Cases that Changed Me - Defence against The Dark Arts (3 Nov 2025)

This transcript has not been edited for accuracy.

Transcripts are available on popular podcast platforms.

Welcome to the Royal College of Physicians of Edinburgh Clinical Conversations podcast. Each episode within this podcast series, we delve into a different medical topic with an expert speaker to join us. If you want to find more about the Royal College, then please do head over to the RCPE website and have a look at the education stream and see if membership would work for you. It offers a host of educational updates and activities such as the evening medical update, the Royal College symposia and many more. Please don't forget if you listen to our podcast to give us a rating on one of the podcast platforms or subscribe so that it can come directly into your podcast stream.

Dr Kat Ralston (KR): Hi and welcome to this episode of Clinical Conversations, brought to you by the Royal College of Physicians of Edinburgh Trainee and Members Committee. My name is Kat Ralston. I'm a member of the T&MC and the Geriatric Medicine Registrar in Edinburgh. This episode is part of our mini-series Cases That Changed Me. I think we've all got cases in our past that have stayed with us, and the way that we reflect and learn from these cases, I think, are really essential to how we develop as healthcare professionals. So, in this series, we'll have the privilege of hearing from experienced consultants about how they've navigated pivotal moments in their working lives that have gone on to shape their practice. Today, I'm really delighted to be joined by Doctor Jane Rimer, a consultant physician and geriatrician in NHS Lothian and the associate postgraduate dean for medical training in Southeast Scotland. Welcome, Jane.

Dr Jane Rimer (JR): Thank you very much. It's a pleasure to be here.

KR: So, I have no idea what you're going to talk about, and I'm very interested to hear your case. So, I think we should just get into it.

JR: Absolutely. So, it's always difficult isn't it, when faced with these kind of open-ended questions, to pick just one case that you've been involved with over the years? I've been a consultant for over ten years now, so it was a little bit challenging, perhaps drawing on one thing. However, after much consideration, I think I repeatedly kept coming back to the same clinical case that I'd been involved in, which happened just shortly after I qualified as a consultant, actually. So fairly early on in my training and my sort of clinical involvement was fairly minimal. However, the repercussions that happened after that lasted several years, so I thought that might be a good case for us to talk about today.

KR: Sounds great.

JR: So just to give you a little bit of background. So it was, as I said, shortly after I qualified as a consultant and I was on call for medical receiving and the hospital that I work in, it's all very general take, and this is a patient who presented fairly early on in the day and had initially presented to primary care, and they got referred up to hospital, presented with breathlessness. And at that stage there was no formal diagnosis of any background respiratory disease. However, he presented fairly unwell with tachypnoea and hypoxia. So, when he presented to the front door, he was started on fairly broad treatment and responded pretty well, to the point where he stabilized and was referred up to medicine and came up to medicine several hours later. So, at that stage, I saw this patient and at that stage responded to treatment, as I said, holding their own, and so made a plan for ongoing management. So later on, that day, unfortunately, they had an acute and fairly catastrophic clinical deterioration, was very promptly seen by most medical and critical care teams. And unfortunately, after this initial management carried on deteriorating and subsequently had a cardiac arrest and died probably within about a half an hour of that deterioration. So, I think for the time that this patient was in hospital from start to finish was probably less than seven hours but had a very quick clinical deterioration. And the sequelae that followed on after that was what I thought might be interesting to talk about today.

KR: So, okay, that sounds like already a really tough case. And I think someone's been in seven hours. You're one of the people that have seen them as a new consultant. And I guess before we get into what happened next story. Yeah. In the moment. How did that feel? How did you deal with that?

JR: Well, it's interesting looking back because at the time you do what you can to compartmentalize how you're feeling as an initial emotional response, and you had to get on with managing the clinical take. And, you know, at that stage, I think we were less aware of the importance of debrief, both in the acute setting, but also a more colder debrief that, well, maybe get on to later on. But I think at the time there was a brief sort of clinical discussion about the people who'd been involved, and we were just trying to manage the situation as best you can, and then you compartmentalize it and then get on with medical receiving, which is interesting, looking back on it, because you're not quite sure how you're going to manage these things when faced with that situation. And certainly, that was the first time that I'd ever had to be involved in something like that that had gone so catastrophically and quickly wrong and yet carry on with managing the medical team as it was at the time.

KR: Yeah. I think often you find these things hit you. Then when you're in bed at night after or the next day when you've had a bit of brain space. So, tell us.

JR: So, what happened then? So quite appropriately, he was referred to the Procurator Fiscal and with all the information that was available then cause of death was issued as acute asthma by infective trigger. And so very distressing, I think, for everybody involved, not least obviously the immediate family, but also for all the clinicians who were involved. And I think the next steps really were to look into the series of events that happened and led up to his presentation and management, and quite rightly so. So, I think the first thing that happened following this was a complaint, which happened relatively quickly and resulted in meetings with the relevant parties who'd been involved to explore what happened in a bit more detail at the same time. Alongside that, there was a significant adverse event review happening and as part of that process gave everybody involved the opportunity to lick and reflect on their involvement at that stage. And I think as a relatively new consultant, that's not really a process that I'd had much direct knowledge of. I think during training you get exposure occasionally ad hoc to these things, but you're relatively protected, I think, from it until you become certainly either more senior trainee or a consultant nominally responsible for care. And so, for me, that's probably the first time that I'd ever had to be directly involved in something like that. And I think the whole process of that, quite rightly, you look back at your own involvement and thank goodness, what happened. Could I have done anything different? And the process of that, I think, always feels quite personal and quite individual. Everybody's very, I think, supportive throughout that process of being keen not to apportion blame, but to look at the series of events and see if there are any lessons learned. And I think going forward, that was something that helped me to look at and understand what might have happened and what we could do differently to prevent anything like this happening again.

KR: So obviously, this was a case at the time that you just had to get on and deal with the rest of the take after it happened. But then you're going through this process of reflection, looking through things with a fine-tooth comb, looking at yourself, which, as you say, feels pretty vulnerable, I would imagine, particularly as a new consultant. How did you sort of navigate that?

JR: I think most clinicians carry with them a strong sense of responsibility for any involvement in any patient care. And I think when something does go wrong, our natural instinct is to look and think, goodness, what did I do? What could have happened? Could I have done anything to improve this, prevent this? And I think probably one of the first things that I learned from this was that you are in no way objective about your own involvement, and that is where you have to think about your sources of support in this kind of case. So, I'm lucky to work in a place where I've got fantastic colleagues round about me, and I've also got very good informal support outwith of work. And I think talking it through with people who were not directly involved, but who understood the pressures of medical receiving, for example, who understood the pressures of being a consultant at any stage was probably one of the most helpful things I could have done right at the start, and helped me to perhaps compartmentalize it a little bit to look at what was my involvement. How can I help myself to understand what happened, and also to not let it necessarily affect how I approach being in that situation in future and having to manage the acuity of the medical team and all the multiple demands that go with that. So, I think, yes, talking to colleagues is probably one of the first things that I did. But crucially, also people whose opinions I respected. And I think that's one of the take home messages from this that I would say is don't keep it to yourself. The temptation, I think, is to become quite introspective and not to draw on the sources of support that are available to you, both informally, but also formally. And that's maybe one of the areas that I felt was less available to me at the time that I think now we're perhaps more aware of the need for more formal mentoring when anybody's having to undergo any of these kind of events.

KR: Yeah, I'd like to pick up on the sort of formal support options. Been a little bit. I just wanted to come back to that thought about you can't be objective, and that that process of reflection you went through with colleagues seemed really important. And I think it's a really good point about someone whose opinion you respect, because I think it can be tempting to gravitate, perhaps either towards being very self-critical or to gravitate towards maybe someone who's going to tell you there's nothing you could have done, you know, this could happen to anyone, and that might be the case. But I think the hardest times when this happens is when you haven't done something that could have been better, or you have made a mistake, and that will happen to everyone. You know, we are not machines. We're humans. And there'll be times when we make mistakes. And I've certainly had times when I've made mistakes. So, what I find interesting is how do you deal with that kind of honest conversation with someone you respect. And then how do you navigate knowing the fact that you've done something or haven't done something that led to something going wrong?

JR: Yeah, indeed. And, you know, reflective practice is such a key and critical part of our development as a doctor. And that's one of the privileges, I guess, of working within medicine is that you're constantly being challenged, you're constantly having things thrown at you. You're constantly outwith your comfort zone and having that ability to reflect and look at what may have gone well or may have not gone so well and learn from that is one of the key aspects, I think, of being a doctor and also being a healthcare professional, really, and helping to look after your patients to the best of your ability.

KR: Yeah, I think these are the things that we learn most from. You know, it's not the times when everything went brilliantly. It's these ones. But it can be hard to navigate in the moment. So, I think that that trusted colleague that people who are going to tell you honestly but kindly, supportively what their opinion is, is really important. So, you talked a little bit about, you know, you had a lot of supportive colleagues. You were working somewhere, which was helpful for you to work through this process of reflection. But some people might not be so lucky. And you talked a little bit about sort of formal support options that you maybe weren't so aware of at the time. Can you expand on that?

JR: So, I work in training circles, and I think there's an increasing awareness of the need for training and support in the non-clinical aspects, as much as the clinical aspects of being a consultant. I think some of the developments that have happened, I've seen change over the last few years is thinking about a more sort of formal mentorship scheme. I know there is, for example, for newly appointed consultants. It always strikes me slightly ironic that during training you could have very close clinical and educational supervisor support network, but actually when you become a consultant, you have less of that formal arrangement. But I think there's an increasing recognition of that. And I think perhaps if you don't have access to that in your immediate work, vicinity is thinking about whose opinions have you trusted over the years? You know, if you're ever faced with a situation in the future, who could you turn to? And these are the really crucial relationships that I think you develop naturally as you progress through training. I think as well, there's other formal aspects of support that will maybe touch on going forward because the case didn't end there. So, for example, there came a point where I had to contact my medical defence union, and I think some of the support that I had via that was actually very helpful.

KR: Well, maybe that's a good point to think about what then happened next.

JR: Absolutely. So, after the SAE review had happened and the findings were presented and shared more widely, which was a really important step, I think as well. Things all went quiet for a while, and then a few years after there was a case being picked for legal action and I, as one of the clinicians involved, was asked to provide a statement. And I think at that stage that's not really ever something that I had come across, particularly before. And I think, you know, it really immediately strikes fear into any clinician as to a sort of fine line of navigating the medical legal aspects of looking after patient care. And so, at that stage, I was asked to draw up a statement. So that's when I contacted my defence union for a bit of advice about how to go approaching that. And I think thinking about the more formal aspects of support, the person who I spoke to there was actually very helpful in giving me both general guidance, but also more of an understanding of what the process might be, because I think at that stage, trying to navigate that with no real knowledge of how things might progress was perhaps one of the most daunting things at that stage. So, I, you know, had to effectively revisit, obviously, the clinical case and what happened at the time. And I think one of the overriding things for me at that stage is that it felt, again, very isolating and very accusatory, and that's because of the process that was happening behind the scenes. It wasn't against any one individual, but really there was a forensic examination of the case again. and things then unfolded from there.

KR: That sounds really difficult.

JR: Yes, it was.

KR: I guess it can feel a bit different. You know, the SAER and things. All of that is about collective learning. You know, it's almost never one person that's made a mistake, that's led someone to come to harm. It's almost always a systems problem, multifactorial. But this I imagine, felt very much like on you.

JR: And again, it's coming back to you. You are in no way objective about your involvement. And I think one of my reflections looking back on it, even at this stage, was that the communication was sporadic at best, and you have no knowledge of what was happening behind the scenes. And probably quite rightly, you're kept separate to what is actually going on from a legal perspective. But sometimes that lack of knowledge of what's happening can be almost as distressing as the process itself. So, what happened to that is you came up with a statement and met with the legal teams, and then things went quiet again. Again for a few years, actually. And then it all resurfaced Surface to the point where things were potentially going to result in a court case. So again, you know, we're at the stage where six or seven years after the index clinical case and that longevity of time span was difficult to have this sort of intermittent but very intense interaction with whilst you're trying to maintain a clinical day job.

KR: Yeah, I feel like it must have felt sort of hanging over you. And it's such a long process,

JR: Indeed, a long process. And you're not in discussion with any of the other clinical teams that were involved at the time, for example, because it's a long time ago and therefore that sort of understanding of how everybody else is feeling, for example, what's being asked of other people is non-existent.

KR: Yeah, absolutely. I was talking to someone else about something interface between doctors and legal aspect, and they were saying the legal system almost feels like an institution, like the NHS feels like an institution to patients, that there's all these unwritten rules and relationships and, you know, things that you have no idea about. And you're trying to enter this world feeling very disempowered. Empowered.

JR: Yes, indeed. And so, one of the things I tried to do at the time was to again, talk to people who had more knowledge of the system than I did. So certainly, the MDS were very supportive and helpful, and I had the same person who I contacted a couple of years beforehand, so that continuity was helpful. And also, some of my colleagues at work who had knowledge of what happened before. One of whom had some knowledge of providing expert opinions, for example, for courts. So, trying to get a bit of an understanding of what might be asked of me was definitely helpful in terms of thinking of how to prepare. So, this went on again for some time and ultimately was settled without us having to go to court. So that was the conclusion. And I think all in all, that was what, seven years from start to finish, which was protracted more than I could anticipate it would be from the start.

KR: Yes. I think we're not used to that. And to have that sort of, like I say, hanging over you for all that time and all these sort of intense interactions that all feel, I imagine, very stressful.

JR: Yeah, but really important learning for everybody involved, and has made me reflect on several different aspects of it and how we could improve on things going forward. And I think certainly for me being involved in training, I think it's a really important area that's not really focused on so much in our current clinical curricula, for example, and it's hard to have an understanding of knowledge of it until you actually have to deal with it yourself. But talking to colleagues who you've had exposure to; it was one of the things that really helped me in thinking about how I would approach it as a clinician. And ultimately, we're all responsible for our own actions, and it's important that there is that accountability, but also having the tools of knowing how you would interact and manage the situations, you'd be faced with it. Or I think a very important aspect of every doctor's development and training.

KR: What advice would you have for yourself at the start of that process, looking back? So, looking back?

JR: Well, it was in a time of very different documentation, for example. So, we were on paper notes at the time rather than everything being computerised. So, I think a very basic thing was to make sure you have a physical copy of all of the documentation that was relevant. So, I obtained a photocopy of all the notes. So, I had that to hand and could repeatedly refer back to it when I was asked for statements, you know, several years later, for example. And the same with things like email communication, it can be hard sometimes to know who are all the players involved. So, who's who within the systems, who's asking you for x, y, z. So, to have a very organized system of all communication that you've had and kept it somewhere that doesn't rely on emails changing, for example, I think we migrated from one email system to the other during that time. So, you need to make sure that you've got copies kept. So that's one very practical thing that you can do. I think as well, I think we have a tendency as doctors to be quite hard on ourselves. And I think, as I've mentioned already, one of the things for me is to have communication and advice from people that you trust, and whose opinions are more objective than your own, and that was helpful to come back to even several years after it happened as well. So, they've got an understanding of how you felt at the time and how things are progressing and can help to guide you in that. Sometimes, you know, as a consultant expected to have all the answers, and I was definitely not the case. And I probably ask more questions now than you ever have when you're in training, for example. So, I think, as I've illustrated, the non-clinical aspects of being a consultant are the things that I think probably are the most stressful to people who are starting out in that journey. And that's probably the thing that you can help your colleagues with most in a more sort of, you know, mentorship type role.

KR: Yes, as the more senior you get, I think the more you realise that if facades of knowing everything is just a fallacy and is actually not safe. So, I think being role modelling, being able to be vulnerable like we're doing now and ask questions and things is really important and that's part of the reason for this series. So, thanks for bringing that up. I'm going to go back to a couple of clinical things. Ish first and then go back to the wider impact. You mentioned documentation, and I just wondered whether this has changed your views on how things are documented when we're thinking about complaints, SAERS, when things go wrong. Because as I'm sort of acting up about to be a consultant, it's difficult to let go of a bit of documentation, isn't it? And I think when you go back, I also went through a case which went through an SAE and a police statement, and I was really reliant on the clinical notes that were made, and luckily, they were absolutely excellent. And I just wondered what you think about that, you know, where's the balance of making sure documentation is enough?

JR: Yeah, absolutely. And I think you hit the nail on the head there when you said the word balance. I have often tried to quantify, for example, how you approach documentation in a busy medical receiving post round versus how you manage it. If you're in a downstream ward, you've got more time, for example. And I think at one point I made a calculation that if you have a thirty patient taken a few hours to see it works out at something like four minutes per patient. And how you use your time, and how you can make the most valued use of your time. And one of the things I find helpful is who you're doing your post-take round with is making sure that they've got an understanding of the time pressure that you're under, but also the need to make sure that documentation is as accurate as possible. I've gone to various different models of trying to work out, and it's perhaps not a one size fits all. And I think some of it depends on the context of where you are and the time in which you are working. And one of the hardest things in medicine these days is the continuity of the team. And you might, for example, be on a medical receiving shift with people you've never met or seen, or you don't know competence, you don't know. And it's trying to think about systems that are robust enough to withstand all these variables. So, for me, the way that I work is I know that I work better if I've got a little bit of pre-knowledge of what I'm coming into. So, if I'm coming into, you know, having to see thirty patients in four hours, for example. I will make sure that I'm more prepared. So, our current systems have set up with computerised records, make it easier, and that I can have a brief look and see what I'm coming into and prioritize effectively. I think inevitably if you've got somebody who is complex or sick, then you're going to spend more time on making sure that all the ducks are in a row before you start. Sometimes when I know, for example, there's less staff around, as is sometimes the case, I'll sometimes do some of the documentation myself. You know, put bullet points, for example, and then work backwards from there. So, I know the basics are there. I certainly have developed systems over the years. I approach medical receiving to make sure that the basics are done and the basics are done consistently. And by that, I mean making sure that the history and examination is robust from the outset, making sure that I've seen the baseline investigations, Bloods, ECG, chest x ray and that system for me has stood me in good stead. How that is documented at the time. Sometimes you just don't have time to make sure it's fully documented, but therefore you need to make sure that you go back and make sure that is in place and that is consistently in place. So, in answer to your question is I think it's a tough aspect, medical receiving. And I think the systems that are developed for me will not necessarily work for you, but I think if you have a robust way of making sure that all the basics are covered and covered consistently well, and you've got a way of approaching the documentation that is adaptable according to the team and environment that you find yourself in, then I think that's a good starting point.

KR: Yeah, I think you just need to find your way, don't you? I think at the minute, and this will probably change. I like to either write or dictate an impression and check the plan as like two key things. But and there's so much to think about I think, and as you say like four or five minutes a patient, it's really short time. So, there is a balance there. But it's how do you get that balance so that you feel okay at the time and you feel you're going to be protected? Say that a complaint comes up a month down the line. And the other sort of clinical aspect I wanted to pick up on was when something like this happens, we can often find that we're paranoid about this thing for the next while, right? So, if you've missed a PE, you want a CCPA. Every single patient that you see. So, does that resonate? Is that something that you were thinking about? How do we navigate that side of it?

JR: So yes, I think undoubtedly all clinicians are coloured by their experiences. A lot of medicine is pattern recognition. I think before you even become a consultant, I think our training systems are set up to try and ensure that we are clinically competent to do the job, and that you have seen enough from an experienced perspective to be confident with your own clinical skills. I think an experience like this, however, does knock your confidence, and I think it took a while for that to come back. You, however, do have background, clinical experience and knowledge. I think to fall back on those systems are hopefully robust enough to enable you to carry on and do the job without being paralyzed by your experiences, for example, and something like this that happens. But yes, I think inevitably it does have an impact. The key is ensuring that it doesn't necessarily alter too much of how you approach things going forward. And it took a while, I think, for me not to focus on this, you know, sort of catastrophizing, for example, what might happen when you recall. But you are a professional, you are trained to do the job. And I think sometimes an experience like this can make you a better clinician.

KR: I don't know whether you're able to say any of this because the case is obviously anonymized, but was there learning points from the case that you think you've taken clinically?

JR: Yeah, I think without necessarily going into too much detail here, I think we all hear about asthma, for example, as having the potential to deteriorate rapidly, having the potential to have a sort of biphasic presentation. But I think until you've seen things yourself change as quickly as they did on this occasion, it's hard to sometimes appreciate the rapidity of how things can change. And I think for me, certainly this sort of catastrophic deterioration and the speed of that was fairly shocking for all the clinical teams who were involved. And I think being able to look at things more objectively from the outside, I think overall the treatment was initiated in the right times. It's just that things progressed so quickly that it resulted in the outcome that it did. But I think looking back on it, there was various different teams involved and involved promptly. And I think, you know, the learning for, for everybody involved was just how quickly things can change.

KR: Okay. So, stepping back a little bit, I'm absolutely sure that you have provided support for other people who've gone through similar things. So, I just wondered what advice you'd have for a supervisor or a mentor or a colleague trying to support their colleagues or mentees.

JR: I think a lot of it depends on the context in which they're in. Regardless of that, though, I think probably the most important thing is somebody whose opinion you trust and the kind of relationship that you've got with people, for example. So, you've got a trusted supervisor from one bloke who then, you know, something happens in a few years later, it's not your supervisor anymore, but you still trust their opinion. Then I think all of us would be absolutely delighted to help, try and support colleague or resident doctor who was going through something like this to try and help support them. I think, as you mentioned early on, a lot of these processes, for example, complaints, processes, legal processes, they're quite infrequent really, and I think unless you've come into contact with them, it's hard to navigate. And so, each scenario is so individualised. And that's a lot of it has to be taken in the context in which it is happening. However, the sort of general advice and support certainly that I received in terms of understanding the systems, of understanding my role within that were invaluable to me at the time, and I hope that I'd be able to provide that for other people if they're faced with this going forward.

KR: And you mentioned that there's really no focus on this in the current curriculum and having gone through it three in the morning, someone demanding a police statement from me and not really knowing what. As a medical trainee, I'm sure an A&E doctor would know in and out what their requirements and rights were. At that point I felt very unclear. So that felt like a real gap in my training. And I actually called my defence union at three in the morning to ask for advice in this situation I was in. So, I wondered, you've obviously got training role. Do you think there's a role for things like this within medical training? What do you think that would look like, if so?

JR: I think some of the changes to the curriculum, for example with the generic sets, perhaps do touch on some of this. And there are obviously leadership management, non-clinical training courses available. And I think we'll see an increasing emphasis on this going forward. I know, for example, the defence unions do run webinars, workshops, those kind of things that I hadn't really clocked much before but actually have since. And I think those kind of events are very helpful. I think there is an increasing recognition, however, for the need to support training in these non-clinical aspects, particularly as people progress towards more senior stages of training and transition into consultant life. But in many ways, until you've had to deal with one yourself, you don't necessarily engage with it quite as robustly as you might have done. So I think involving people in the complaints process, if there's a connection or indeed if they're in a clinical attachment and it's just happening in the background and being transparent about it, I think is a change that I've seen recently and I think is a positive change, and hoping to help people feel that it's not a personal scrutiny, if you like, even though the whole process does feel like that.

KR: I think that's really hard, though, isn't it? Because I think, like you say, I think that medics gravitate towards being hard on themselves and everything feels very personal. So, if you think that something's gone wrong or you've done something wrong, it's hard not to kind of berate yourself in the middle of the night. And catastrophize like you've mentioned in this case, any sort of practical tips on how you can try and make it feel more objective? I think we've talked about some of this already.

JR: I think when you get the email, for example, saying there's been a complaint and immediately your visceral response is your heart rate goes up, you think, goodness, what's happened? And then that is natural. That is human nature. And I think all of us as responsible clinicians probably are not going to get away from that. But I think then having the opportunity to review things and then perhaps review it with colleague, for example, what I will often do is just read two things park it for a little bit of time, let that immediate emotional response settle down, and then come back to it and think, well, okay, what is it that happened? What are the questions that they're asking? And at the end of the day, you know, we're all here to serve the patients as best we can. We're all here to be as good clinicians as we can. And as you mentioned before, we are all human. And of course we will all make mistakes. And that is a natural part of being a doctor. But the important thing is what you learn from that. And if there are serious things that go wrong, it's about sharing that learning, being transparent about it and helping systems to be as safe as they can be. And for me, that's doing the basics and consistently and well. And I think that's a good starting point for any kind of approach to clinical care.

KR: I think we've covered quite a lot of ground there, Jane. I was going to wrap up. I always like to end on things I'm going to take away from this conversation, and it'd be great if you have anything else to share along those lines. So, I think for me, we came back to this time and time again. But I think being able to get their opinions and support of respected, trusted colleagues feels really important and help you work through that reflective process, because on your own it's very difficult to be objective. And I think that other points I took away were involving others along similar lines. But thinking about I'm just about to be a consultant, you know, that shared learning, vulnerability, making it sort of normalized that these things happen and how we work through them as a team. And then the last thing is just thinking about those basics systems, thinking about things like documentation. So how do we make sure we're consistently having a balance and having the documentation right the next time?

JR: Yes, indeed. And I think they're all excellent equal messages aren't they. And I think perhaps I'd also add to that and say that unfortunately awful things do happen within medicine, and we're all vulnerable to that by virtue of the profession that we do. And there are support mechanisms in place, but I think it's also the value of being a medical professional is that you are in this position to do your best by patient care, and it's our professional responsibility, I think, to learn from where things do go wrong and to be able to have a reflective and open forum by which that can be shared. And for me, that's a case that has stuck with me all the way through my professional career and will continue to do so. I hope that I am a better doctor because of it, but I also hope that being honest about what I've had to go through, that other people will realise that they are not alone if they're facing this.

KR: Thanks so much, Jane. That was a really lovely thought to end on and some really important messages for I think, anyone listening. So, I hope everyone's enjoyed the episode and hope to see you next time.

JR: Thank you very much for having me on.

The T&MC sister podcast, Career Conversations, supports medical students and trainees with career guidance and progression as well as professional development. We wish to recommend our Demystifying Paces podcast series on career conversations. As some of you may know, in late 2023, MRC UK updated the Paces exam format, so we developed this new series to support Paces candidates. Episodes. Cover exam organisation calibration every paces station including key changes and candidate perspectives.