Colleague related scenarios

1. Coming late
2. Social media (twitter dr goodwill, facebook related, f1 doctor written abt
schizophrenia, david f1 adding pts in friend list nurse will tell u this
3. Medical student taking drugs
4. Alcohol for 2 weeks
5. F2 taking alcohol for months n months, clumsy n coming late
6. Dr A want to talk abt dr B, dr b is coming late, smelling alcohol n clumsy
7. Cocaine

APPROACH:
1.build rapport: hello, how are u doing, how is ur rotation, how are things
going ? How is the department?
2. Talk about topic: I have been smelling alcohol near you, I have noticed u
coming late, I have noticed u posted something on social media abt a patient n I
am here to talk about it
3. Gather data hx video games, explore
4. Implications: tell why its wrong(coming late why it can be problematic, n how
it will affect it future profession, taking alcohol drugs while coming to hsp, why
posting on social media abt pt is wrong)
5. Solutions:

1.COMING LATE-5yr std coming late, by one hr, speak to him about this
1.Rapport:Hello, u are Alex or are u Alex, I am Amna one of the f2, we have met before,
How are u today
I understand u are in 5th year of med school right
How is it going ?
Are u excited about finishing med school ?
How are u finding this department?
How is the staff ?
2.Topic: So Alex I have been noticing this for few days that u are coming late these days can I
pls ask u why u are not able to make it on time
Alex: I am not late
Unfortunately its not only me but nursing staff has also noticed the same, I am wondering is
it something going on
That u are not able to make it on time
Is anything going on ?
Do u travel from far ?
Alex no
Then any reason why u are coming late
Alex: oh its just 5 mins
I am afraid Alex even coming late by 5 mins is late
3. History:
What is the reason u are coming late ?
Alex sometimes I come early n stay with my friends
Are ur frnds med students?
What time do u wake up
Alex: 9
At what time do u leave for work ?
Is there any possibility u may sleep late ?
Alex yea late
What time ?
Alex 3am
Can I please ask were u reading at that time
Alex no I was using phn
Can I ask what were u using on phn
Alex : On social media
What do u do on social media ?
Do u play any games or run a page on social media ?
Alex: play gams
Do u play daily ?
For how many hrs ?
How much do u sleep ?
What are ur hobbies
Do u go out with frnds ?
Do u drink alcohol?
Do u drink on weekends?
How much do u drink ?
How are ur exams ?
Are u passing ur exams ?
Are u given any assignments ?
Are u able to complete them on time ?
Alex: I am getting A grade its good
4. Implications: Let me explain to u why coming late to work is wrong, its important for us
to come on time because
1. Coming late is actually considered as unprofessional
Even if u are not treating the pt u are a part of the team
2. It creates negativity in team, affects team morals
3. As doctors n med stds as well, we are expected to be punctual
 .u mentioned to me about learning this will affect ur learning,
1.if u come late u will miss some real cases that may come in ur exam as well
2. U can miss some teachings as well in morning round that consultant is teaching
3. It can also affect ur feedback, references n portfolio for ur job
5. Management:
For consequences about this, I would advice u to be on time
If the reason is because u are waking up late so I would advice u to sleep early
Social media is quite addictive, so u can play the games but on ur free time or in holidays,
what do u think abt it?
I will advice u to Speak to ur consultant about this, they will also help u in this
Alex: why to senior
They have experience of similar situation in the past, they will advice u in a better way so its
better to talk to them and get some help
Alex : are u going to tell seniors about this ?
I might consider if I have a chance to meet them, but discussion will be about what we have
discussed today

2. Twitter(social media): telephn call with f1 he wants to talk abt a f1 who posted
something on twitter(v imp)
1. Rapport: hello are u alex ? I am Amna, I understand u are f1, how is everything going
2. I have seen some tweets from some dr goodwill accouny. Can u tell me whats in the
tweet.
What are u concerned about
Put something abt pt, put a video n written something abt consultant
What he has written about the pt ?
He has written his pt was smelly today
Is there any confidential info shared like pt name, age, their medical condition n treatment
No
Whats in the video ?
Nurse are looking after pts
Is anyone visible/recognizable in the video ?
Is any specific body part visible?
Whats in the selfie ?
Is any body recognisable in the selfie ?
What has he written abt consultat
His glasses are boring n he teaches for too long
How other people are reacting to it ?
Like commenting or sharing the posts ?
Do u think this has a potential to become viral ?
Have u spoken to anybody about it ?
4. Implications: Alex, let me explain to u why its wrong
1. Breech of confidentiality : writing abt pt even if not putting name or sharing info it could
be a breech in confidentiality
2. Unprofessional : writing about the professional like consultants, pts or anyone else is not
professional,
3.if we write things like these, public will loose trust in doctors. Confidentiality is the pillar of
doctor pt relationship and its all going to be affected
And it doesn’t adhere to good medical practice
5.Solution: delete, read n talk
1.We will advice him to delete everything
2. We will advice him to read about good medical practice cz it’s the guidance
3. We will also advice him to talk to seniors about it
4. We will speak to consultants about this and we will see what they say about this
Alex: can u keep it confidential? That’s its not from me
Why ?
Alex it may damage my relation
No problem I can speak to him however, I don’t think it will cause any problem with ur
relationship, u are helpimg him somehow but if u want I will keep it confidential
Alex will he get into trouble
Writing something abt patient in social media has the potential to cause him trouble

3. Social media-fb, f2 in A&E , need to speak to another f1 he has written on his fb acc abt
pt that she was telling shes the queen on england. Speak to david about the issue, he’s
very talkative, will laugh when u talk abt topic
1. Hello david how are u today, I am Amna working here,I see u are f1 doctor, how is
everything going on, how is the department
2.Actually I have seen some post on ur social media and it seems like u have written
about it, can u tell me more about it?
Is it about a pt?
Is it ur pt?
What condition u r treating?
Who is the consultant?
How are u treating
Is the pt accompanied by anybody ?
Have u seen this pt before
Does the pt have mental capacity?
3.can I ask few qs about ur fb account
Do u come out as a dr on fb
When u post something on ur acc, who can see ? Is it available to everyone ?
When u put something, can anyone share or do u restrict it ?
Do u control ur fb account ?
Have u checked anyone commenting n reposting this ?
4.Implications: Do u think it can cause problem for u
In my opinion it could have a potential to cause problem for u
1. Breech of confidentiality : writing abt pt even if not putting name or sharing info it could
be a breech in confidentiality
2. Unprofessional : writing about the professional like of consultants, pts or anyone else is
not professional,
3.if we write things like these, public will loose trust in doctors. Confidentiality is the pillar of
doctor pt relationship and its all going to be affected
And it doesn’t reflect/adhere to good medical practice
Solution; I can see u r active on social media, u can
1. We will advice u to delete everything
2. Talk to senior about it
Alex do I need to tell pt ?
U dint have to tell its fine

4.Nurse wants to speak to u abt david cz he is adding all the pts on his fb
1. I understand u want to speak to me about david
What is it ?
Nurse: david adds pts on his list?fb?
2. Can u tell me more abt it
Is it on fb ?
For how long has this been going on ?
Who are these people ? Pt, family? Frnds ?
 How do u knw these people are pts ?
Nurse cz I have seen the pts
What is he actually trying to? Is he just trying to be friendly ? Or trying to give
advice ?
Is he discussing any confidential info ? Their medical condition ?
Has he got any intention of getting into relationship with them ?
Have u spoken to david abt this
What do u expect me to do about this
4.It is unprofessional cz we are not allowed to have this sort of relationship with pts, we can
only have professional
It is wrong to add pts as out frnds
Its wrong to meet our pts outside like going to their birthday party, or their wedding
We are not allowed to see this sort of things
Our profession is regulated, we have a regulated body which doesn’t allow us to do such
things
This will damage the dr pt relationship n trust
5.We will advice him to remove them from his frnd list
He can explain to them that being a doctor he is not allowed to do it
Nurse can u keep it confidential
Of course we can but if any of our colleague is doing this we should speak to them about this

5. F2 in surgical department
Medical student on drug(can come), not a drug addict, party goer, when frnds give him
drugs he takes it, u saw him his is lil overactive today, nurse also talking that he was taking
something in the party
Intro
David I need to talk to u abt something
What do u want to talk
Last night I saw u in the party
Were u in party, I didn’t see u
How was the party
I saw u in the party that u were taking something was it cocaine
So are u taking any drugs?
No
The nursing staff is also talking about this
I have also noticed u are lil hyperactive today
No I am like this
Implications: Look david whatever we discuss will remain between us
No I don’t u must have mistaken me with someone else
The reason I have decided to talk to u incase if u have been taking drugs this can cause u
problem, this can prevent u from gaining license to practice medicine and gaining
qualification from uni cz we are not allowed to take any drugs and that’s why I am worried
about this.
u may not be worried abt this so that’s why I wanted to talk u if u are taking the drugs
I might have taken drugs
Take hx now:
How long this has been going on
What sort of drugs do u take
Do u inject anything
On what occasion do u take it
From where do u get it
Frm frnds
Are they medical students as well ?
Have u ever get into trouble with police for taking drugs
How often has this been happening? Is this every w ?
How is ur studies going ?
Have u missed any exam, assignmnt cz of it ?
Are u passing ur exams ?
Have u done anything with pts today
I just read the prescription only
Let me explain to u why I have decided to talk about it cz medical std n docs both we are not
allowed to take any recreational drugs, cz we are in a regulated profession.
When we are in regulated profession we are not allowed to do certain things, we are not
allowed to take drugs even in private life.
Taking drugs affects out clinical judgement and can put pts life at risk. We can become
addicted and we lose capacity of taking care of pts that’s why we are not allowed to take
drugs
My career is over, everything is over for me
U don’t need to think like that right now, its not like ur career is over but unfortunately it’s a
serious issue as u are a medical student u have more support available as compared to a
practicing doctor, therefore its too early for u to think this way, speak to u educational
supervisor and get some help
Solution:
1.never think of taking this in future
2.Leave today
3.Speak to somebody, u need help, u can speak to ur consultant n educational supervisor or
university and tell them what u have done n when, they will guide u further on how to take
it out from ur records.
They may also provide support to stds taking drugs
4.In the meantime I will speak to my consultant about this, the discussion we had today.

6.Alcohol colleague, u smelt alcohol from him

1. Built rapport: how are u today, same qs as above
2. I want to talk to u abt something, I smelt alcohol from u so I wanted to ask did u
drink any alcohol at all
Yes I did evryone drinks alcohol
Hx:
when was the last time u drank alcohol
Have u ever come to work after consuming alcohol
How long have u been drinking?
Since 2 week
Any reason why ?
My gf broke up with me
I am sorry to hear about this it can be difficult
 On weekends or daily ?
What sort of alcohol u drink ?
How many pts have u seen so far ?
Do u have a list of it ?
Have u admitted , We are not allowed to come to work under influence of alcohol cz
we are in regulated body and we are not allowed to do so, it can impair out clinical
judgement, decision making skills can be affected and this may put pts life ay risk.
Even we are not allowed to come smelling alcohol even if we haven’t drink it cz it
give bad impression to pts n affects pt dr relation
Solution: leave hsp
Speak to consultant about this
Take some days off
Speak to rota manager
Speak to ur gp abt alcohol counselling
I am going to get the list of pts u have seen n going to review all the pts u have seen
Its better to Sign up for any detoxification programme

7.Chronic alcohol colleague f2, smelly alcohol, coming late n pt noticed he is clumsy
I smelt alcohol from u so I wanted to make sure did u drink alcohol at all ?
No
Pts also noticed the same
I didn’t drink
Offer confidentiality, look david everything we will discuss will stay between us
No I didn’t drink
Then same above thing
Hx: what do u drink
For how long
What sort of alcohol
Have u ever came to work drinking alcohol
Do u get any withdrawal symptoms if u don’t take alcohol
Do u think u need to drink more alcohol in order to feel the same everyday
Do u need to take alcohol to come to work
Ask abt pt
Coming late qs
Implications:
We are not allowed to come to work under influence of alcohol cz we are in regulated body
and we are not allowed to do so, it can impair out clinical judgement, decision making skills
can be affected and this may put pts life ay risk. Even we are not allowed to come smelling
alcohol even if we haven’t drink it cz it give bad impression to pts n affects pt dr relation
Solution:
We advice u to leave hsp
Speak to consultant about this
Take some days off
Speak to rota manager
Speak to ur gp abt alcohol counselling
I am going to get the list of pts u have seen n going to review all the pts u have seen
Its better to Sign up for any detoxification programme
Alex wants to talk abt david, hes coming late n smelt alcohol
Ask hx from alex
Since when
Do u knw whether he come to work drinking alcohol
Did u witness him taking alcohol at work ?
Inplications: Let me explain to u why its wrong,
We are not allowed to come to work under influence of alcohol cz we are in regulated body
and we are not allowed to do so, it can inpair out clinical judgement, decision making skills
can be affected and this may put pts life ay risk. Even we are not allowed to come smelling
alcohol even if we haven’t drink it cz it give bad impression to pts n affects pt dr relation

Solution:
are u okay to advice him if not no worries I will advice him
We will advice him to leave hsp
We will Speak to consultant about this
We will advice him to take some days off
Speak to rota manager
We will advice him to Speak to his gp abt alcohol counselling
I am going to get the list of pts u have seen n going to review all the pts u have seen
We will advice him that Its better to Sign up for any detoxification programme