There are two types of doctors: those who regularly submit adverse incident reports, and those who never do. I am firmly in the first group, to the point that colleagues joke about it. I report when clinics run late, when results are missed and when serious events occur, including wrong site surgery. I do not do this because I enjoy paperwork. I do it because I believe each failure reveals bigger system problems, with real consequences for patients and staff.
Yet even with the most serious incidents, I still hear the same response. “Reporting won’t fix anything.” “It’s management’s fault.” “It will just create more work.”
Sometimes those frustrations are justified. Reporting alone does not solve structural problems. It can feel slow, bureaucratic and disconnected from real change. But choosing not to report guarantees that nothing will change.
From my experience challenging the sunbed industry’s misleading advertising claims, I learned how one voice can make a difference for everyone.
Over recent years, I have seen numerous patients attending dermatology clinics describe sunbed use as beneficial to their health, often quoting advertising claims about reduced cancer risk, improved sleep, longevity and libido. These conversations concerned me, not because they were unusual, but because they were becoming routine.
This messaging is not evidence based. Sunbed use is classified as a Group 1 carcinogen by the International Agency for Research on Cancer, with substantial associated morbidity and mortality since its commercialisation in the 1980s (1).
Last year, after hearing these claims repeated in clinic, I reported misleading sunbed advertising to the Advertising Standards Authority (ASA). Some of the patients affected were very young, and some already had melanoma.
When the ASA upheld my complaint and the adverts were removed nationwide, I was surprised by how many senior colleagues later said, “I noticed that too, but I didn’t think it was my role to challenge it.”
The parallels with adverse incident reporting are striking. Many people could see the problem, but few felt able or willing to act. It felt easier to complain than to engage with the system designed to deal with it.
I also had to confront my own fear. Challenging advertising in a multi-million pound industry that relied on misinterpreted research led by senior figures was uncomfortable. As an early-career clinician, hierarchy still feels real. There is a quiet worry about being seen as naïve, difficult or out of place: it would have been easier to stay silent.
I will admit to something more uncomfortable: there are moments when I envy colleagues who seem able to look the other way, because their lives must in some respects be easier. But speaking up when something is wrong does not feel like a choice; it feels like the minimum the role requires, and I cannot reconcile silence with the oath we take at the start of our careers. There is also a weariness that comes with being known as the person who always raises concerns. Colleagues find it predictable. It has become easier with seniority, but expectation carries its own pressure. When raising concerns becomes part of how others define you, the weight of consistency is never entirely absent.
What changed my perspective was recognising that speaking up is not about being brave or rebellious; it is about responsibility. We see the downstream effects of misinformation and system failures in our patients. If we do not act, we are not neutral observers. We become part of the silence that allows harm to continue.
Since that initial ruling, further complaints about sunbed marketing have been upheld and national guidance has been strengthened (2). This has reshaped how I think about early-career leadership: leadership does not start with job titles or seniority. It starts with noticing when something feels wrong and being willing to use the systems that already exist, whether that is an advertising regulator or an adverse incident form.
Reporting is rarely the whole solution. It is often only the first step. But without that first step, improvement has nowhere to begin.
My main lesson is a simple one: speaking up is uncomfortable, imperfect and sometimes slow, but silence is far more costly. If we want safer systems for patients and healthier workplaces for staff, we cannot leave the work of raising concerns to the same few voices. We all have a role, especially those early in our careers who still notice when things do not feel right.
For senior leaders, that role extends further: actively creating the psychological safety that makes it possible for others to act, and recognizing that hierarchy weighs heaviest on those earliest in their careers. Flattening it does not mean abandoning expertise; it means ensuring that seniority is never the reason a valid concern goes unvoiced. Senior colleagues must reassure those around them that speaking up in good faith is almost always the safer choice. Staying silent while watching harm unfold is not neutrality. It is participation.
References
- IARC Working Group on the Evaluation of Carcinogenic Risks to Humans. SOLAR AND ULTRAVIOLET RADIATION. In: Radiation [Internet]. International Agency for Research on Cancer; 2012 [cited 2026 Apr 5]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK304366/
- Advertising Standards Authority. Beauty and Cosmetics: Sunbeds [Internet]. [cited 2026 Apr 5]. Available from: https://www.asa.org.uk/advice-online/beauty-and-cosmetics-sunbeds.html
Author
Amy Perkins
Dr Amy Perkins is a Consultant Dermatologist. Alongside clinical work, she is involved in undergraduate and postgraduate education and serves as an Honorary Clinical Lecturer at the University of Glasgow. She sits on the Board of Examiners for the Royal College of Physicians, contributing to the development, assessment and cybersecurity of postgraduate medical examinations.
Dr Perkins works with the Scottish Government exploring future regulatory approaches to sunbed use in Scotland, and has been involved in major changes to sunbed advertising. She frequently contributes to national and international media on skin health and the impact of health misinformation online.
She is completing an MSc in Skin Ageing and Aesthetic Medicine at the University of Manchester, with a focus on ethical integration of social media into undergraduate medical curricula.
Her work sits at the intersection of dermatology, technology and innovation. She has collaborated with OpenAI on the development and evaluation of large language models, with a strong interest in the ethical integration of artificial intelligence into healthcare.
Declarations of Interest
Collaborations with Cantabria Labs, Avène, Uriage, Cult Essentials
Advisory boards: DIC Sunscreen, Beame SPF
Equity and advisory role with BrightMed
Honoraria and conference support from L’Oréal, AbbVie, Novartis, Lilly, Johnson & Johnson, Almirall
Paid media contributions (TV, radio, print)
Aspiring Leaders in Healthcare
Aspiring Leaders in Healthcare Network aims to foster a multi-professional community of practice, united by the common goal of nurturing future healthcare leaders across the globe. Our regular online meetings, social media communities and conference huddles connect members to a wider network passionate about leading positive change and improvement in healthcare.
In this blog series, we showcase our members’ diverse experience of leading with impact at the earliest stages of their careers to empower and inspire the BMJ Leader Blog readership.