Communication
CPSA · Communication · De-escalation
A colleague’s error, and raising a concern
Patient first, then candour, then the system. You are not required to be certain — only to act. The trap is loyalty, or a conversation that becomes about blame.
The framework
Patient first
- Address the clinical consequence before anything else. Tell a senior immediately.
Speak to the colleague
- Privately, non-accusatory, curious rather than certain — you may be missing context.
- Describe what you observed, not what you concluded about them.
Candour to the patient
- The patient must be told what happened, apologised to, and told what will be done — by the appropriate person, promptly.
The system
- Incident report. If it is a pattern, or the colleague may be unwell or impaired, escalate to the educational or clinical supervisor.
- If patient safety remains at risk and local escalation fails: freedom to speak up guardian, medical director, ultimately the GMC.
Phrases that work
- “I wanted to check something with you — I noticed the dose on Mr Patel’s chart was ten times what I expected. Have I misread it?”
- “I am not trying to catch anyone out. I am worried about the patient.”
- “I am going to have to let the registrar know, and I would rather we did that together.”
- “I am sorry — this should not have happened, and I want to explain what we are going to do about it.”
Pitfalls that lose marks
- Saying nothing out of loyalty or fear.
- Confronting publicly, or in front of the patient.
- Concluding intent — “you were careless” — rather than describing the observation.
- Reporting and not telling the patient, or telling the patient and not reporting.
- Believing you must be certain before acting. You must not be.