as directed. He asks a nurse to monitor the patient while he rings the medical on call team. Whilst he is on the phone the patient suffers a cardiac arrest, and attempts to revive him sadly fail.

Both you and the FY2 are understandably upset. The surgical senior trainee arrives and documents in the records that he spoke directly with the junior doctor and advised him to treat the patient's pain with morphine. However, he adds that he advised starting at 2mg and titrating up to 10mg if the patient coped, and also to give aspirin and sublingual GTN before calling the medical registrar. You're immediately worried, as you know this wasn't the case.

Because this is a post-operative death it's referred to the coroner, and concerns are raised that this frail elderly patient was given a relatively high dose of morphine in one go. You later learn that the nurse, who was with the patient when he arrested, also made a complaint about the trainee to the ward manager, who was aware that this doctor was difficult to work with and unsupportive of juniors.

You speak to the ward manager privately and tell her about the trainee's inaccurate records. As a result, probity concerns are now raised, a formal complaint is made to the medical director and a disciplinary investigation into the doctor's actions begins.

Blowing the whistle - a guide to raising concerns