As medical professionals, our primary duty is always to our patients. However, there are times when we fail – these situations are always important to investigate and understand to prevent these failures from happening in the future.
In this guide, I will be taking you through everything you need to know about negligence in a medical context and see how you may encounter this topic in a med school interview.
Written by Rozh Akram
What is Medical Negligence
The definition of negligence is as such:
Negligence – failure to take proper care over something
As doctors and health care professionals, we have a duty of care. Duty of care for doctors and healthcare professionals is the legal and ethical obligation to provide a standard of care that ensures patient safety and well-being.
This means acting in the patient’s best interest, delivering care consistent with accepted medical practices and avoiding harm. Failure to meet this standard can lead to legal consequences, including malpractice lawsuits, and ethical violations can result in professional disciplinary actions.
For negligence to have occurred, you have to establish that the doctor being sued had a duty of care towards the patient (a duty of care is owed towards anybody who you may reasonably foreseeably injure), that this duty of care was breached and this breach directly caused harm or loss to the patient.
When it comes to practising, it is absolutely crucial that we make every effort we can to protect the safety and well-being of our patients. But also in the event that something goes wrong, we are protected legally and do not have our license revoked.
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The Bolam Test
Negligence is commonly determined by the Bolam Test. This basically says that if a body of experts in the same field as the doctor on trial determines that their actions were reasonable in that situation, then they are not guilty of negligence (yes, that’s a mouthful, read it a few times if you didn’t get it).
Therefore, a doctor (or any other healthcare professional) only needs to prove that a respected body of opinion found their actions to be acceptable practice. Judges have the authority to consider their opinion unreasonable if they personally finds it illogical, however in the majority of cases the fact that experts of a profession agree with the opinion will validate it.
If negligence is established, the case then has to prove causation, which is that had the negligence not occurred, the patient’s disease would have been diagnosed/ treated properly.
Dr. Bawa Garba - Medical Negligence Case Study
You may have heard of the famous case of Doctor Garba, let’s briefly explore what the case entailed.
Dr. Hadiza Bawa-Garba, a UK paediatrician, was involved in a tragic case of medical negligence following the death of 6-year-old Jack Adcock in 2011. Jack, who had Down’s syndrome and a heart condition, was admitted to Leicester Royal Infirmary with symptoms of sepsis, but was misdiagnosed with gastroenteritis.
Dr. Bawa-Garba, the senior doctor on duty, was working under severe conditions with staff shortages and failing computer systems, leading to delays in recognising and treating Jack’s sepsis. A critical error occurred when Jack was mistakenly given enalapril, a drug that further lowered his already dangerous blood pressure, contributing to his cardiac arrest and eventual death.
She was convicted of gross negligence manslaughter in 2015, and after initially being suspended, she was struck off the medical register by the GMC in 2017. However, following widespread outcry from the medical community, which argued that systemic failures were not adequately considered, she successfully appealed and was reinstated in 2018.
This case sparked ongoing debate about the criminalisation of medical errors, the impact of systemic issues on healthcare, and the balance between individual accountability and broader institutional responsibility.
Now I have some questions for you to ask yourself:
- Do you think she was treated fairly initially?
- What could have been done differently?
- How does this case make you feel about the current state of the NHS and our shortages that still exist to this date?
How you answer these questions will likely influence how you discuss neglect at medical school and potentially in your interviews.
Reflective Practice
Reflective practice is this idea where we evaluate the work we do constantly, thinking about what went wrong, what went right and other ways we can make our current practice better and improve any mistakes we may have.
There are many ways we can implement reflective practice other than consciously thinking about what we’ve done:
1️⃣ Writing things down and journaling.
2️⃣ Discussing our practice within the multidisciplinary team.
3️⃣ Feedback seeking, either from colleagues, mentors or patients. This could be in the form of anonymous surveys or direct feedback.
Medical schools very much encourage and implement reflective practice. You will have to write a reflective essay after every series of placements and patient experiences you have, detailing how you would go about improving your own practice.
In fact, at some medical schools (as well as in other university degrees) if you make a critical error during your OSCEs, you would be asked to submit a reflective piece of writing detailing what went wrong and what you’ve learned from the experience.
Example Medicine Interview Questions - Medical Negligence
Here are some example medical school interview questions you can be asked about this:
1️⃣ What do you understand by the term medical negligence?
2️⃣ What do you understand by the term reflective practice? And how do you plan implementing this in your own practice?
3️⃣ What do you understand about fault reporting in medicine?
4️⃣ Tell me about the differences between Negligence and Malpractice.
An ethical scenario could also be given at either a Panel interview or MMI. Let’s take a look at one and consider how we would answer it:
Medical Ethics Scenario - Medical Negligence
A 55-year-old woman with chest pain is misdiagnosed as having anxiety and sent home without proper tests. She later dies from a heart attack. Discuss the potential negligence and how you would handle such a situation.
Here’s my model answer:
In the scenario, I feel the doctor’s failure to fully assess a patient with chest pain, instead attributing it to anxiety without proper tests, constitutes negligence. The oversight led to a missed diagnosis of a heart attack, which tragically resulted in the patient’s death.
Outcomes like these highlight the critical importance of adhering to standard care protocols, especially when dealing with potentially life-threatening symptoms. However, the issue of understaffing in A&E departments does often forces doctors to rush assessments and triage patients quickly, which can compromise the thoroughness of evaluations and lead to missed diagnoses.
Preventative measures should include improving staffing levels to allow doctors the time needed to conduct comprehensive examinations. Plus, when faced with high-pressure situations, seeking out assistance or prioritising care can help mitigate the risks associated with rushed decisions.
Reflecting on this case is crucial for understanding the factors that contributed to the error, including systemic issues like understaffing. Learning from these experiences and advocating for better resources can help prevent similar incidents in the future, ultimately enhancing patient care and safety.
This isn’t necessarily the perfect response, but it covers the key points that would be important to consider in a case like this:
- Recognising the negligence
- Implications of the breach
- Preventative Meassures
- Reflection and learning
If you keep these four points in mind, you should be able to successfully take on any scenario relating to negligence!
That concludes my guide to Medical Negligence in medical ethics. Keep in mind that this can sometimes be seen as a high-level topic that may not be tested on applicants. However, it’s still good to know just in case – plus it will be incredibly helpful to understand once you start your studies.
There are plenty more ethical topics to learn about, so be sure to explore the rest of our Medical Ethics Guides. If you’re looking for more in-depth support with your interviews, our Interview Tutoring Bundles offer everything you need to effectively prepare, all underscored by one-to-one support from an expert medicine tutor. Discover our bundles today or book a free consultation to speak with our team.
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