Immediately the scenario made the students feel uncomfortable – the idea that financial gain was more important than patient welfare was alien and immoral. They felt a responsibility to act and protect the patient but felt limited by their junior role within the team. The power of good communication was discussed – to involve both the patient and consultant in detailed conversations about their care. Many students felt that, although moral obligation would urge them to respond, the fear of creating bad team relations would limit them. The balance between the principles of consent, patient safety and teamwork had been featured in the discussion.
We discussed the principle of informed consent, a point that many students raised. It was decided that this procedure was not appropriate under the principles of informed consent. The patient must fully understand the risks and benefits and have a realistic view of the outcome.
As the scenario developed students felt increasingly uneasy about the situation. They described feelings of powerlessness and guilt that they were unable to do anything for the patient. One student suggested that this experience could influence your behaviour as a doctor with continual progression throughout your career. It may make yourself more approachable to juniors and open to challenges.
We questioned who you could turn to in this situation, in the UK we feel reassured by the governing presence of the GMC but would feel isolated and have a lack of knowledge in a foreign setting. We debated with the idea whether this scenario would put you off going to America to experience such a health system – most students decided it wouldn’t. Ignoring a problem does not mean it is not there. It would be the wrong attitude to take towards an experience which may otherwise be very educational. We also explored how elements of this scenario could be experienced in the UK – staff hierarchy, poor communication with patient and unapproachable seniors.
Overall the discussion showed the importance of good doctor-patient communication regardless of where you are and reminded students of how health care around the world can be different.