It was a fresh start to my first day of medical school as a second-year student. With a slightly stronger arsenal of information compared to my first year, the energy was palpable. My team and I huddled in our small conference room, gathered around the table, ready to tackle our first case of the week as part of our team-based learning. The first patient was a 1-year-old female infant presenting with signs of a bleeding disorder that required immediate medical intervention. Upon transfusion of blood, she demonstrated signs of hypotension, chills, fever, and dyspnea.
As we delved into possible causes for the infant’s condition, the discussion among my peers pointed towards a diagnosis of a febrile non-hemolytic transfusion reaction (FNHTR). The consensus seemed almost unanimous. However, deep inside, I felt a gnawing sense of unease. The recent information I had learned about transfusion reactions swirled in my brain as I tried to make sense of the symptoms the infant exhibited. Hypotension, chills, fever, and dyspnea seemed more severe than those typically exhibited by a FNHTR. I couldn’t shake off the thought that perhaps the patient was experiencing an acute hemolytic transfusion reaction (AHTR) instead, a far more serious condition.
Despite this intuition, I found myself hesitating to speak up. The fear of being wrong loomed large. An inferiority complex that often accompanies the early stages of medical education weighed heavily on me. We are expected to know so much information, and the possibility of being mistaken in front of my peers and superiors was daunting. I felt like I was carrying a giant weight inside of me, holding onto a truth yet choosing to stay silent.
The discussion continued, and the team proceeded with the management plan based on the FNHTR diagnosis. I sat there, a silent observer, unable to voice my concerns or ask why the possibility of an AHTR hadn’t been considered more thoroughly. This internal struggle was overwhelming, and I felt a profound sense of responsibility and guilt for not speaking up. Yet at the same time, I also feared the embarrassment of potentially being incorrect.
As more information about the patient’s case was revealed, it was found that the patient was indeed suffering from an acute hemolytic transfusion reaction. The realization hit me hard—I had been right all along. While I was grateful that this was only a hypothetical patient scenario created for our teaching purposes, I realized how I might encounter a similar case in real clinical practice one day. My silence at that moment can prevent timely intervention that could potentially alter the patient’s outcome. Reflecting on this severity, the weight of my silence now felt even heavier, knowing that I had missed an opportunity to contribute to preventing medical error and a patient’s timely care.
Later that day, I thought more about why it was so difficult for me to speak up to my team members even when I had an inclination that I may have been right. The Socratic maxim, “Primum non tacere—first do not be silent,” resonated deeply within me. It became a powerful reminder that my duty as a future physician is to avoid harm and speak up in the face of uncertainty. In the medical field, where patient safety and outcomes are at stake, these actions are not just encouraged—they are essential—especially in moments where the stakes teeter on a fine boundary between life and death.
Even when unsure, speaking up can prevent errors and lead to better patient outcomes. It fosters an environment where every team member, regardless of their experience level, feels valued and heard. Asking questions is equally important. Had I taken the courage to raise my concerns, I would have led the team to rule out all possibilities before arriving at a consensus. Questioning when something doesn’t feel right is a key aspect of clinical vigilance. It’s about trusting your instincts and recognizing that sometimes, those gut feelings are crucial red flags that need to be addressed. It demonstrates a commitment to understanding and ensures that decisions are made based on comprehensive information.
In retrospect, this experience taught me the importance of voicing concerns, no matter how uncertain I may feel. The safety and well-being of patients should always be our top priority, and speaking up is a crucial part of that responsibility.
As I continue my journey in medicine, I will always remember the 1-year-old infant whose case was not just a lesson in diagnosis but a profound reminder of the importance of our voice in medicine. I aspire to cultivate an environment where every team member feels empowered to voice their thoughts and concerns. It’s a lesson in humility, courage, and the relentless pursuit of working in our patient’s best interests as a collective team to provide them with the best possible health care.
Riya Sood is a medical student.
