You are a junior doctor working in a busy emergency department. You notice that a senior colleague, Dr. Chen, appears to be under the influence of alcohol during their shift. Dr. Chen is about to see a critically unwell patient.
What would you do in this situation?
What factors would you consider in deciding how to act?
See Q1 to Q4 example answers
Here's the same scenario answered at each quartile, from weakest to strongest. Notice how the Q4 answer starts with the people involved, while the Q1 answer jumps to action and buzzwords.
I would report Dr. Chen to the head of department immediately. Patient safety is the number one priority and I would act in a non-confrontational, non-judgmental way. I would document everything and follow the hospital's policy on impaired practitioners. It is important to maintain professional standards at all times.
First, I would ensure the critically unwell patient is safe by offering to see them myself or asking another colleague to step in. I would then approach Dr. Chen privately and express my concern. If Dr. Chen refused to stand down, I would escalate to the consultant on call. I would also consider whether Dr. Chen might need support, as substance use could indicate burnout or personal difficulties.
My immediate priority would be patient safety, I would find a way to ensure Dr. Chen does not see the critically unwell patient, perhaps by offering to take over or quietly asking a registrar to step in. I would then speak to Dr. Chen privately, expressing genuine concern for their wellbeing rather than accusation. I understand that doctors can face enormous stress and this might be a sign that they are struggling. I would encourage them to step away from clinical duties for the rest of the shift and offer to help them access support services.
This is an incredibly difficult situation, and I can only imagine how much pressure Dr. Chen must be under to come to work in this state. My first step would be to quietly and discreetly ensure patient safety, I would take over the critically unwell patient myself or arrange another doctor to do so, without drawing attention or embarrassing Dr. Chen in front of staff. Once the immediate risk is managed, I would find a private moment to sit with Dr. Chen. I would lead with care, not accusation, something like, "I noticed you don't seem yourself today, and I'm worried about you. Is everything okay?" This opens the door for them to share what is going on without feeling attacked. I would gently suggest they step away from clinical duties for the rest of the shift, framing it as looking after themselves, not punishment. I would offer practical support: "Let me help you get home safely" or "I can cover your patients." I would also encourage them to reach out to the Doctors' Health Advisory Service or their GP. I would need to notify the consultant on call, because patient safety requires it, but I would do so with sensitivity, framing it as concern for a colleague rather than a report. I recognise this could affect Dr. Chen's career, so I would want to handle it in a way that protects patients while treating my colleague with dignity.