A comprehensive study on doctor whistleblowers in Scotland has revealed “shocking” experiences of repercussions including bullying by managers, being blacklisted, marginalised and having their mental state questioned.  
 
Most of those surveyed (87%) as part of the study encountered challenges to speaking up about concerns in the NHS, while fears around disciplinary procedures and a detrimental impact on their career were raised as issues by potential whistleblowers. 
 
One doctor said their health board had made up false complaints, referred them to the medical regulator and blacklisted them in response to raising concerns. 
 
Another said that the backlash to raising concerns about a manager or patient safety would ruin a doctor’s career and mental health, while one told of complainants being “interrogated while in tears”. 
 
The survey the study is based on found doctors who were white and older were more likely to be whistleblowers, with one ethnic minority doctor saying that raising concerns is equal to “digging the grave”.  
 
The research carried out by Dr Iain Kennedy, Chair of BMA Scotland, found: 

• Less than one in five (17%) were satisfied with their organisation’s response to whistleblowing.
• Just over half (51%) of doctors surveyed had experience of whistleblowing, with patient safety the most common reason for doing so.
• Reported repercussions of whistleblowing included bullying by managers (56%); questioning of mental state (39%); workplace marginalisation (36%) and negative peer response (36%).
• Fears raised by potential whistleblowers include disciplinary procedures (51%); bullying (50%); detrimental career impacts (47%); negative reaction from senior doctors (46%); referral to the General Medical Council (GMC) (45%); and peer disapproval (44%). 

Comments from doctors who took part in the survey included: 

• “Being an ethnic minority and IMG (international medical graduate), hardly anyone takes you seriously, raising concerns is equal to digging the grave.”  (Consultant)
• “I was not listened to. I perceived that the management were more concerned about their reputation than patient safety.” (SAS doctor)
• “[Health Board] made up false complaints about me, referred me to the GMC, and blacklisted me.” (GP)
• “I do not think my concerns were taken seriously. I felt I was not listened to. I felt my concerns were dismissed by medical manager. Organisation tried to discuss my whistleblowing concerns as part of my sick leave review. Eventually, with the support of the BMA I believe my concerns were acted on.” (Consultant)
• “Backlash, if you wish to ruin your career and mental health, raise concerns about the behaviour of the manager or patient safety.” (Consultant)
•  Resistance and discouragement from management to report systemic bullying by particular managers. I can think of two examples, both still working and the managerial approach is very much in support of them. I know both complainants and both were made to sit in meetings where they were interrogated whilst in tears.” (Consultant) 

Dr Iain Kennedy, Chair of BMA Scotland, led the research and is a former whistleblower himself.  
 
He said: “This study aimed to examine the challenges faced by doctors when speaking up within the NHS and to identify ways to better support whistleblowers or indeed anyone raising concerns with their employer. 
 
“The experiences uncovered by this research – including being bullied, marginalised and even having their mental state questioned - reveal a shocking picture of what can happen to those who do bravely and correctly decide to put their head above the parapet and speak out when things are going wrong. 
 
“While 94% of those in the survey believe whistleblowing enhances patient safety and 90% believe it addresses wrongdoing, it is extremely concerning to find only 17% are satisfied with their organisation’s response. 
 
“It’s frankly shameful that some doctors continue to feel they cannot speak up on behalf of patients without suffering personal consequences – despite all the apparent reassurances to the contrary. 
 
“We need urgent action to change this and better support to encourage whistleblowers, particularly for younger and non-white doctors.  
 
“NHS boards, with the clear support and backing of the Scottish Government, must do more to implement whistleblowing procedures which guarantee anonymity and protection for anyone speaking up and they must encourage reporting without fear of retaliation.   
 
“We also need to see a wider shift in the NHS to a culture which is based on feedback and learning, not blame and finger pointing. 
 
“Such a change needs to start at the very top and the Scottish Government must focus on fostering a culture which prioritises patient safety and staff well-being over health boards instead simply trying to do everything they can to manage their reputation. 
 
“I would also like to thank every doctor who have taken the often difficult step of whistleblowing and would encourage others to speak up if they so feel able, despite the challenges highlighted by this research.  
 
“There is no doubt their actions have undoubtedly saved lives and will continue to do so.”

Dr Sajid Farid, Chair of the BMA’s Scottish Race Equality Forum said: “Ethnic minority doctors, particularly international medical graduates (IMGs), are afraid to speak up as they feel that their voices will not be heard.

“Ethnic minorities lack knowledge of whistleblowing procedures and can have communication challenges.  They also experience more ‘dignity at work’ issues. Ethnic minorities are subject to more GMC referrals and often feel that they are not regarded as part of the NHS but rather just used until they are no longer needed.  

“The working environment in the NHS is becoming worse day by day, and the staff shortage is adding to the workplace stress.  Whistleblowers need to have more confidence that their voices will be heard and that they will not face negative consequences.  Furthermore, doctors should receive feedback and follow-up on the concerns they have raised.”

Dr Chris Smith, Chair of BMA Scotland’s Junior (soon to be Resident) Doctors’ Committee said: “We’re expected to raise concerns, and this is even mandated by training curricula, but the evidence shows that we feel the reverse is true; whistleblowing is seen as a threat to progression, not conducive to it.  

“When junior (soon to be resident) doctors rotate into different departments, we can provide a fresh set of eyes to identify an issue, but we can also too easily be cast as the troublemaker rocking the boat and causing problems where none had been raised before.  

“Doctors need to see positive action being taken when whistleblowing occurs, which both results in system change and shows that individuals are believed, listened to, and engaged in implementing that change.”

Notes to editors

An on-line survey was conducted of BMA Scotland members with 436 responses. Whistleblowing is a particularly sensitive subject, where doctors are especially concerned about confidentiality. The findings form part of MBA thesis research conducted by Dr Kennedy, supported by the University of Warwick and University of Aberdeen.

The BMA is a professional association and trade union representing and negotiating on behalf of all doctors in the UK. A leading voice advocating for outstanding health care and a healthy population. An association providing members with excellent individual services and support throughout their lives.