Achieving good medical practice: guidance for medical students

Domain 2: Patients, partnership and communication

The approach and attitude of a doctor can have a lasting impact on a patient. Treating patients with kindness, compassion and respect can profoundly shape their experience of care.

Good doctors recognise that patients are individuals with diverse needs, and don’t make assumptions about the options or outcomes a patient will prefer. They listen to patients and work in partnership with them. They do their best to make sure all patients receive good care and treatment that will support them to live as well as possible, whatever their illness or disability.

Treating patients fairly and respecting their rights

  1. All registered doctors must recognise and respect every patient’s dignity and right to privacy, and treat them fairly and with respect, whatever their life choices and beliefs.
  2. As a medical student, you'll learn how to treat patients fairly and respect their rights. Therefore you must:
    • recognise and respect a patient’s dignity
    • recognise a patient’s right to choose whether to accept your advice, and respect their right to seek a second opinion
    • treat patients fairly
    • treat information about patients as confidential
    • be clear with patients about the role you'll take in their care.
  3. You should discuss with your supervisor and check that the patient has given consent before you carry out any invasive or intimate procedure.
  4. Doctors must treat patients fairly, give priority to patients based on their clinical need and must not discriminate against them or allow personal views to affect their relationship with the patient, or the treatment they provide or arrange. They must not refuse or delay treatment because they believe that a patient’s actions or choices contributed to their condition.
  5. As a medical student, you won't be expected to make decisions about treatment options. But you mustn't let your own opinions or views affect the way you treat patients and others or the information you give them.

Making a conscientious objection

  1. Doctors may choose to opt out of providing certain types of treatment because of their personal beliefs and values, as long as this does not act as a barrier to a patient’s access to appropriate care and meet their needs. If a doctor has a conscientious objection to arranging or providing a particular procedure, they must explain this to the patient, tell them about their right to see another doctor and make sure the patient has the information to do so. Doctors must not express disapproval of the patient's lifestyle, choices or beliefs in doing this. You can find more information in the GMC's guidance Personal beliefs and medical practice.
  2. Medical schools should consider adjustment requests for cultural or religious beliefs, but they must balance these adjustments against practical considerations . For example, they may need to schedule clinical placements or assessments during certain religious festivals or at times of religious observance.
  3. As a medical student, you also have the right to hold a conscientious objection to some types of treatment and you should discuss this with your medical school. However, you must achieve the capabilities described in Outcomes for graduates.

Maintaining patient confidentiality

  1. Doctors must treat information about patients as confidential, including after a patient has died.
  2. However, confidentiality is not absolute, and appropriate information sharing is essential to the efficient provision of safe, effective care. You'll learn about this at medical school, but you need to be aware that you must never share confidential information about a patient with anyone who is not directly involved in their care without the patient's permission.
  3. Many improper disclosures are unintentional. You must not share identifiable information about a patient where you can be overheard, such as in a public place or on social media, or include it in any work or logbooks you submit. You must be clear about what confidential information a patient has agreed can be shared with friends and family before you discuss their care.
  4. You can find more information about when and how you can disclose personal information about patients - with their consent, where the law requires it and when doctors are able disclose information when it is in the public interest to do so - in the GMC's guidance, Confidentiality: good practice in handling patient information.
    As a medical student you will never be responsible for deciding whether information about a patient should be disclosed in the public interest. If you think such disclosure might be appropriate you should speak to your supervisor and discuss the issue with them.
  5. You must also follow any policies of your medical school, higher education institution or placement provider to make sure personal information is stored and disposed of securely.

How does confidentiality apply to my placements?

It's normal to want to talk about things you have seen on clinical placements with colleagues or friends. You'll see unusual medical conditions and may be put in situations where patients experience adverse outcomes. But you must never disclose patient identifiable information without a patient's consent. If you're not sure what to share if you're asked to provide information for an inquiry or logbook, you should ask for advice from your medical school or supervisor before you disclose any information.

You should also make sure you never discuss patients in a public place or on social media (see Social media dos and don’ts). Even if you don't mention a patient by name, there's a chance that someone nearby (or online, if you're on social media) might know whom you are talking about.

If you do want to talk to a colleague, friend or supervisor about what you have seen on a placement, you should only do that in a private place. And you shouldn't mention the patient by name, except to a clinician directly involved in their care.

For more information, see our guidance for registered doctors, PAs and AAs - Good medical practice, Confidentiality and Using social media as a medical professional.

For more information on consent, see our guidance Decision making and consent.

Treating patients with kindness, courtesy and respect

  1. All registered doctors must treat patients with kindness, courtesy and respect. This doesn’t mean agreeing to every request or withholding relevant information that may be upsetting or unwelcome. It means communicating sensitively and considerately, listening to patients, and trying not to make assumptions.
  2. As a medical student, you'll learn how to treat patients with kindness, courtesy and respect. Therefore you must:
    • communicate sensitively and considerately at all times
    • listen and respond to patients' views and concerns
    • try not to make assumptions
    • recognise that patients may be vulnerable
    • be alert to signs of pain or distress.

Sharing information with patients

  1. The exchange of information between doctors and patients is central to good decision making. Doctors must give patients the information they want or need in a way they can understand. They must listen to patients and encourage an open dialogue about their health, asking questions to allow them to express what matters to them, and responding honestly to their questions.
  2. As a medical student, you'll learn how to communicate effectively in a variety of clinical, simulated and non-clinical settings and it is important that you apply your learning in your interactions with patients.
  3. When communicating with patients you must:
    • be honest when you don't know something. As a student, you're not expected to know the answers to all questions a patient may have, but you are expected to listen to them and respect their views. You should do your best to find out the answers to the patient's questions yourself, or pass queries on to someone who will be able to help
    • make sure that, prior to giving information to patients, you have agreed it with your supervisor and the information is clear, accurate, up to date, and based on the best available evidence
    • take steps to meet the patient's language and communication needs and other potential barriers to effective communication (for example, pain or anxiety) so you can support them to engage in meaningful dialogue and make informed decisions about their care. You should ask for support to help you communicate effectively if necessary
    • check the patient’s understanding of the information they’ve been given, and do your best to make sure they have the time, support and resources they need to make informed decisions if they are able to. You should seek help from your supervisor if required
    • consider and respond to the needs of patients with impairments or disabilities. Not all impairments and disabilities are easy to identify so you should ask patients what support they need, and offer reasonable adjustments that are proportionate to the circumstances, seeking appropriate advice if unsure
    • treat each patient as an individual.

Supporting patients to make decisions about treatment and care

  1. While you are at medical school, you'll learn that all patients have the right to be involved in decisions about their treatment and care, and be supported to make informed decisions. You’ll also learn how to determine a patient has given consent or you have other valid authority before examining or treating patients. You'll learn that the consent process is about shared decision making between a doctor and a patient, where the doctor uses their specialist knowledge and experience to help their patient consider their options and make an informed decision.
  2. Towards the end of your studies, you may be responsible, under supervision, for explaining to a patient what will happen to them. Your supervisor should first explain to the patient how you will be supervised and emphasise that you are part of the clinical team.
  3. In some cases, you may take consent for minor procedures such as taking a blood sample or a blood pressure reading. However, you must not take written consent for any procedures, this should be obtained by the doctor or other registered healthcare professional responsible for the treatment.

You can find out more about consent in the GMC's guidance for registered doctors, Decision making and consent.

Consent - things to remember

Patients need to know that you are a student so they can make an informed decision about whether they want you to be involved in their care. Once they know you are a student, you can ask if they're happy for you to talk to them about their health, examine them or carry out a procedure.

Remember:

  • you should not carry out any procedure on a patient without their consent for that specific procedure.
  • if you have any concerns about whether a patient has given consent to you being involved in their care or undertaking any type of procedure, talk to your supervisor about your concerns.
  • you should be aware that sometimes patients might not have the mental capacity to give consent.
  • you must respect the decision of patients who do not want you to be involved in their care.

Communicating with those close to a patient

  1. Doctors must be considerate and compassionate to those close to a patient and be sensitive and responsive in giving them support and information. As a medical student, you must be polite and considerate to anyone close to the patient, such as relatives, carers and friends at all times - not just during a consultation. You should not assume that a patient will want information about their health to be shared with those close to them and should always seek consent from the patient before disclosing any information about them. More detailed guidance can be found on this in Confidentiality: good practice in handling patient information.

Caring for the whole patient

  1. Doctors must support patients in caring for themselves and empower them to improve and maintain their health. As a medical student, you must:
    • help patients to access information and support to manage their health successfully
    • support them to make decisions that improve their health and wellbeing.

Safeguarding children and adults who are at risk of harm

  1. Doctors must consider the needs and welfare of people (adults, children and young people) who may be vulnerable, and offer them help if they think their rights are being abused or denied. More detailed guidance can be found on this: Protecting children and young people and 0-18 years: guidance for all doctors.
  2. As a medical student, you must promptly speak to your supervisor if you have any concerns about a patient – or someone close to them – who may be at risk of abuse or neglect, or is being abused or neglected. See How to raise a patient safety concern for more information on how to raise a concern.

Helping in emergencies

  1. Doctors must offer help in an emergency, taking account of their own safety, competence, and the availability of other options for care.
  2. As a medical student, before helping in an emergency you should take account of your own safety. You should consider whether you are competent to act and feel able to offer assistance, or decide whether it is better to try to access help for a person in distress.

Making sure patients who pose a risk of harm to others can access appropriate care

  1. Patients must not be denied care because their condition puts others at risk. If a patient poses a risk to a doctor’s health or safety, they should take all available steps to minimise the risk before either providing treatment themself, or making alternative arrangements for the patient to access care to meet their needs.
  2. If, as a medical student, you feel that a patient poses a risk to your health and safety, you should speak to your supervisor before becoming involved in the patient’s care.

Being open if things go wrong

  1. Doctors must be open and honest with patients if things go wrong. If a patient under their care has suffered harm or distress, they should:
    • put matters right, if possible
    • apologise (apologising does not, of itself, mean that you are admitting legal liability for what’s happened)
    • explain fully and promptly what has happened and the likely short-term and long-term effects
    • report the incident in line with their organisation’s policy so it can be reviewed or investigated as appropriate – and lessons can be learnt and patients protected from harm in the future.
  2. As a medical student, you won't be directly responsible for patient care because this responsibility will lie with your supervisor. But if you think any aspect of care that you are involved in has gone wrong, you should tell your supervisor as soon as possible. Your supervisor will support you and, if necessary, will help you to put things right. This may include explaining to the patient what has happened and offering an apology. See also Responding to safety risks.
  3. During your medical course, you may witness or be involved in something going wrong with a patient's care, and you may be asked to contribute to an internal inquiry. Although your medical school will normally be told about significant events, you should contact senior staff (for example, your year director or personal tutor) at an early stage, so they can arrange support for you. This will protect patients and allow the clinical team you are working with to respond appropriately.
  4. You must contribute honestly and openly to the process. Openness and honesty are key to being a medical student and a safe and trustworthy doctor. You may hear this referred to as your professional duty of candour.

The GMC and the Nursing and Midwifery Council have produced joint guidance for nurses and doctors, Openness and honesty when things go wrong: the professional duty of candour.

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