In a new BMJ opinion piece, We must be more systematic about risk holding throughout doctors’ careers, Professor Mumtaz Patel, president of the Royal College of Physicians (RCP) joins with chief medical officer for England, Professor Chris Whitty, to discuss their co-authored paper Holding of risk in medicine must evolve through all stages of the medical career, which calls on the medical profession to map expected levels of risk holding at each career stage and embed this in postgraduate training, supervision and assessment, aligned with GMC standards.
Doctors regularly weigh risks and benefits for patients when making high-stakes decisions. However, while the medical profession has become increasingly structured in how it teaches knowledge and technical skills, it has been far less systematic in how doctors are trained to ‘hold risk’ – that is, to take responsibility for complex, uncertain clinical decisions. This leads to sudden jumps in responsibility, which can be stressful for doctors and potentially unsafe for patients.
The authors argue that risk holding should increase gradually, with explicit support at key career transition points, so doctors are neither overburdened too early nor shielded for too long, and they recommend that medical schools and royal colleges map the appropriate level of risk at each stage of training and teach the practical management of risk alongside other core clinical skills.
Professor Mumtaz Patel, RCP president, said:
‘This paper rightly recognises that holding risk is a core part of what it means to be a doctor, yet it remains one of the least supported aspects of our professional development. Our resident doctors deserve structure as they learn to balance uncertainty in the interests of their patients.
‘I was grateful for the opportunity to contribute to this work on behalf of the Royal College of Physicians. By being clearer about expectations at each stage, supporting residents appropriately, and recognising that risk cannot be eliminated but must be shared and understood, we can better protect patients and strengthen postgraduate medical training.’