Synopsis

In this clip a nurse and a resident doctor step away from Patient 1’s bedside during a ward round to talk in front of Patient 2’s bed. Their conversation follows a tense exchange with Patient 1, who refuses to take medication as prescribed despite a team‑agreed plan. The staff refer to the patient as a “nightmare” and express a desire to discharge them as quickly as possible.

As you watch, pay attention to:

• How the clinicians discuss the patient’s non‑adherence – the language they use, any judgmental remarks, and whether they explore underlying reasons.
• Professional boundaries and empathy – whether the nurse and resident maintain a respectful tone or let frustration dominate the dialogue.
• Decision‑making and discharge planning – how the team balances patient safety, therapeutic alliance, and the urge to expedite discharge.

Maintaining Integrity and Patient Trust

Maintaining integrity and patient trust is fundamental to healthcare practice. For a patient to feel safe, respected, and confident in care, they must believe that clinicians act honestly, with competence, and always with their best interests in mind. Integrity encompasses ethical consistency, truthfulness, respecting boundaries, and taking responsibility when things go wrong. Trust is built over time through transparent communication, professionalism, and respecting patient dignity.

One key way to uphold integrity is by being very mindful of language use. What we say—and how we say it—matters. Avoiding jargon, using inclusive and non-stigmatising terms, and choosing words that reflect respect rather than judgement can greatly influence how patients perceive their care. For example, describing a patient as “non-compliant” can feel blaming; saying “struggling to follow the treatment plan” or exploring barriers that make following the plan hard may preserve trust. Also, being accurate, clear, and honest—even when the truth is difficult—helps maintain integrity. If errors happen, acknowledging them, apologising, and explaining what is being done to rectify and prevent recurrence supports trust.

Clinicians should introduce themselves properly, confirm their role, explain diagnosis, options, risks in understandable language, check comprehension, and involve the patient in decision-making. Boundaries between professional and personal must be respected. Conflicts of interest (financial or otherwise) must be disclosed. Maintaining confidentiality, upholding promises, and following through on what you say you will do further reinforce integrity.

When integrity is compromised—through misleading communication, neglecting responsibility, or using disrespectful language—patient trust erodes. This can lead to patients withholding information, poorer adherence to treatment, and worse outcomes.

Discussion Points

• Confidentiality – caution in clinical areas where patients can overhear general info about other patients – ‘the magic curtain’ effect.
• Maintaining professionalism when discussing patients.
• Exploring attitudes towards patients – if non-compliant, is this due to the patient lacking understanding, are they exercising patient autonomy?
• Effect on patient doctor relationship for those overhearing – trust in professionals themselves, the system, the profession.
• What actions could you take if you overheard this in practice?

External Resources

• Good medical practice – GMC
• The doctor-patient relationship Ethics Toolkit – BMA