Disclosing Mistakes

SJT Textbook: Disclosing Mistakes

Disclosing Mistakes MSRA

This guide covers the high-stakes topic of Disclosing Mistakes MSRA scenarios. In the Professional Dilemmas paper, candidates often fear that admitting an error means failing the question. The opposite is true: hiding an error is the only way to guarantee a fail.

🎥 Video Lesson (YouTube)

🎧 Podcast Lesson (Spotify / Apple / Amazon)

🎯 THE CORE PRINCIPLE

Disclosing mistakes is the practical expression of candour: being open and honest when things go wrong, or could have gone wrong, with patients and with your organisation. It includes clear communication with the patient or family, prompt apology, and a realistic plan to investigate, support, and prevent recurrence.

In the UK, this is underpinned by the professional duty of candour (GMC/NMC guidance) and the organisational statutory duty of candour (CQC Regulation 20). As a clinician, your responsibilities are to prioritise immediate safety, share what is known without speculation or blame, explain what will happen next, and ensure the incident is reported (e.g. via LFPSE) and handled under PSIRF or local patient safety frameworks.

The SJT tests whether you resist the urge to hide, minimise, or delay, and instead act promptly: stabilise the patient, disclose, apologise, outline next steps, escalate to seniors and governance structures, and document. High-scoring options show honesty, compassion, and systems thinking; low-scoring options conceal, deflect, or falsify.

⚡ HIGH-YIELD ACTIONS (What Scores Points)

1. Check and secure immediate safety (review the patient, mitigate harm, arrange monitoring or treatment).
2. Inform an appropriate senior/consultant and nurse in charge early to share responsibility.
3. Tell the patient (or relevant representative) what has happened, using clear language, and offer a sincere apology.
4. Explain what is known so far, what is uncertain, and what the next steps and timescales will be.
5. Offer practical support (clinical, emotional, or practical) and a route for questions or follow-up.
6. Document the event, clinical findings, discussion, apology, and agreed plan contemporaneously.
7. Report the incident via local systems (e.g. LFPSE) and ensure the case is considered under PSIRF or equivalent.
8. Contribute to learning actions and ensure outcomes are fed back to the patient and team where appropriate.

Most traps delay disclosure, avoid responsibility, or undermine honesty and record integrity.

💬 MODEL PHRASES (Use These in SJT Logic)

* “We will investigate this, record it in our incident system, and share what we learn with you and the team.”
* “I have informed my consultant and the nurse in charge; you will receive a written summary and contact details for follow-up.”
* “I will document today’s events and our discussion, including the plan and who you can contact with any further questions.”

TAPER = Tell • Apologise • Plan next steps • Escalate/report • Record

Use it to remember the flow: once the patient is safe, tell and apologise, outline the plan, escalate/report, and document.

📋 QUICK FAQ

Do I have to apologise even if the investigation is not finished?
Yes. You should offer a sincere apology for the event and distress, explain what is known now, and outline the investigation process and timescales. This is not an admission of legal liability.

What about near misses where no harm occurred?
Near misses should always be reported internally for learning. Whether you discuss them with the patient depends on potential for harm and local policy, but openness is encouraged where the event may reasonably cause concern or distress.

Who is responsible for the formal duty of candour under Regulation 20?
The provider (organisation) holds the statutory duty. Clinicians must escalate notifiable incidents promptly so that organisational processes (written notification, apology, record-keeping) can be followed.

What belongs in the clinical record after an error?
A factual timeline of events, findings, immediate actions taken, people informed, the disclosure discussion (including apology and patient questions), the agreed plan, and relevant identifiers (e.g. incident report number).

Can I change notes after discovering an error?
You can make an additional, clearly dated and timed entry that explains the correction or clarification. You must never delete or alter original entries to hide an error.

📚 GMC ANCHOR POINTS

* Be open and honest when things go wrong; apologise, explain, and put matters right where possible (GMC Good medical practice).
* Follow the professional duty of candour guidance, including telling patients, providing information, and offering remedies and support.
* Maintain clear, accurate, and contemporaneous records, including documentation of errors and discussions.
* Participate in systems of quality assurance and quality improvement, including incident reporting and learning.

💡 MINI PRACTICE SCENARIO

A patient was given 50 mg of a drug instead of 5 mg due to a prescription error. They are currently stable but more drowsy than expected. The nurse informs you of the mistake; your consultant is in clinic for the next 45 minutes.

Best action: Review and monitor the patient, reverse or mitigate effects if indicated, inform the nurse in charge and on-call senior, then promptly explain to the patient what has happened, apologise, outline the plan and monitoring, document the event and discussion, and complete an incident report so it can be reviewed under local patient safety processes.
Why: This protects immediate safety, fulfils professional candour duties, escalates appropriately, and ensures accurate records and learning.

🎯 KEY TAKEAWAYS

✓ Safety first: assess and mitigate harm before anything else.
✓ Candour is time-critical: disclose and apologise promptly.
✓ Share known facts and a clear plan; do not speculate or blame.
✓ Escalate through senior clinicians and governance systems (LFPSE/PSIRF/Reg 20).
✓ Document events, decisions, discussions, and follow-up accurately and contemporaneously.

🔗 RELATED TOPICS

* → Dealing with Errors & Complaints
* → Responding to Patient Complaints
* → Duty of Candour
* → Handover & Documentation
* → Raising Concerns & Whistleblowing

📖 FULL PRACTICE QUESTIONS

Example SJT — Best of 3 (8 options; choose three)

You administer 10 units of short-acting insulin instead of the prescribed 1 unit to a patient with type 2 diabetes. The error is noticed within minutes. The patient’s capillary glucose is 9 mmol/L and they are currently well. Your registrar is in theatre for the next 30 minutes.

Options:
A. Inform the nurse in charge, commence close monitoring (observations and glucose checks), and seek urgent advice from an available senior if needed.
B. Say nothing for now because the patient is currently well; review later and decide whether to mention it.
C. Tell the patient what has happened, offer a sincere apology, explain the risk of hypoglycaemia, and outline the monitoring and treatment plan.
D. Change the drug chart to 10 units and sign it so it looks intentional.
E. Complete an incident report (e.g. LFPSE) and inform the clinical governance lead or on-call consultant.
F. Blame the nurse for “not checking properly” in front of the patient to reduce your responsibility.
G. Make a clear, timed entry in the notes describing the error, your assessment, the discussion with the patient, and the monitoring plan.
H. Wait until your registrar returns next day before doing anything, as “it will all be clearer then.”

Example SJT — Rank 5 (best → worst)

A chemotherapy dose was calculated incorrectly by 10% above the intended dose and administered. The patient remains stable but at increased risk of side effects. This has just been identified on a busy afternoon ward round.

Options:
A. Review the patient’s condition, inform the consultant and nurse in charge, disclose the error to the patient with an apology and explanation, discuss monitoring and potential side effects, document fully, and complete an incident report.
B. Review the patient but decide not to tell them yet, in case they become distressed, and wait for the next MDT meeting.
C. Send an email to pharmacy asking them to change their records and do nothing further.
D. Alter the electronic prescription retrospectively so it appears that the higher dose was intentional.
E. Ask a colleague for informal advice and, if they say “it’ll probably be fine,” drop the matter and move on.

Options:
A. Full safety, candour, escalation, documentation, and reporting.
B. Safety check, but delayed candour and lack of clear plan.
C. Minimal action, no disclosure, escalation, or learning.
D. Falsification of records; serious misconduct.
E. Minimising concern without proper governance or candour.