“Are you questioning my clinical judgement?” Suppressing parents’ concerns is a serious patient safety risk

Summary

In this blog, Lotty Tizzard, Patient Safety Learning's Content and Engagement Manager, writes about a recent experience taking her son to a local walk-in centre. She describes the negative response she received when asking questions about her son's treatment, and considers the potentially dangerous consequences of patients and parents being disempowered to fully understand and contribute to their own, or their children's, care.

Content

One hot Saturday in June, I sat with my nine-year-old at our local NHS walk-in centre. His toe was very swollen following a minor injury a few days before, and we’d been advised by a pharmacist to get it checked out. The waiting room was packed and it was a couple of hours before we were seen by the nurse.

She gestured at the bed while she sat and finished her notes from the last patient—apparently the IT system hadn’t been playing ball. When she eventually took a look at my son’s foot, she grimaced, but didn’t say much. Her bedside manner wasn’t the best, but I figured that was OK as long as my son was treated well. I was trying hard to appear cheerful and in control, as he was quite nervous by this point.

But I began to feel uneasy as the nurse prepared to make a hole in his toenail. She said nothing about what she was doing, and it looked very much like she wasn’t going to disinfect his nail before proceeding. I didn’t get the impression she wanted my thoughts on the whole process, so I subtly mentioned that his toe might be a bit on the dirty side, so probably needed a wipe down. Without speaking, she grabbed a bottle of disinfectant and did as I’d hinted.

Once it was over, he seemed to be in a lot of pain, so I asked whether she was sure it wasn’t infected. I was taken aback by her response. “Are you questioning my clinical judgement?” she demanded. Feeling I needed to justify my question, I assured her that I wasn’t and explained that he had had an infected nail before, so I just wanted to be sure. “Well, you may have experienced infections, but that doesn’t mean you know anything about this case.” I decided to shut up and just get through the rest of the appointment so we could be on our way.

Sadly, from speaking with friends, and from my own history, I know our experience wasn’t a one-off. There is an irritation that surfaces in some healthcare professionals when you ask questions as a patient or parent. For some it may be grounded in pride or insecurity. For others, it is probably just about wanting to get through the patient list as quickly as possible.

The strain that healthcare professionals are under at the moment is immense; I know that the frustrations of the poor IT system and obvious understaffing are likely to have affected the way this nurse responded to me. But there can be catastrophic consequences for patients when they and their parents, families and carers feel unable to raise concerns—or are ignored when they do.

A few weeks after our experience at the walk-in centre, I read an article by journalist Merope Mills about the tragic and avoidable death of her 13-year-old daughter Martha. Martha died because doctors repeatedly missed signs of sepsis following a bike accident that caused pancreatic trauma. A striking feature of Merope’s account is the way her concerns and questions were repeatedly dismissed or minimised by nurses and doctors. She was told on multiple occasions that she was overreacting and should defer to the doctors. The inquest into Martha’s death vindicated many of Merope’s concerns and demonstrated that a string of serious errors had been made in Martha’s care. She writes, “Something that’s obvious but doesn’t get said enough [is] our trust in doctors should have limits.”[1] But so often, parents feel that when they push these limits and ask questions, they are seen as interfering, or wanting to have too much information. 

Interactions like my son and I had with the nurse at the walk-in centre back up the idea that as patients, we have no right to ask questions. These experiences aren't just unpleasant—they have the potential to cause serious harm. For my son, nothing bad happened. But in Martha’s case, it was deadly.

We were asked to return to the walk-in centre a few days later to have the dressing removed and the toe checked. Fortunately, we had an entirely different experience with a much friendlier nurse who was happy to answer my questions and reassure my son. She actively invited us to share the smallest concern and be part of the decision-making process. She smiled. She explained what she was doing. She wished us well. The nurse in this second appointment had the opposite effect to the nurse in the first—we felt safe.

References

1 Merope Mills. ‘We had such trust, we feel such fools’: how shocking hospital mistakes led to our daughter’s death. The Guardian, 3 September 2022