PUID: 59 || PLAB 2 Mock :: Medical Ethics: Colleague with Alcohol Problem

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Summary

This scenario involves managing a situation where you discover a fellow doctor attending work under the influence of alcohol. The focus is on safeguarding patient safety, upholding professional and ethical standards, and managing the matter in line with GMC guidance.

Key Points

Professional & Ethical Obligations

• Primary duty is to protect patient safety (non-maleficence).

• GMC’s Good Medical Practice mandates acting promptly if patient safety may be compromised.

• A colleague under the influence of alcohol is a serious breach of professionalism and a risk to patient care.

Immediate Clinical Considerations

• Patients already seen by the impaired doctor must be reviewed for errors or omissions.

• Duties should be reallocated by the consultant to prevent further risk.

• The impaired colleague should be removed from the clinical environment for safety.

Escalation Process

• Confront the colleague respectfully, giving them the opportunity to escalate the matter themselves.

• If they refuse, you must escalate to the consultant or educational supervisor immediately.

• Maintain factual, non-judgmental documentation of the incident.

Important Considerations

• Do not “cover” for the colleague — it may harm patients and breach GMC standards.

• Patients may have noticed the smell of alcohol; reputational damage and loss of trust are possible.

• Colleague’s personal issues (e.g., breakup, stress) do not excuse unsafe behaviour but may require support.

• Avoid gossip; keep the matter confidential except to relevant parties.

• Offer information about support services: occupational health, practitioner health programme, alcohol cessation services.

Diagnostic Approach (to the situation, not the patient)

1. Recognise the risk — smell of alcohol, altered behaviour.

2. Verify concerns — check patients seen, speak directly to colleague.

3. Assess impact — any immediate clinical errors?

4. Take action — remove from duty, reassign patient care.

5. Escalate — inform consultant or educational supervisor.

6. Document — time, date, observations, actions taken.

Management

1. Immediate Safety Actions

   • Stop the colleague from seeing more patients.

   • Arrange urgent review of patients they attended.

2. Escalation

   • Request the colleague to self-report to consultant.

   • If refused, escalate yourself.

3. Support & Rehabilitation

   • Signpost to professional support services.

   • Encourage ongoing monitoring and follow-up.

4. Follow-up

   • Maintain confidentiality.

   • Participate in any investigation.

   • Ensure learning outcomes are implemented in the team.

Communication Skills

• Begin with small talk to set a respectful tone, then be clear and direct about your concern.

• Use ethical reasoning rather than authority (“patient safety risk” not “I’m your senior”).

• Show empathy — acknowledge personal difficulties but stress the non-negotiable patient safety duty.

• Prepare for defensiveness — remain calm, stick to facts, avoid emotional escalation.

• If accused of gossiping — clarify you are acting on first-hand observation and/or direct reports, for safety reasons.

Ethical Considerations

• Non-maleficence — avoid causing harm to patients.

• Duty of candour — be open and honest when safety is compromised.

• Confidentiality — share information only with relevant senior staff.

• Fitness to practise — alcohol at work breaches professional boundaries and public trust.

• Supportive culture — balance accountability with compassion.

Additional Resources

• GMC Good Medical Practice (Domains 3 & 4 — safety, professionalism, raising concerns)

• GMC Guidance: Raising and acting on concerns about patient safety

• Practitioner Health Programme (PHP) – confidential support for doctors with health issues

• NHS Occupational Health Services

• PLAB 2 examiner guidance on avoiding stock phrases and maintaining genuine interaction