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Battles between the unimpeachably right and the indisputably wrong can make for great stories. They tend to be simple, morally clear… and best left to Star Wars and Indiana Jones.
Life is murkier than that, and in this year’s BMA writing competition we asked you for something different. For conflicts not between right and wrong, but between different kinds of right. Or the least harmful wrong.
We asked you to write about ‘doing the right thing’ – one of those sub-university entrance exam type questions that can seem infuriatingly vague, but never fail to attract intense, revealing and deeply personal stories from doctors.
You told us of the intense efforts to save the life of a patient who had wanted nothing more than to end that life, of your moral entanglements with patients and colleagues, of why the ‘right thing’ was that you leave clinical practice altogether.
But our hero is Sarah. Not her real name, I imagine, but a real doctor, somewhere, who might just read the tribute to her and recall a very difficult day she had as a medical student.
Students need to practise their skills, right? It’s in everyone’s interest, especially the future patients they will treat. Sarah and her fellow students were given that chance to practise. Gloves on, take it in turns… but something wasn’t right.
Oxford GP and clinical lecturer in general practice Andrew Papanikitas, this year’s winner, recalled the moment that a student had the courage to challenge what an experienced doctor was telling her to do.
The judges, as always a mixture of doctors and BMA editorial staff, thought he did so with clarity, vivid detail and a keen ear for dialogue. A discomfiting tension hangs over the piece.
It ends with a rallying cry: ‘When someone does not remind us of our ideals we risk trampling them in pursuit of ambition or flight from fear.’
The two runners-up from more than 100 entries were Derbyshire GP Jo Cannon and a public health registrar who writes under the name of Lily McRae.
Dr Cannon has won the competition on two previous occasions, and came pretty close to a hat-trick with the story of a difficult moral choice around a member of staff. For Dr McRae, ‘doing the right thing’ was the agonising decision to take herself away from direct patient contact.
Highly commended were entries by west Sussex consultant in rehabilitation medicine Lloyd Bradley, London GP Niamh McLaughlin and Edinburgh clinical teaching fellow in psychiatry Jennie Higgs.
All of the entries will be published in forthcoming weeks, with specially commissioned illustrations.
The BMA writing competition has been running for almost 20 years. For many of the entrants, including some who go on to be winners, it is their first experience of writing in a new style. They have found it cathartic and stimulating, and it has often led them to write more.
Read the winning entry by Andrew Papanikitas and find out more information about the writing competition.
Neil Hallows is BMA content editor and one of the writing competition judges
I can appreciate the difficult clinical situations we face as doctors but the scenario depicted does not articulate the moral/ethical issues at play. I do not think the registrar had just plucked this teaching methodology out of a clear sky! This must have been taught to him and I vividly recall early in my surgical clinical experience a consultant surgeon demonstrated how to exam and reduce a hernia on middle aged male patient. Just as in the portrait you have decided to use, we stood around the bed side, male and female medical students, and studied the situation with intent to learn the procedure. None of us protested. Would you say we were daft? The only thing different from this portrait is that the consultant did not ask all of us to examine the patient but two. And the teaching round went on like that with each one us getting a chance to practice a procedure in turns as the clinical situation dictated. Can someone tell me that this was all wrong and idealistic or rather repent on the type of procedure . By the way, the consultant in our scenario had always drawn the curtains around the bed for privacy and dignity of the patient. Given the importance of this matter, I would like to be reassured that the absence of a drawn curtain around the participants in this case is not another of the Registrars omissions and pursuit of ideals being illustrated. How are teaching ward rounds conducted these days?
Anonymous: In the situation you describe, did the patient have mental capacity to consent to this examination, and did he consent?
If so, then that is a difference between your scenario and the scenario described above. A crucial difference.
Sorry, that second Anonymous was me. Forgot this site doesn't have my details.
Sarah Vaughan, GP, Wilts.
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As the author. I thought I'd wait a bit before weighing in. I had a number of responses, both public and private, to this piece. Some colleagues were rightly outraged, and stated how in their experience such 'atrocity' simply did not occur or if it did it was in a much less atrocious manner. Theirs is a valid but different experience. Others got in touch to say that they had been put in similar position as students: whether the patient was a person with dementia or a stranger under general anaesthetic. Saying that the world is or should be better than how it is depicted, does not change the moral issues in the depiction and medical ethics is often put to task after someone has done something wrong - i.e. its less a question of what we should do, but what should we do now? In some ways the world has changed for the better, and some of this issue has now been side-lined by people who voluntarily act as living models for intimate examination in medical teaching settings, or by altruistic and capacitous patients in clinical settings. The story focusses on the students and sets up the surgeon almost as a bit of villain, but as has been mentioned in the published correspondence his teaching methods did not rise from nowhere. The hidden curriculum is maintained by qualified doctors who suggest that the ideals are all very well for passing exams but in the 'real world' things are done differently and the main thing is not to get caught... In this scenario the surgeon (I will never know if this was the case) is someone that may well have gone to his next in-training appraisal and discussed a need to review his knowledge on the limitations of consent in medical education. By contrast with medical students, foundation year doctors, speciality trainees, and those now fully qualified do not have anywhere near the same level of education on ethics, and like much postgraduate continuing professional development this is often reactive. People seek ethics CPD, for example, following a patient unmet need or doctor educational need as above, after receiving criticism from the GMC, or when this is identified as something which will be tested in a postgraduate examination. Much more support is needed for the surgeon in this story, so that he can discuss the uncomfortable issue that arose on his teaching round in a way that allows him learn without being silenced by fear. Unfortunately, simply denying that bad things happen prevents us learning from them.
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