Medical Council logoComhairle na nDochtúirí Leighis | Medical Council

Case Studies

Training to become a doctor, you will give much thought to the importance of the ethics associated with practice. Below are two ethical dilemmas to get you thinking about the high standards of ethical behaviour expected of doctors.

Social Media

Sinead is a first year Medical Student. In her first term, she spends a week on Inis Mór with a GP as part of an “early patient contact” programme run by the University.

Sinead finds the week exciting and it confirms for her that a career as a doctor is the right choice for her. On the final day, she accompanies the GP to a home visit. When they arrive, they are called to a neighbouring house where a pregnant woman, Eibhlín, also a patient of the GP, has gone into labour.

It is a little earlier than expected. This is the Eibhlin’s 4th pregnancy and when they arrive the delivery is progressing quickly and smoothly, with the assistance of a neighbour who is a public health nurse. A healthy baby girl is born to everyone’s delight.

Sinead takes a picture of the mother and baby with her phone and the mother agrees that she can use this picture in a report she has to write based on her “early patient contact” week. Brimming with enthusiasm for her experience, Sinead posts the picture to a social media site that week with a message “Congratulations Eibhlín and family – what a privilege to attend the arrival of your new baby girl”.

Eibhlín learns about this second hand and makes a complaint to the Medical School.

(Before reading further, take a moment to reflect on the scenario presented above, and the issues which you think this scenario raises)

Sinead’s actions were in no way malicious and were not intended to cause harm.

However, she was not acting with the patient’s best interests in mind, and her actions represent a clear breach of trust and patient confidentiality.

Medical students must be aware from their first day in medical school that they have chosen to pursue a profession which can have a huge impact on patients’ health and wellbeing; it therefore demands the highest professional standards.

From the outset, the core principles of consent and confidentiality will be a constant factor in every doctor’s career, and these principles should have been at the forefront of Sinead’s thoughts when considering whether to post the picture of Eibhlín and her child to a social media site.

Students must err on the side of caution if they are unclear about any aspects of their medical schools policies, or are uncertain about their medical school’s (and the Medical Council’s) expectations of students.

If in doubt, students must seek the advice of their supervisors whose role it is to teach and reinforce best medical practice. Sinead will no doubt learn from this incident, and she will be motivated to ensure that professionalism and best practice remain at the core of her development as a doctor.

Health problems

Faizal and Tek are fourth year Medical Students. They are Malaysian and are studying in Ireland through a government programme. Three mornings a week, the students have lectures in the teaching facility at the University Hospital.

The University operates a sign-in policy and there are attendance requirements to complete the year. A fire drill is conducted one morning and the students congregate at the assigned safety area. The lecturer uses the sign-in sheet to confirm everyone has been safely evacuated.

Tek’s attendance is confirmed but Faizal cannot be located. On closer inspection, the lecturer notes similarity in penmanship used to sign both Tek and Faizal’s name. She looks back over previous sheets and notes this is a recurring pattern.

She challenges Tek on this point after class and he explains that Faizal has not been well for a number of week: Faizal’s mood is low, his sleep disturbed, he has lost interest in his studies and can’t see the point in continuing.

Tek explained that this happened in first year too and Faizal recovered after a couple of months, though needed to repeat some exams. Tek admits his error but explains that it would cause Faizal and his family much embarrassment if Faizal had to leave the course.

(Before reading further, take a moment to reflect on the scenario presented above, and the issues which you think this scenario raises)

In the above scenario, there are a number of factors to be considered. In the first instance, Tek should not have played any role in falsifying his colleague’s attendance record, or misleading the University in any way.

Tek could have advised Faizal to seek pastoral, and possibly clinical, support through the University which has support structures in place. Doctors are obliged to raise concerns regarding the conduct or wellbeing of colleagues and fellow students at the earliest opportunity, and with patient safety as the over-riding priority.

The falsification of the attendance record, which may have been done with misguided good intentions, still amounted to falsification of official University training documents.

Falsification of documentation is a serious transgression of a doctor’s responsibilities, and could have serious personal, professional and patient safety implications.

Faizal had a responsibility to manage his own health by seeking support at the earliest opportunity from the University to ensure he received whatever assistance was required.

Doctors and students may sometimes be reluctant to confront or recognise their own limitations, or be reluctant to seek help, but it must be remembered that support is always available, and that their duty as doctors or future doctors must outweigh any personal reservations.