What would you do if you saw a colleague drunk/drinking alcohol prior to a surgery?

Food for Thought: an example interview question

You are entering a hospital staff room 15 minutes prior to conducting surgery with your colleague Dr John. When you enter, you see Dr John take a swig of a drink from a bottle and quickly close his locker. You suspect the drink is alcohol. What would you do in this situation?

An ethical scenario! Although you are less likely to get this sort of interview question at an Oxbridge interview, they frequently come up in MMI and traditional panel interviews so being able to apply your foundational ethical knowledge is essential.

Answer:

When looking at an ethical scenario, it is always important to have the four pillars of medical ethics at hand to help structure and inspire your answer. The four pillars are:

• Beneficence (doing good)

• Non-maleficence (to do no harm)

• Autonomy (giving the patient the freedom to choose freely, where they are able)

• Justice (ensuring fairness)

In this specific scenario, you are asked to put yourself in the shoes of a doctor and balance your duty to ensure patient safety and your duty of care for your colleague and the work environment. As such, it is vital that you do not make any assumptions or accusatory claims but rather you approach your colleague in an open manner and find out what they were drinking because it very well may be water!

Assuming that you have managed to identify that the drink is in fact alcohol, from a patient safety standpoint, Dr John should definitely not be allowed to carry out the surgery. You should talk to him in a calm manner and encourage him to go home, if this proves difficult then you can involve a superior colleague. However, it is also equally important that you only involve the necessary parties, as you don’t want to spread gossip or rumours around the hospital. Make sure that Dr John does not drive home if he has been consuming alcohol and that he gets home safely.

Now that Dr John is safely on his way home/is being dealt with, you have to either find emergency cover so that the scheduled surgeries can go ahead, or inform the patients and relevant staff that, due to personal circumstances, the scheduled surgeries will not go ahead today.

In the slightly longer term, it is important that you try to work out the underlying cause of the alcohol so that it does not happen again. Of course, this is only if Dr John is comfortable talking to you about it. If he is not, then it is worth suggesting referral to the relevant services that will help del with the problem. Likewise, it is your responsibility to ensure that the incident is accurately reported and is on file so that the relevant procedures can take place.

If you have concerns that a colleague may not be fit to practice, you must take appropriate steps without delay, so that the concerns are investigated and patients protected where necessary.

• You have a few options:

• a. You can report your concerns to your clinical or medical director

• b. You can discuss your concerns with National Clinical Assessment Service (NCAS).

• c. report your concerns to the GMC

Returning to the ethical pillars, the most relevant to this case are beneficence and non-maleficence. Of course, you want beneficence for your colleague, and you will help to ensure this by helping him get home safely and exploring any underlying issues later down the line. Likewise, you want to ensure non-maleficence to the patients, and you will do this by ensuring the surgery does not go ahead unless there are qualified and able surgeons to take on the role, by ensuring appropriate cover for the shift is provided and by reporting any concerns you have to the relevant people.

Although this question does at first seem daunting, try to think through it logically by looking at the relevant stakeholders and your duty (in terms of the ethical pillars) towards each of them - hopefully by using a model like this your answer will come naturally and begin to take structure!