What to Do If You Witness Unethical Behavior While Shadowing

The worst ethical lesson you’ll ever get might be the one nobody meant to teach you.

You’re shadowing to learn medicine, not to watch corners being cut, patients disrespected, or rules quietly ignored. But it happens. And if you do not know exactly what to do in that moment, you’re at risk of either becoming complicit—or blowing things up in a way that hurts you and does not help the patient.

This is where you need a script and a plan, not vague advice.

(See also: Managing Shadowing When You Work Nights or Weekends to Pay Tuition for more details.)

Below is exactly what to do, step‑by‑step, if you witness unethical behavior while shadowing as a premed or early medical student.

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Step 1: Freeze the Scene and Get Very Specific

Before you react, you need to be brutally clear on what you actually saw.

Shadowing is messy. You’re new, the culture is unfamiliar, and a lot of what you see will feel uncomfortable but is not actually unethical. You must distinguish between:

• Truly unethical behavior
• Questionable or gray‑zone behavior
• Normal but uncomfortable realities of clinical care

Ask yourself these questions immediately after

Write down the answers on your phone (privately) or in a notebook after you leave the clinical area:

1. What exactly happened?

   • Who said/did what?
   • What were the exact words, actions, or omissions?

2. Who was present?

   • Doctor, nurse, tech, student, patient, family?
   • Anyone else who might have noticed?

3. When and where did it occur?

   • Clinic room 3? OR? Hallway? Nurses’ station?
   • Time of day and context (busy ED, routine clinic, etc.)

4. How did it affect the patient or staff?

   • Emotional harm (shaming, disrespect)
   • Physical harm (unsafe action, ignoring symptoms)
   • Legal/ethical harm (HIPAA violation, consent issues, falsifying notes)

If you can’t describe the behavior specifically (“He was rude” vs. “He loudly mocked her weight in front of other patients”), you’re not ready to escalate.

Quick “gut check” categories

You’re probably dealing with something to take seriously if it falls into one of these buckets:

• Patient safety risk
  Example: Physician skips required checks before a procedure, ignores a clear allergy warning, or discharges a clearly unstable patient.

• Exploitation or boundary violation
  Example: Inappropriate comments, sexual jokes, clear flirting with a patient, touching that doesn’t seem medically indicated.

• Serious confidentiality breach
  Example: Staff loudly discussing patient details with names in a public hallway or elevator; posting identifiable info on social media.

• Discrimination or harassment
  Example: Racial slurs, mocking LGBTQ+ patients, denying care based on bias, belittling a patient’s religion or background.

• Dishonesty or falsification
  Example: Documenting vitals or an exam the clinician didn’t actually perform; backdating notes; telling a patient something clearly untrue to cover a mistake.

If what you saw fits those categories, you shouldn’t just let it go.

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Step 2: Prioritize Safety—Yours and the Patient’s

Your first obligation as a shadowing student is safety, not heroics.

Ask yourself three questions in this order:

1. Is the patient in immediate physical danger?
2. Is the patient in serious immediate emotional/psychological danger?
3. Is my personal safety or status at real risk if I intervene right now?

If there’s imminent physical danger

This is rare, but it happens.

Examples:

• A physician is about to administer a medication you know the patient is allergic to (because you just heard the nurse say it clearly).
• Someone is actively rough with a patient in a way that looks like abuse, not just firm medical care.
• A staff member is intoxicated or clearly impaired while providing care.

You’re not the hero of the story, but you still have options:

• Use a “naive question” intervention
  “Excuse me, I might have misunderstood, but didn’t the chart say she was allergic to that medication?”

• Redirect to another staff member
  If there’s a nurse/tech nearby:
  “Sorry, I’m new, but I thought I heard something about an allergy—am I confused?”

You’re not accusing. You’re buying time and drawing attention.

If that fails and you truly believe a patient will be seriously harmed, you may need to:

• Step out and immediately find the charge nurse or another senior staff member.
  “I’m a premed shadowing with Dr. X; I’m concerned something unsafe is about to happen in Room Y.”

That’s a heavy step, but in immediate danger situations, it’s justified.

If there isn’t immediate danger

Most unethical behavior isn’t an emergency. It’s disrespect, corners cut, or culture rot.

In those cases:

• You do not confront in the moment.
• You do commit to addressing it later through the right channel.

Trying to “call out” your attending or preceptor in front of a patient is likely to:

• Backfire politically
• Make the patient more anxious
• Shut down any chance of honest conversation later

So you hold the reaction for now, and plan the response.

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Step 3: Decide Who to Talk To—and In What Order

Who you speak with depends on your status and how formal your shadowing is.

Scenario A: You’re an informal premed shadowing in a private office

Your “chain of command” usually looks like this:

1. Your preceptor directly (if safe)
2. The office manager or practice administrator
3. Your premed advisor or health professions advisor
4. The relevant licensing board or reporting authority (for severe behavior)

For many private practices, there’s no big institution to report to. That means your decision about step 1 matters.

Scenario B: You’re shadowing in a hospital or large clinic

Your chain of command usually looks like:

1. Assigned preceptor (if safe and not the person involved)
2. Clerkship director / student coordinator (if this is through a program)
3. Hospital ombuds office or compliance office
4. Anonymous reporting system (many hospitals have one)
5. External reporting only if internal channels fail and the risk remains serious

When in doubt, a student affairs dean or pre-health office can help you strategically choose among these.

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Step 4: How to Talk About What You Saw (Without Blowing Up Your Future)

You’re not writing a social media post. You’re describing a concern inside a profession that’s small and interconnected.

So you stay:

• Specific
• Neutral in tone
• Focused on behavior and impact, not on labels

Script for talking to your preceptor (if they’re not the problem)

Use this if you saw another staff member or clinician behave unethically:

“Dr. Patel, do you have a minute for a quick question about something that happened earlier?

When we were in Room 4, I noticed [describe concrete behavior: e.g., ‘the nurse discussed the patient’s HIV status loudly at the nurses’ station where other visitors could hear’]. It made me uncomfortable because I thought that might be a privacy issue.

I’m still learning, so I wanted to ask: is that considered acceptable practice, or is that something that should be handled differently?”

You’re doing three things:

1. Reporting what you saw.
2. Asking for clarification instead of accusing.
3. Creating a chance for the preceptor to explain, correct, or escalate.

Script for when the preceptor is the one behaving unethically

This is trickier. It also happens.

Example:

• Preceptor mocks a patient’s weight in front of them.
• Preceptor makes sexual jokes about a nurse.
• Preceptor blatantly violates confidentiality.

You have three options, depending on severity and safety:

Option 1: Ask a neutral, reflective question later

“Dr. Smith, could I ask you about something I was unsure about from earlier?

When we were with the patient with diabetes, the comment about her weight felt harsh to me as an observer. I’m trying to learn appropriate ways to talk about sensitive topics. How do you think patients generally experience comments like that?”

Sometimes they’ll realize how it landed. Sometimes they won’t. You’ve still sent a signal.

Option 2: Skip confronting them and go above

If you felt threatened, unsafe, or the behavior was clearly beyond “teaching moment” territory (e.g., sexual harassment, clear abuse, obvious discrimination), you bypass them.

In that case, you speak to:

• The clinic manager (for private practice)
• The student coordinator or pre‑health office that placed you
• The hospital’s student affairs or compliance office

When you do, you stay factual:

“I’m a premed student shadowing Dr. X on [dates]. On [date] during a visit with [brief patient descriptor, not name], Dr. X [describe behavior precisely].

This made me uncomfortable because [connect to safety, professionalism, or ethics]. I’m not sure what the appropriate next step is, but I felt I had a responsibility to let someone know.”

You’re not the judge, jury, and executioner. You’re a reporter of facts.

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Step 5: Document Privately and Professionally

Memory is slippery, especially when you’re stressed.

You should create a private record of concerning incidents, including:

• Date and time
• Location and setting
• Who was present
• What was said/done (verbatim if you remember exact phrases)
• Your response (if any)
• Who you reported it to and when

Rules:

• Don’t include names or identifying details of patients.
• Don’t write this in your official “shadowing hours” log that you might later submit.
• Don’t store this in a shared cloud folder with others.

Think: personal, offline document or a secure notes app with a lock.

If things escalate and you are ever questioned, having this contemporaneous record strengthens your credibility.

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Step 6: Protect Your Own Position Without Becoming Silent

You’re not a resident with a contract and institutional backing. You’re a premed or early medical student, often functioning as a guest.

So you balance courage with strategy.

Concrete self‑protection moves

• Do not confront when you’re alone with the physician in a closed room if the power imbalance is extreme and the topic is volatile.
  Pick a slightly more public, but still professional setting if you want a direct talk.

• Avoid committing judgmental language to email early.
  First emails should be neutral, like:
  “I observed something during my shadowing with Dr. X that I’d appreciate guidance about. Could we schedule a short meeting?”

• If you feel unsafe with that preceptor, end the shadowing.
  You are allowed to withdraw. You can cite “schedule conflicts” or “realized I need a different specialty exposure” if you’re not ready to detail everything.

• Loop in a trusted advisor early.
  Pre‑health advisor, faculty mentor, or dean’s office. They’ve seen these patterns before and can tell you:

  • Whether you’re overreading a situation
  • How this institution usually handles complaints
  • How to protect your trajectory (letters, evaluations) while acting ethically

You are allowed to choose carefully when and how you act. That doesn’t make you cowardly. It makes you effective.

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Common Scenarios and Exactly What to Do

Let’s go through a few high‑yield situations you’re likely to run into.

Scenario 1: The “Joke” That Wasn’t Funny

You’re shadowing in clinic. After an obese patient leaves, the physician laughs with the nurse and says, “She’ll never stop eating long enough to fix her diabetes.”

What you do:

1. In the moment: You do nothing visible. You keep a neutral face.

2. Right after clinic (or next quiet moment) you ask:

   “Dr. Lee, can I ask about something that confused me? After that visit, the comment about the patient’s weight stuck with me. I’m trying to understand how to balance candid talk about lifestyle with being sensitive. Can you share your thinking about how you talk about these issues with patients?”

3. Watch:

   • If they show insight (“You’re right, that was unprofessional”), that’s useful.
   • If they double down (“Patients like that don’t deserve sympathy”), that’s a deeper professionalism concern.

4. If the pattern repeats and is clearly discriminatory or demeaning, document and discuss with:

   • Your pre‑health advisor (for off‑site shadowing)
   • Clerkship director/student affairs (for school‑based shadowing)

Scenario 2: HIPAA Breach in the Hallway

You’re in a hospital hallway. A resident loudly says, “The guy in 324 with HIV and meth use is driving me crazy,” while visitors and staff walk by.

What you do:

1. In the moment: You say nothing. You’re not going to “shush” a resident in front of others.

2. Later that day, in a quieter moment, you ask:

   “Hey, I’m still learning the boundaries around confidentiality. Earlier in the hallway when we were talking about the patient in 324 and his diagnosis out loud, is that considered okay? I thought hallway conversations about specific patients might be a concern.”

3. Best case, they realize you’re right. Worst case, they dismiss you. Either way, you’ve flagged it.

4. If public, identifying conversations are frequent and egregious, it’s reasonable to bring this to:

   • Clerkship leadership
   • A compliance or privacy office (usually through a protected channel)

Scenario 3: You Witness Clear Sexual Harassment

During shadowing, your preceptor repeatedly makes sexually suggestive comments to a nurse: innuendo about her body, “jokes” about what she does off‑duty, etc. The nurse looks uncomfortable and withdrawn.

This is not a minor professionalism issue.

What you do:

1. Do not confront the attending directly. The power gradient is too steep.

2. Document the incidents after you leave: dates, approximate times, who was present, what was said.

3. As soon as reasonably possible, speak to:

   • The clerkship director or student affairs dean (if school‑based)
   • The clinic manager or institutional HR/compliance (if external)

   Script:

   “I’m a premed student shadowing Dr. X on [dates]. On multiple occasions, I observed Dr. X make sexually suggestive comments to [staff role, not name] in front of others. For example, on [date], he said [quote]. The staff member appeared uncomfortable.

   I’m concerned this may be harassment. I don’t know the formal process here, but I felt obligated to make someone aware.”

4. Ask explicitly about:

   • Retaliation protections
   • Confidentiality of your identity as the reporter

Most institutions take sexual harassment reports seriously. They should tell you next steps.

Scenario 4: Unsafe Clinical Shortcut

You watch your preceptor skip handwashing between patients multiple times. No sanitizer, no sink. Just in and out of rooms.

Unethical? Yes. Dangerous? Potentially.

What you do:

1. After a session, not in front of a patient, you ask:

   “Can I ask a quick infection control question? In school and training sessions, they emphasize hand hygiene between every patient, but I noticed sometimes we go room‑to‑room pretty quickly. For my learning, can you walk me through when you consider it essential vs. optional?”

2. They might reveal:

   • They’re using an alcohol gel you didn’t see.
   • They’re negligent and minimize it (“We don’t have time for all that”).

3. If it’s clearly a pattern of noncompliance:

   • Note it in your private record.
   • Decide whether to report to infection control / clerkship leadership based on:
     • Severity
     • Repetition
     • Culture of the institution (ask a trusted mentor first)

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Step 7: Aftermath—Processing and Moving Forward

Witnessing unethical behavior can shake your idealism. That’s normal.

Do some intentional follow‑up:

• Debrief with someone you trust
  Advisor, mentor, therapist, or senior student. You’re not weak for being disturbed by what you saw.

• Reflect on your future boundaries
  Ask yourself:

  • What will I refuse to participate in as a student/resident?
  • How do I want to speak up in ways that are sustainable?

• Capture this for your growth, not your resentment
  In a private reflection (not your official shadowing log), note:

  • What this taught you about the hidden curriculum in medicine
  • How you want to handle such situations when you have more authority

Down the line, this can become a powerful, mature story in interviews or essays—if you frame it around professionalism, patient advocacy, and humility, not as a rant.

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FAQ

1. Could reporting unethical behavior hurt my chances of getting a letter or into that program?
Yes, there is always some risk, which is why you must be strategic. If the person behaving unethically is your only potential letter writer, strongly consider finding alternative mentors rather than tolerating abuse for a letter. When reporting, use formal channels, keep your tone factual, and document everything. Many institutions explicitly protect students from retaliation; ask about those protections when you report.

2. What if I am not 100% sure what I saw was actually unethical?
That is exactly when you seek a confidential sounding board. Start with a pre‑health advisor, trusted faculty mentor, or dean’s office. Present the facts without names if possible and ask, “How would you interpret this as a professional?” They can help you distinguish between awkward but standard practice versus truly problematic behavior—and guide your next steps.

3. Should I ever post about this anonymously online (Reddit, SDN, etc.) to get advice?
No. Public forums are terrible places for handling real‑world, identifiable clinical situations. You might unintentionally disclose protected information, misrepresent the context, or create discoverable material that complicates any investigation. Get advice from real‑world mentors, not strangers online. If you need peer validation, keep all details fully de‑identified and never mention names, locations, or specific dates.

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Key points:

1. Get specific about what you saw and prioritize safety before action.
2. Use thoughtful questions and proper channels rather than public confrontation.
3. Protect your position, document privately, and let this shape—not shatter—your professional ethics.