By Daniel Sokol

When I was a student, some time around the Jurassic period, a professor at All Souls College, Oxford told me that the key to publishing successful articles was finding a good idea. A good idea or topic, he said, could offset even mediocre writing skills.

At first, finding these ideas was a challenge. I had to search far and wide for them, immersing myself in the world of medicine, with trips in ambulances as a ‘third man’, stints as a pharmacy assistant, shadowing GPs and surgeons in the UK and abroad, and doing internships in various hospitals.  Through these experiences, and discussions with clinicians at the coal face, I discovered now and again the subjects of my next article.

Now, I have the opposite problem. I have an abundance of ideas, but in a cruel twist of fate I have little time to explore them. In the hope that others may find them of interest, here is a selection of ideas, covering areas which I believe are neglected in the medical literature.

All of these ideas were provided to me by doctors on my one-to-one remedial ethics course, or whom I am mentoring on a regular basis, and I thank them for their trust and generosity. To preserve anonymity, I have omitted details that could identify the patient, doctor, or hospital.

 

Keeping surgical patients alive for 30 days

On the surgeon’s orders, an incapacitous, post-operative patient is on ‘active treatment’. Aside from the surgeon, who has not visited the patient in weeks, the entire medical team agrees that the patient should be on palliation. Despite this consensus, the surgeon remains steadfast in his decision to treat the patient aggressively. It dawns on the resident doctors that the surgeon does not want the patient to die within 30 days of the operation as this would reflect poorly on his 30-day mortality statistics.

To my dismay, several surgeons have since confirmed to me that this occurs.

 

Lying to the anaesthetists

A resident doctor is unable to insert a cannula in a patient who is acutely unwell. A nurse tells the doctor to call the anaesthetics team for an ultrasound guided cannula insertion. The nurse warns the doctor that the anaesthetist will ask if the registrar (who was busy with other tasks) has tried, and advises the resident doctor to lie: “just tell him that everyone’s tried but failed. Otherwise, they won’t help.”

I am aware of one anaesthetist, sensitive to this ruse, who requires a registrar to document the unsuccessful cannulation attempts in the patient’s notes before agreeing to assist.

 

The ‘blood transfusion’ trick

Before a blood transfusion, two independently collected blood samples from the patient, taken minutes apart, may be required to reduce the risk of the patient receiving the wrong blood, which could cause death or serious harm.

To save patients from a second venipuncture and perhaps also to shorten a long ‘to do’ list during a busy shift, many doctors take two samples at the same time, send one off immediately and keep the second in their pocket. They send the second blood sample once the required time has passed, giving the false impression that the two samples were taken independently, at different times. The safety check is thus removed.

 

Sedating patients in the interest of healthcare professionals

To make patients easier to manage overnight, nurses over-sedate patients, even though this is not in the patients’ best interests. This can create tensions between the nursing and medical staff.

These are not the dramatic issues that tend to be taught at medical or nursing school, such as end-of-life dilemmas or trolley problems, or written about in the pages of learned journals, but they nonetheless merit consideration. These inconspicuous incidents, which fall within the domain of ‘everyday ethics’ or ‘microethics’, can affect the health and well-being of clinicians and patients, and lead to complaints and disciplinary proceedings.

 

As for questions, some obvious ones are: how common are these issues and why do they arise? What legal and ethical issues do they bring up? How can we bridge the gap between knowing what is ethical and acting ethically? There is ample scope for worthwhile projects for anyone interested in medical ethics.

 

Daniel Sokol is a medical ethicist and barrister in London, UK. He is the author of ‘The Ethical Clinician: Practical Lessons from the Bedside and Courtroom’ (2026).

Competing Interests: None declared

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