SJT Textbook: Openness and Honesty When Things Go Wrong (Duty of Candour)
Duty of Candour GMC Guidance
This duty of candour GMC guidance explains how doctors must be open, apologise promptly, report incidents, and support patients whenever harm or distress occurs.
🎥 Video Lesson (YouTube)
🎧 Podcast Lesson (Spotify / Apple / Amazon)
🎯 THE CORE PRINCIPLE
The professional duty of candour requires doctors to be open and honest with patients when treatment or care has caused harm or distress. This includes giving a timely, truthful explanation, offering a genuine apology, and providing appropriate support and remedy. Apologising is a professional duty and does not imply legal liability.
Candour also applies to openness with colleagues, employers, organisations, and regulators. Creating a learning culture through early reporting of incidents and near misses is essential to improving patient safety. Senior doctors and managers carry additional responsibility for fostering an environment where staff feel safe to speak up.
In MSRA SJT questions, high-scoring answers show early disclosure, sincere apology, clear explanation, reporting via formal systems, and learning-focused follow-up.
Duty of candour GMC applies to all doctors regardless of seniority.
⚡ HIGH-YIELD ACTIONS (What Scores Points)
1. Inform the patient promptly when harm or distress has occurred.
2. Give a clear, factual explanation of what is known at the time.
3. Offer a genuine apology without delay.
4. Explain the next steps, including investigations and support.
5. Report the incident using local governance systems.
6. Record the discussion and actions accurately in the notes.
7. Report relevant drug or device incidents to the appropriate authority.
8. Encourage a learning-focused response, not blame.
9. Be open with colleagues and seniors about what happened.
10. Follow up with the patient as more information becomes available.
MSRA SJT frequently tests breaches of duty of candour GMC principles.
• Blaming others to avoid responsibility
• Failing to apologise
• Altering or falsifying records
• Discouraging reporting of incidents
• Treating near misses as irrelevant
These traps prioritise self-protection and avoidance over honesty and patient trust.
Duty of candour GMC requires disclosure after both harm and near misses.
💬 MODEL PHRASES (Use These in SJT Logic)
* “I will explain what we know so far.”
* “We will investigate fully and keep you updated.”
* “I will report this incident through our safety systems.”
* “Your care and support are our priority.”
Apology is a core part of duty of candour GMC and is not legal liability.
O – Open immediately
P – Provide facts
E – Express apology
N – Next steps explained
C – Clinical support
A – Accurate documentation
R – Report and review
Failure to follow duty of candour GMC guidance undermines patient trust and safety.
📋 QUICK FAQ
Must I apologise even if the outcome was unintended?
Yes. An apology is required whenever harm or distress has occurred. Does apologising mean I accept legal blame?
No. An apology is not an admission of liability. Should near misses be disclosed?
Yes. Near misses should be discussed and reported. Who has a duty of candour?
All healthcare professionals, and also health and care organisations under statutory duty. Should I wait for a complete investigation before speaking to the patient?
No. Initial disclosure must be prompt, with updates as more information emerges.
📚 GMC ANCHOR POINTS
• Being open and honest – Duty of Candour Guidance
• Apology and explanation – Good Medical Practice
• Reporting incidents – Patient Safety Guidance
• Learning culture – Leadership and Management Guidance
• Organisational candour – Statutory Duty of Candour Regulations
💡 MINI PRACTICE SCENARIO
A patient receives the wrong dose of medication and is briefly hypotensive but recovers. Best action: Inform the patient promptly, apologise, explain what happened, and report the incident. Why: Harm occurred and the duty of candour requires immediate openness and reporting.
🎯 KEY TAKEAWAYS
✓ Be honest when things go wrong
✓ Apologise promptly
✓ Explain clearly
✓ Report all incidents and near misses
✓ Support the patient
✓ Document accurately
✓ Promote learning, not blame
🔗 RELATED TOPICS
* → Raising and Acting on Concerns
* → Leadership and Management
* → Decision Making and Consent
* → Confidentiality
* → Professional Integrity
📖 FULL PRACTICE QUESTIONS
Example SJT — Best of 3 (8 options; choose three)
A patient is given an incorrect dose of insulin causing mild hypoglycaemia.
Options:
A. Inform the patient about the error
B. Apologise sincerely
C. Wait for a complaint before disclosing
D. Document the incident in the notes
E. Avoid reporting to protect the team
F. Submit an incident report
G. Blame a colleague
H. Say nothing because harm was mild
Correct three: A, B, F
• A: Prompt disclosure is required.
• B: Apology is mandatory.
• F: Reporting supports learning.
Why others are weaker/wrong:
• C/E/H: Breach candour and learning duties.
• G: Undermines professionalism.
• D: Important but not one of the primary three.
Example SJT — Rank 5 (best → worst)
A patient deteriorates after a delayed diagnosis.
Options:
A. Be honest, apologise, and explain
B. Report the incident for investigation
C. Inform senior colleagues
D. Wait to see if the patient notices
E. Alter the notes to reduce fallout
Ideal order: A (1) > C (2) > B (3) > D (4) > E (5)
• A/C/B: Open, safe, and accountable.
• D: Avoidant and unsafe.
• E: Dishonest and serious misconduct.