Colleague Consultation · Intermediate · Communication

Managing a Colleague's Suspected Substance Misuse

Practise this PLAB 2 colleague consultation station on Substance Misuse. 8-minute voice AI simulation with feedback on all 3 marking domains.

Clinical scenario

You are a Senior House Officer (SHO) in a busy A&E department. Your colleague Dr Sarah Mills, an experienced consultant, has been showing signs of impaired performance over the past few weeks. You have become concerned about patient safety and must approach this sensitively yet firmly.

Background notes: PMH: Depression (untreated), recent bereavement (mother, close friend), divorce 2 yrs ago, estrangement from daughter, financial stress

What this station tests

  • Immediate patient safety action: she cannot see patients if impaired, regardless of seniority
  • Escalation to clinical director: seniority does not override patient safety
  • GMC duty: professional obligation to act when a colleague poses a risk
  • Practitioner Health Programme: confidential support for doctors with substance misuse
  • Framing as protective not punitive: protecting patients and her career

How to use your 8 minutes

  • 0-1 min — Introduction: Introduce yourself and your role. State the purpose of the consultation clearly.
  • 1-3 min — Present Case: Use SBAR structure. Situation, Background, Assessment, Recommendation. Be concise and relevant.
  • 3-5 min — Discussion: Discuss differential diagnosis and management. Listen to colleague's perspective. Share concerns professionally.
  • 5-7 min — Agree Plan: Agree on management plan. Clarify roles and responsibilities. Discuss escalation criteria.
  • 7-8 min — Closing: Summarise agreed actions. Confirm documentation. Arrange follow-up communication.

Consultation approach

The opening

Suspected substance misuse in a senior colleague is the most difficult colleague conversation. Dr Mills is 48, a consultant, and you have noticed slurred speech, unsteady gait, and a medication discrepancy. Patient safety is at immediate risk. Open with: 'Dr Mills, I need to speak to you privately. I am concerned about something I have noticed.'

Core approach

This is different from the wellbeing conversation: patient safety is at immediate risk. If she is impaired right now: she cannot see patients. This must be addressed today, not next week. Express your concern directly: 'I have noticed you seem unwell today. I do not think you are safe to see patients right now.'

She may deny, become angry, or break down. If she denies: 'I understand this is difficult, but I have a duty to patients. I need to speak to the clinical director.' If she admits: 'Thank you for being honest. Let me help you get support, but you cannot see patients today.'

GMC duty is clear: if a colleague's conduct or health poses a risk to patients, you must take action. This may mean escalating to the clinical director today, even if she is senior to you. Seniority does not override patient safety.

Closing and safety netting

Immediate actions: she must stop clinical work today. Inform the clinical director. Occupational health referral. Practitioner Health Programme. She will need a fitness-to-practise assessment before returning to clinical work. This is not punitive: it is protective (for patients and for her).

Support her as a colleague: 'I know this is devastating. I am not trying to end your career. I am trying to protect you and your patients.' Document everything. Follow-up: check in with her, but the clinical governance process must proceed.

How examiners mark this station

Examiners will assess both Domain 1 (Data Gathering) and Domain 2 (Clinical Management) as primary: clarity and structure of your case presentation, appropriateness of your clinical reasoning, and whether you agree a clear plan. Domain 3 (Interpersonal Skills) assesses professional communication and collaborative approach.

Domain 1 (Supporting)

Scores well: Signs identified. Immediate risk assessed. Medication discrepancy documented.

Costs marks: Not recognising impairment.

Domain 2 (Primary focus)

Scores well: Clinical work stopped. Clinical director informed. Occupational health. Practitioner Health Programme. Documentation.

Costs marks: Not stopping clinical work. Not escalating. Not documenting.

Domain 3 (Primary focus)

Scores well: Direct but compassionate. Not accusatory. Offering support alongside governance. Acknowledging how difficult this is for her.

Costs marks: Accusatory. Threatening. No support. Public confrontation.

Common examiner feedback (and how to fix it)

Did not communicate clinical information effectively

Fix: Use SBAR (Situation, Background, Assessment, Recommendation) every time. State clearly what you need from the colleague at the outset.

Did not identify the patient's problems and/or did not develop a management plan adequately

Fix: Before ending, confirm: What is the plan? Who is doing what? When will you communicate next? Document the agreed plan.

Common mistakes in this station

  1. Not acting because she is senior: seniority does not override patient safety
  2. Waiting to see if it happens again: if she is impaired now, patients are at risk now
  3. Not offering support alongside the escalation: she needs help, not just governance

Resitting PLAB 2?

If colleague consultation stations have been challenging, practise the SBAR format until it is automatic. The most common issue is failing to clearly state why you are consulting the colleague and what you need from them. Be direct about your clinical question.

Example opening

Hello, this is Dr [Name], I'm the FY2 on [ward]. Thank you for taking my call. I'd like to discuss a patient I'm looking after and get your advice on management.

Frequently asked questions

What is the best way to structure the substance misuse discussion with a colleague?

Suspected substance misuse in a senior colleague is the most difficult colleague conversation. Dr Mills is 48, a consultant, and you have noticed slurred speech, unsteady gait, and a medication discrepancy. Patient safety is at immediate risk.

What are examiners marking in this substance misuse station?

Marks are won for: Signs identified. Immediate risk assessed. Medication discrepancy documented. Marks are lost for: Not recognising impairment.

What is the most common mistake candidates make in this substance misuse station?

Not acting because she is senior: seniority does not override patient safety. Another frequent error: Waiting to see if it happens again: if she is impaired now, patients are at risk now.

How do I prepare for this station if I have not managed substance misuse in clinical practice?

Structure beats experience here. Focus on escalation to clinical director: seniority does not override patient safety. Work through the consultation approach above, then rehearse it aloud under the 8-minute time pressure so the structure holds up in the exam.

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