Cases that Changed Me - Whistleblowing (17 Nov 2025)

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Dr Kat Ralston (KR): Hello 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 a geriatric medicine registrar in Edinburgh. And this is another episode in the miniseries about cases that changed me in medicine. We've all faced moments that challenge us or made us reflect. These difficult times are inevitable, but I think they're also essential to how we learn and develop in medicine. 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 delighted to be joined by Ed Jesudason, who is a consultant in rehabilitation medicine and NHS Lothian. His interests include living with complex conditions in the community and how medical ethics can be used therapeutically within rehabilitation. Welcome, Ed.

Professor Edwin Jesudason (EJ): Thank you Kat and thank you to the College for this opportunity to take part in a really interesting series. I suppose my story's a little different from other cases in the series, because the case isn't actually a patient. It's me and a whistleblowing case, and in a previous career I have been in the paediatric surgical department. That's one of the consultants, and myself and another colleague blew the whistle on things that weren't going right there. In the end, that resulted in a Royal College investigation and twenty-six items that needed reform. So, there was some positive upshot from that. However, the whole process sufficiently damaged working relationships that he and I couldn't remain within the department, and it's a small specialty, couldn't find a foothold elsewhere. So that experience of being unmoored after having blown the whistle was very difficult. And I think it would be fair to say in general terms that legal remedies are hard to find when you are self-funding and against a nationally funded institution. So that led to a significant change in career and saw me become a consultant in rehabilitation medicine, in part because I valued the opportunity to retain the importance of my physical examination skills and physical medicine skills, but also because it seemed like a great space to pick up the kind of work I'd been doing with children and people, particularly with disability. But now on the adult side, to see how they progress through transition and beyond in terms of how it impacted on me, the impacts were profound on me, Family, friends, etc. and we'll talk about that more a little later on. But I suppose as a headline point, we do need to reflect on the importance of whistleblowing in not just the NHS, but the financial sector. Or indeed, when you look at some of the issues going on in the US around Jeffrey Epstein, etc., these matters come to light because people speak up about them, even in circumstances where legal measures are deposited on them to try and prevent them. So, we do owe a lot to whistleblowers, not just in the NHS, but elsewhere. Having said that, I can't leave listeners with the illusion that it's a sunny upland. It definitely isn't, and it's a whole body and whole life experience.

KR: Yeah. Wow. That sounds like a really tough experience that you went through. And obviously you've got through the other side and, you know, have a fulfilling and rewarding career. And we'll get into how you got there in a little bit. But it's just interesting to hear your reflections on that process. And what struck me, I guess, is that we are very well trained for the medical side of our jobs or the surgical side of our jobs, but I don't know how prepared you felt to deal with going through the process of whistleblowing, but I imagine that we are not well prepared for navigating legal systems. And actually, the fallout that might happen with that. And what comes to mind is, is that something we should be focusing on a little bit more as well?

EJ: Yeah. So, I think you raised an important point. I felt terribly unprepared. I had, I think, naive assumptions that prompt investigation and resolution would be the way forward. But I think whistleblowing raises concerns of reputation for big institutions. That can be quite complicated, and it can lead to a desire not to be quite so candid on the matters of safety at hand. I think for clinicians, you probably don't realize how much we rely on the papers and lawyers poring over them and looking at them sentence by sentence. And I think that's also quite different, because we work very much face to face talking with people. And the notes are a sort of secondary record. It's quite interesting to see that they become the sort of almost the evidence in chief.

KR: Hmm. I had a similar conversation for another case in this series on navigating kind of complaints or things potentially going to court, and I think what is familiar in both cases is actually that we as medics, are not well prepared to enter systems like this. It's really hard. But I think that your point of the fact that although this has had a profound impact on you and I imagine was an extremely difficult time. Actually, this is key to patient safety. And, you know, your whistleblowing efforts will have saved lives. And I think that's important to have in our minds. I'm interested in just thinking about the fact that I can imagine that this process might have led you to lose trust in the NHS, in the system going through, you know, this big whistleblowing case. How does that have parallels with the trust that we have between patients and clinicians and navigating that? What are your thoughts?

EJ: Yeah, no, I think it's a great question. I think there are strong parallels. Ultimately, you know, you could say, uh, modernity from Kafka onwards is about the relationship between the individual and the institution and the individual not really having to give its reasons or indeed have a face, but the individual feeling increasingly powerless in front of it. And patients, particularly with long term conditions or multiple conditions, I think when you meet them, they often have that issue. They need the institution because it needs to provide them with healthcare, but they find it difficult to trust, and that can be difficult for them to regulate emotionally, and that can feed into further unsatisfactory consultations. So, one of my interests, I think, growing from that and related, I think, to my own experience within the civil litigation, is how to build that trust. Generally, it starts with listening. So, with patients, it starts with listening to hearing their account, hearing their evidence, and taking that seriously even if one doesn't agree with it. And actually, as I've said in the past, writing that account down and providing it back to the patient as part of the clinical record to show that they have been heard.

KR: Yeah, I was just thinking I actually had a request recently. A patient was requesting their notes. And I think your initial thought is, oh gosh, someone's going to be reading all of the notes that they've had on their, you know, on their records. And I think that's sort of more routinely the case in some places in England now. But I suspect quite a lot of clinicians have this initial thought of, oh, no, you know, someone's going to read them. And why is that? And actually, having been a patient on the other side, not having access to that is really frustrating. So why do we have this kind of feeling that we want to keep it all to ourselves? You know, that's our clinician's bit. It doesn't belong to the patients, but it should.

EJ: Yes. And that relates to, you know, my current field of work, because disability justice is a big part of that. And one of the things out of the disability movement in the nineteen sixties was nothing about us without us. And so, I tried to bring that into my practice, having felt that often litigation was about me, without me. And one way to do that is to write patients. It's a wonderful thing to do because you are able to sense check their accounts, show that you've fed them and put their account on the record, and then gently either confirm or dispute what conclusions we might draw from that. But at least that is principal disagreement that's on the record rather than behind their backs. So, trust can more readily be maintained. And therefore, I have less qualms about notes being disclosed because I send the stuff to them anyway. And if I have a referral to a colleague, I tend to write that at the end of the letter so that the patient can also see the referral to the colleague, that there's nothing hidden. I found also that that changes me, because you're more thoughtful about how language can land with other people. So, their heart failure has connotations. And therefore, if that's what you mean, you need to explain it, but also what that means in terms of outlook and you know, what the patient might expect, or it might not be as severe as that. You might need to say that heart failure can be quite mild or moderate and explain that is also important. So, writing two people, it changes us because we have to think about how it would land them. Often you start the exercise by thinking how would I feel? And one of the things I've changed as well, in terms of my correspondence, is I don't have the long problem list right at the start of the letter, because if you're writing to patients and you start with a nine item problem list, I think as a patient opening that you feel defeated before you've read the substance. And so, you know, rehabilitation in large measure is trying to encourage people after life changing illness to imagine a future and one that feels worthwhile to them. And that's something of an art that we can touch on separately. But it does require a different relationship between clinician and patient, rather than looking at patients down the end of the microscope. We actually need to recognize that we're players on the same team, on the same pitch, and the way that we play the ball effects how they do.

KR: Yeah, I think two points. One is that often I'm seeing increasingly these sort of shared care plans, perhaps with patients who might be frequent attenders to hospitals that have been written with patients. And I think they are really effective, actually. And I think that you have to be involved in your own care as a patient. I think that's really the way forward. And in terms of correspondence, I think we're all being encouraged now to write to patients and phrase it to the patient instead of writing in sort of all this medical speak that, you know, if you received a copy of the letter, you wouldn't have a clue what was going on. I'm interested in the problem because we love a problem list in geriatric medicine. And I think part of it is like, who are the notes for the patients or the professionals or both. And is there a case for maybe having that in a separate part of the notes? I don't know, because I think, you know, if you're seeing a new patient in A&E or something, that problem list from an experienced professional who knows the patient really well can be extremely helpful. But I can totally understand if you were a patient faced with this, it's could be really off putting or sort of worrying to read.

EJ: Well, I think the problem list is a problem. I mean, it is convenient and it smacks of a certain type of certainty, but actually it's not infrequent to find a problem list or a diagnosis list that's inaccurate, where someone else, during an inpatient admission suddenly acquired COPD or OSA with no evidence to support that. And so, I think what I like about corresponding with patients is that as you go through each issue one by one, examining the evidence for and against and the options that has to go through the higher centres. And I think sometimes with a problem list, particularly with copy and paste function and electronic records, you can get into a sort of something that feels a bit more automatic.

KR: Yeah, I absolutely agree with that. And it's not uncommon, like you say, that people pick up diagnosis that don't actually exist. And I've seen whole problem list copied and pasted from wrong patient's notes into other patient's notes and stay in the notes for about a week before anyone noticed. So, I'm very much with you on that. I'm just thinking about how we share information between professionals, because if you're busy and you know you're doing a post-take ward round or something, you've got less than ten minutes of patient a big, long letter to the patient, all in prose is going to be really, actually difficult to find out what is the salient points for that patient's health. So, it's like where's the balance?

EJ: Great point. And I suppose just as you would with any letter, you'd say, well, we've met on the wardrobe. The salient issue today was your breathlessness. And that's it in context of previous diagnosis of COPD and smoking history. For the more recent issue of producing yellow sputum and positive sputum culture, on the basis of that, we took the view that community acquired pneumonia and applied the following treatments. And that worked to a point. And then we re-evaluated, wondering whether some of those breathlessness was related to parking and so on and so forth. So essentially what you're doing is just giving decisions and reasons, and it does take practice. But as I've just shown, it doesn't need to take a lot of time.

KR: Yeah, I can definitely see your point. And I'm very pro involving patients and shared decision making. And I think that's so important. And I think writing to patients in the correspondence is key. But I think outpatient and inpatient medicine can feel a little bit different sometimes. So, it's how do we keep a record of what's going on? If you were seeing that patient at three in the morning, you would know at a glance and avoid the copy paste wrong diagnosis thing, because I think you can't get away from the fact that issues lists are problem lists are going to exist. So how do we how do we do them well? Or how do we how do we have a balance? Because I think it's going to have to be a balance.

EJ: I think you're quite right. And I think the big difference is that in acute, we listen in relatively narrow fashion to the patient and in clinic and in community. We have the opportunity to listen further and to listening further. You recognize the impact of letters of the type we've described with long problem lists with inaccuracies, etc., which in acute you never get that feedback because you might never see that patient again.

KR: Yeah, absolutely. And I think there's a really important place for that, particularly in outpatient medicine. And I'd like to hear more about the way you put it. The importance of listening, which I think is absolutely key. But the fact that you are saying that's kind of hearing their evidence and examining the evidence for and against. How does that land with patients? And can you tell me a bit more about that?

EJ: Yeah, sure. I mean, for example, let's say you've got someone with a medium to long term cardiac condition and they have varying symptoms including breathlessness, chest pain, fatigue, etc. And in that context, it can be very easy to simply say, well, let's approach this as functions, results of a diagnosis and or side effects of their drug treatment. But very often through further discussion, one is able to work out that actually some of it is down to the distress of having a long term condition which comes with changes to your breathing pattern, etc. and some of it's related to the discouragement the one feels in the context of life changing illness. So, fatigue isn't necessarily about an anaemia or some kind of mitochondrial dysfunction or what have you. Actually, we feel fatigued when we feel down and discouraged. And these are normal human factors that are present in our every day that we seem to breeze past en route to pills and procedures. So just remembering that and learning to work with all of those disease, drugs, distress and discouragement and recognizing their treatments for each allows you then to negotiate that with patients and say, well, you know, where do you think at the moment the centre of gravity is for all of us, because we look at your tests, lung function, CT, etc., and your own reports that on occasion you can exercise quite well. These occasions you've described where you've got breathless very quickly and got tachycardic very quickly, might be more anticipatory, related to distress. And so, you can talk to patients about the difference between getting chest pain halfway up the hill or after that's repeated chest pain simply on looking at it and why they might differ. So, it's quite an important part of clinical medicine, but it's often the hurly burly of things overlooked.

KR: Yeah, that really resonates. Yeah, I think that we're probably, you know, often time limited fashion or is that a fallacy? Do we make it time limited? But the art of listening can be really lost. And then that is able to then lead you to this negotiation and coming to a formulation, shared treatment plan that's going to help you move forward with the patient.

EJ: I think you've raised an excellent point there. I think in some contexts, obviously time is pressured and the opportunity to listen more limited. But I think they're probably rarer than we would concede. And I do wonder whether there are times when we keep time short in order to make sure that we don't have to listen too far and too far. Is into that realm of suffering that makes us feel really uneasy. So, GP appointments are short? Yes, because the pressure on GP is high, yes. But is there also something in having short appointments? That means the GP has an end to hearing an account of suffering that's actually distressing for them.

KR: I think that's a good point. I think it can go both ways, but maybe we need to be more open and mindful to the therapeutic benefit of listening.

EJ: So, I've written something on this and it's published in the British Journal of Hospital Medicine, and it's called 4D Model Rehabilitating a Realistic Medicine. And it came out in April twenty-five. So, if it's of interest, there's quite a bit on this link there, including the techniques used by FBI hostage negotiators, which are surprisingly good.

KR: Yeah, we can put a link to that in the show notes, and I'll definitely read that after. I quite like comparing my job to a hostage negotiator, so I feel like we've gone on an excellent tangent there. And now you're a rehab medicine consultant. So, I'm interested in hearing what happened with your journey, how you managed to move past this, how you managed to not actually just give up medicine completely. Could you tell us a bit more about what happened next?

EJ: Yeah, as I say, I was ten years and there were some extremely low points and difficult points and points, I think, which again now make me a better doctor because they do remind you of the wider sense of suffering. Again, the stuff that can't be dealt with by simple pills or procedures. So obviously the mainstay of getting through it was the support of family and friends. The journey to rehabilitation medicine was stepwise, and I think for a while I did think about leaving medicine and pursuing research because I had an active research career as well. But over time, I recognized that I actually like listening to patients because, you know, you might say there's aspects of medicine that retain a certain grandeur and surgery amongst it, but actually patients are where all the mystery is when you really start to listen to them and in discussion with friends, family and reflecting also on my interests earlier in my academic career. So, I did philosophy whilst I was at Cambridge, so I had a real interest in some of the whys and why not of the world. I recognised that, you know, basic science research wasn't for me because I wanted to see patients. I also recognised that going to something like psychiatry, you know, good specialty, but removal from physical medicine or distance from physical medicine wouldn't be optimal. And asking around rehabilitation medicine came up as this nice spot in the Venn diagram, because you're at a point where you're thinking about repair of the body, but you're also thinking about rehabilitation of the self. And the beauty of Bring that all together is that life changing illness and life changing events, both of them bring a degree of moral injury and distress, and learning to manage that for oneself is also an education in helping others to manage it for themselves.

KR: What do you think you've learned about managing moral injury for yourself, and how do you think that's changed your practice for patients?

EJ: I think compassion is at the heart of it. You know, one takes the more literal meaning of compassion it's to suffer with. And I think going through the whistleblowing process just really brought home how often as clinicians, particularly as we challenge through our training and so on and so forth, we can be somewhat spectators to suffering, forgetting that it is visited upon us two, and the suffering with the shown compassion is a really important skill. Feeling something of it and allowing that to change you and help others change. So, I think that's been a big part of it, and I've hoped that it had always been there to a greater or lesser extent. I just haven't necessarily given it that much thought. And alongside that, I think the arts and humanities are an essential part of our own. As human beings, we don't address suffering simply through science because there's plenty of science simply cannot fix. So whether it's poetic elegy for grief or narratives that help us, that inspire us to feel that change might come, these all keep us going from, you know, the fairy tales that we learn in our youth to the books that we read as adults. And I think that's a big part of what modern medicine has lost, that anthropological sense of what it is to be human, and what we used to get from understanding culture. So that's become a bigger part of my practice. But I think that drew on reserves that, again, I've encountered at university through studying philosophy and spending time within the arts faculty.

KR: This is maybe a slight aside, but I guess in the world of, you know, artificial intelligence and conceivably some people's part of their roles or jobs might be being or in the future replaced by technology. I wonder whether what is it to be human as a doctor, I think is really important, and it's going to become even more important as technology takes over parts of our role that doesn't need that human element. So, do you think that might come back or be more of a focus in the future?

EJ: I've written a paper in Journal of Medical Ethics, Manufacturing Safe Medics, which makes that point that actually, as AI and technology take over sort of technocratic aspect of medicine, the numbers, the ethical aspect, what ought we to do will come to the fore. And so much of my work and what we've touched on in our discussion is a bit like being expert medical counsel. So, you have a client in difficulty, and you're trying to look at the evidence with them and counsel them as to their best options. And that draws us back to the whistleblowing case, because it's something I've taken from that experience that we all need wise counsel when faced with clinical or legal difficulty.

KR: Yeah, I do think part of that has been lost. And I think when we're looking to the future of what medicine looks like. That's such an important part, because we're not needed to be racing in the notes and things or to be looking at all the numbers or. But actually, what patients need is humans.

EJ: Yes, I think that's right. And I think we've talked about listening, but there's something about knowing that you've been listened to, and humans are quite good at that through facial expression, gesture showing that you are listening, paying attention. I'm sure robots of the future will be able to mimic some of that, but it's not quite the same. I also think we should quarrel with the term artificial intelligence, because if you term it differently, for example, in human prediction, you can then see that there are substantial problems with, you know, being human means it's tireless and pitiless, and prediction means that actually we start. It can erode trust because we don't need experts anymore, and it can also erode intellectual property, which means we don't need workers anymore. And so, if you put all that together, you get sort of economic losers and environmental losers, because that tirelessness requires energy. And they're all efficiently surveyed by governments that have much greater power. And that's already happening around the world in different parts. I think in human prediction, it's quite a nice thing. Anything you read about artificial intelligence, just insert that there and see whether it still works.

KR: Yeah, I quite like that. It just changes your perception of it. I'm very technophobic, so I'm on board with that.

EJ: But she’s using zoom.

KR: Well, Zoom is as far as I stretch. But yeah, that's really interesting. And I guess we're sort of probably coming to the end of the conversation now. We've covered a lot of ground, I think. I wondered if there's anything else you'd like to reflect on in terms of how going through this experience has changed you and changed the way you practice?

EJ: Well, we've touched on the obvious and outward manifestation of moving from being a reader in paediatric surgery to being a consultant in rehabilitation medicine. I feel oddly very fortunate for having had the experience. And, you know, there were times when it was horrendous. But I feel fortunate because I think sometimes when we go into medicine and do particularly cross specialties, there is a sell by date on that Things become routine. People can become a little bit checked out and at times going to and having a mid-career change seems, at least for me, to have avoided all of that, and moving into the specialty that I've moved into rehabilitation medicine is a very creative one. It's rather like being an architect. Your client comes to you with some resources and says, what can I do with this? And you have to think through with them what might work. And because everyone's different, there's that element of mystery. What do they say they want? What do they really want? What would they be happy with and what could we achieve? And I think that is, in its own way, rejuvenating. Keeps you very, you know, very happy to be a doctor.

KR: Yeah. Thank you so much for sharing that. And I mean, the story is it's about whistleblowing, but it isn't really about whistleblowing. It's about how that shaped you and how that shaped your journey and rehabilitation medicine and how you interact with patients. And I guess I also don't want this to put people off whistleblowing. I don't know if you'd have any advice for anyone who is going through a similar period or time in their lives to do with that whistleblowing.

EJ: I think on the hopeful side, the issues will pass. You know, time will pass and hopefully just by attention to a bit of self-care support from friends and family, you'll get through it. You know, doctors are resourceful, capable people, and we should be able to get through it, even if it's at the loss of a career, home, etc. you know, these things can be refound. So, you know, there's that aspect. Secondly, you know, a compassionate view. Lawyers, including for the other side, are human beings and they suffer too. But actually, they're simply trying to do their job as best they can. And that shouldn't stop us. As a medical profession, taking greater interest in cases of public interest. So, when whistleblowing cases come up, we should support our colleagues by watching. Nowadays, we can actually ask for permission to watch online because regulations have changed. But also looking out for coverage. And if you do know someone who is going through this sort of thing, just reaching out to them if you can and offering support, you don't have to side with them, but just offering human support.

KR: Yeah, I think that's all really important. But yes, I think a lot of really interesting learning and development and reflection you've clearly had through this process. And I managed to, you know, go through a mid-career change and come out, you with it. What sounds like an amazing career and relationship building with patients and rehabilitation medicine. So yeah. Bow down to you. And I like to think of a couple of learning points after the conversation. And anyone listening to think about what they might take away from it for me. I think that concept of writing to patients and being more mindful about that and making it a true shared dialogue with patients, particularly in things like outpatient correspondence, is really important. And as part of that, that art of listening and making time for listening within consultations, as probably the most important thing you'll do in that consultation is really important. And I think the other point is the importance of being a human as a doctor, and that compassion for yourself and compassion for patients. That's where I'm going to take away.

EJ: Yeah. Listen, that's a much better summary than I would have Just say thank you. I'll take that.

KR: Great. Okay. Well, it's been really lovely to speak to you, and I hope the listeners have also taken away as much as I have. Thank you.

EJ: Thank you. Bye bye.

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.