Working with Senior Colleagues — When to Defer, When to Challenge Respectfully

One of the most common SJT themes involves scenarios where a junior team member must navigate a relationship with a senior colleague. These questions test whether you understand the balance between respecting experience and authority on one hand, and protecting patient safety on the other.

This lesson teaches you exactly when to defer to a senior's judgement and when — and how — to challenge respectfully.

The Fundamental Principle

The SJT operates on a single overriding principle when it comes to hierarchy:

Respect seniority for clinical judgement. Override seniority for patient safety.

This means:

Situation	Correct approach
A senior makes a clinical decision you would not have made, but it is within acceptable practice and patient safety is not at risk	Defer — they have more experience and clinical responsibility
A senior makes a decision that you believe puts a patient at risk of harm	Challenge — patient safety overrides hierarchy
A senior asks you to do something beyond your competence	Decline respectfully — explain your limitations and ask for support
A senior behaves unprofessionally but it does not directly affect patient care	Address it — through appropriate channels, not confrontation
A senior behaves unprofessionally and it directly affects patient care	Act immediately — raise the concern with the appropriate person

When to Defer to Senior Colleagues

Deference is appropriate and expected in many clinical situations. Medical students and junior doctors are still learning, and seniors have accumulated experience, knowledge, and clinical responsibility.

Situations Where Deference Is Appropriate

Scenario	Why deference is correct
The consultant chooses a different antibiotic than the one you learned about in lectures	Clinical decision-making involves nuance that textbooks cannot fully capture; the consultant has assessed the specific patient
The registrar decides to discharge a patient you think should stay longer	The registrar has assessed the patient and taken clinical responsibility; if you have no specific safety concern, defer
A senior nurse suggests a different approach to wound care than you expected	Experienced nurses often have practical knowledge that complements medical training
The consultant disagrees with your suggestion during a ward round	If patient safety is not at risk, accept the decision and learn from it

How to Defer Professionally

Deference does not mean blind obedience. It means:

Express your view — "I thought the guidelines suggested X; could you help me understand why Y is better in this case?"
Listen to the explanation — The senior may have information or experience you lack
Accept the decision — If their reasoning is sound and patient safety is maintained
Learn from the interaction — Use it as a learning opportunity, not a defeat
Document if needed — In rare cases, record that you raised a concern and the senior's response

SJT insight: Questions that test deference often present a scenario where a senior does something differently from what you learned. The correct answer is almost always to ask a clarifying question politely rather than either silently accepting or aggressively challenging.

When to Challenge Senior Colleagues

Challenging a senior is one of the most difficult things to do in healthcare, but it is a professional duty when patient safety is at stake.

Situations Where Challenge Is Required

Scenario	Why challenge is necessary
A consultant prescribes a dose that is clearly outside safe limits	Direct risk to the patient
A registrar dismisses your observation of a deteriorating patient	The patient may come to harm if the deterioration is not addressed
A senior asks you to perform a procedure you are not trained for	Patient safety and your professional integrity are at risk
A senior colleague appears to be under the influence of alcohol or drugs	Immediate and serious patient safety risk
A senior makes a discriminatory comment that affects patient care	Patient dignity and equality of care are compromised

How to Challenge Respectfully

The SJT rewards challenges that are respectful, clear, and focused on the patient:

Step 1: Clarify

"I may have misunderstood, but I thought the maximum dose of [drug] was [amount]. Could we double-check?"
This gives the senior an opportunity to correct themselves without losing face.

Step 2: State your concern clearly

"I am concerned about [specific observation]. I believe this could indicate [specific risk]."
Use "I" language and focus on facts, not blame.

Step 3: Propose an action

"Could we review the patient together?" or "Would it be appropriate to get a second opinion?"
Offering a constructive next step is more effective than simply criticising.

Step 4: Escalate if necessary

If the senior dismisses your concern and you still believe patient safety is at risk, escalate to the next level — another senior, the clinical lead, or the on-call consultant.
You are never wrong to escalate a genuine patient safety concern.

Working with Senior Colleagues — When to Defer, When to Challenge