Duty of candour, incident reporting and raising concerns

Why this matters on day one

You will make mistakes. What determines whether they become harm, and whether you remain trustworthy, is what you do next. Candour is a professional duty and, for notifiable incidents, a statutory one.

The sequence

1. 1Patient first. Address the clinical consequences before anything else. Tell a senior immediately — for your patient's sake and your own.
2. 2Be open with the patient. Tell them what happened, apologise, explain the likely consequences and what will be done. Promptly, in person, and in language they can use. Document the conversation.
3. 3Report it. Complete an incident report (Datix or local equivalent). This is for learning, not blame. Report near-misses too — they carry the same information at none of the cost.
4. 4Reflect properly. Not self-flagellation: what were the contributing factors, what would you do differently, what system change would prevent recurrence. Discuss in supervision.
5. 5Raising a concern about others. If patient safety is at risk, you must act. Start locally — your educational or clinical supervisor. If that fails or is inappropriate, escalate to the guardian of safe working, the freedom to speak up guardian, the medical director, and ultimately the GMC. You are protected in doing so, and you are not required to be certain.

What goes wrong

• Hoping nobody noticed.
• Apologising in a way hedged with justification.
• Not reporting because "no harm came of it".
• Reflecting only on your own feelings and not the system.
• Staying silent about an unsafe colleague or rota out of loyalty or fear.