Your Voice Matters: Raising Serious Concerns About Patient Safety

By: Maria Ahmad, co-author, Unlocking The Leader Within: A Medical Student’s Guide to Practical Leadership

A recent study estimated that over 237 million medication errors are made each year, just in England¹. 237 million! And that doesn’t include other errors – mistakes made during operations, missed or incorrect diagnoses, unsafe discharges…the list goes on.

So, as a medical student or foundation doctor, chances are that you will witness someone somewhere about to make a mistake.

How confident would you feel telling a scary consultant surgeon that they are about to operate on the wrong leg? Or telling the nurse-in-charge that they are about to give penicillin to a patient with an anaphylactic reaction to it?

As daunting as it is, you need to use your leadership skills to raise these concerns because, for many patients, that could genuinely be the difference between life and death.

But how? Worry not, we have a handy framework for you: PACE.

PACE stands for Probe, Alert, Concern/Challenge, Escalate/Emergency². This is called a model of graded assertiveness which means that, as you go through the letters, you slowly give a more assertive response. PACE is a great model to raise concerns to those scary seniors to ensure patient safety while still sounding polite and respectful to your seniors.

Here’s an example for raising your concern to the nurse in charge who is about to give penicillin to a patient with anaphylaxis to it:

Probe – “Have you checked the patient’s allergy status?”

Alert – “I think the patient has had an anaphylactic reaction to penicillin before.”

Challenge / Concern – “Tazocin contains penicillin, and this patient has had anaphylaxis to penicillin before. I am concerned it is unsafe to give the patient Tazocin.”

Escalate / Emergency – “STOP! We cannot give this patient Tazocin. (Also highlight the issue to a senior).

By the time you’ve reached the Challenge/Concern stage, almost all seniors will be attentive to your concern, because you’ve just highlighted the dangers to the patient three times in three different ways. If they are still proceeding with something dangerous, you need to stop them and get another senior involved.

But what if you find out later that you were wrong? That’s ok, use it as a learning opportunity and know that you were advocating for the best for your patient. It won’t go unnoticed.

So, next time you see someone about to make a mistake, use PACE to politely and assertively raise your concern. They will be ever grateful to you, and so will the patient, whose life you might have just saved.

Want to learn more about how to use leadership skills to keep your patients safe and your colleagues happy? Find out more in ‘Unlocking The Leader Within: A Medical Student’s Guide to Practical Leadership’.

Additional References:

1. BMJ Newsroom. 237+ million medication errors made every year in England – BMJ Group [Internet]. 2020. Available from: https://www.bmj.com/company/%20newsroom/237-million-medication-errors-made-every-year-in-england/ [Accessed 8^th December 2025]
2. Yianni L, Rodd I. G236(P) Pace – “Probe, Alert, Challenge, Escalate” Model of Graded Assertiveness Used in Paediatric Resuscitation. Archives of Disease in Childhood [Internet]. 2017 May 1;102(Suppl 1):A93–3.