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PUID: 63 || PLAB 2 Mock 7 :: ManagingColleagues3: Student Abuses Drugs And Alcohol


Summary:

This station focuses on managing a colleague suspected of being under the influence of cocaine at work, prioritising patient safety, professionalism, and appropriate escalation in line with GMC guidance.



Key Points:


1. Patient Safety (MOST IMPORTANT)

  • Always prioritise patient safety above everything else

  • Directly assess:

    • Whether the colleague is currently under the influence

    • Whether they have:

      • Seen any patients

      • Performed any procedures

  • If missed → automatic station failure

  • If intoxicated:

    • Stop them from working immediately

    • Prevent further patient contact


2. Identifying Current Intoxication

  • Do NOT focus only on past use (e.g., last night)

  • Key issue = possible current intoxication

  • Clues:

    • Hyperactivity

    • Behavioural changes

    • Reports from nurses (important cue in question)

  • Always explicitly ask:

    • “Are you under the influence right now?”


3. Use of Information in Question

  • If nurses are mentioned:

    • Use this to support your concern

    • Example:

      • “I’ve noticed this, and nursing staff have also raised concerns…”

  • Never ignore cues given in the scenario


4. Substance Use History

  • Explore thoroughly:

    • Type of substances (cocaine, alcohol, others)

    • Frequency and quantity

    • Source of drugs

    • Attempts to quit

    • Insight into problem

  • Ask:

    • “Do you feel you might have a problem?”


5. Professional Responsibilities

  • This is a professional dilemma, not a clinical one

  • Guided by  (Good Medical Practice):

    • Must act if patient safety is compromised

    • Must raise concerns about colleague fitness to practise

  • Key principles:

    • Patient safety first

    • Honesty and integrity

    • Duty to escalate concerns


6. Escalation & Reporting

  • Essential steps:

    • Encourage colleague to:

      • Inform Educational Supervisor

    • If they refuse:

      • You must escalate yourself

  • Explain:

    • This is to help them, not punish them

    • Early action prevents serious consequences


7. Confidentiality

  • Maintain confidentiality BUT:

    • Not absolute

    • Must be broken if:

      • Patients are at risk

  • Clearly state:

    • “I will need to escalate this due to patient safety concerns”


8. Management Approach

  • Do NOT just “advise and leave”

  • Key actions:

    • Remove from clinical duties

    • Escalate to senior

    • Offer support services:

      • Occupational health

      • Substance misuse services

  • Provide reassurance:

    • Early help can protect career


9. Communication Style

  • Be clear and direct:

    • Use the word “cocaine” if needed

  • Avoid:

    • Being vague or overly soft

  • Structure:

    • Observation → Concern → Patient safety → Action


10. Examiner Expectations (PLAB 2 Focus)

Based on examiner guidance :

  • Do NOT miss the main issue (patient safety)

  • Stay relevant and focused

  • Avoid over-rehearsed phrases

  • Show:

    • Logical thinking

    • Clear decision-making

    • Appropriate escalation


Important Considerations:

  • Never say drug use is “okay”

  • Illegal drug use is always unacceptable for doctors

  • Even outside work hours, it violates professional standards

  • Must balance:

    • Supporting colleague

    • Protecting patients

  • Always:

    • Offer help

    • But do not compromise safety



Diagnostic Approach (Station Strategy):

  1. Build rapport

  2. Identify concern (use observations + nurse input)

  3. Ask directly:

    • “Are you under the influence right now?”

  4. Assess risk:

    • Seen patients?

    • Done procedures?

  5. Take substance history

  6. Assess insight and willingness to seek help



Management:

  • Immediate Actions:

    • Stop colleague from working

    • Ensure no patient harm

  • Escalation:

    • Encourage self-reporting

    • Escalate to:

      • Educational supervisor

      • Senior clinician

  • Support:

    • Occupational health referral

    • Substance misuse support

    • Encourage rehabilitation

  • Follow-up & Safety Netting:

    • Offer ongoing support

    • Provide contact availability

    • Monitor wellbeing



Communication Skills:

  • Acknowledge difficulty:

    • “I understand this is uncomfortable to discuss”

  • Be non-judgmental but firm

  • Avoid:

    • Overuse of stock phrases

  • Use:

    • Clear, structured language

  • Safety-net:

    • Offer support and availability



Ethical Considerations:

  • Patient safety overrides confidentiality

  • Duty to:

    • Raise concerns about impaired colleagues

  • Maintain:

    • Professional integrity

  • Follow GMC principles:

    • Protect patients

    • Act if safety is compromised



Additional Resources:

  • GMC: Good Medical Practice 

  • PLAB 2 Examiner Tips

  • Understanding PLAB marking domains

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