Drug cupboard

Question 1

You are the IMT1 doctor working on a cardiology ward.

Whilst on the ward you see your registrar taking a bottle of morphine sulphate solution and putting it into their personal bag.

This has not been prescribed for any of their patients to your knowledge.

How would you approach the scenario

Answer 1

This scenario raises a number of potential issues
* Patient risk
* Professionalism of the registrar also called into question

Main concern:
* Drug addiction / drug abuse by my colleague (not only explanation)
* Family member unable to access adequate pain relief

Immediate Priorities
* Ensure patient safety is not compromised (e.g. if the registrar is under the influence of drugs)
* Act non-judgmentally while gathering more information

Initial Action
* Speak directly to the registrar to understand the situation and assess risks
Encourage them to report the incidenct themselves to a senior colleague for resolution
Offer support or signpost resources if needed

Escalation
If unresolved / immediate risk persists, escalate to:
* Consultant / nurse in charge
* Head of department / supervisor

Documentation
* Record objective details of the event and actions taken

Reflection
* Reflect on the situation to improve future responses

Question 2

Please explain how you would approach and communicate with the registrar

Answer 2

Choose an Appropriate Setting
* Find a private, quiet space away from clinical areas to ensure confidentiality and minimise distractions

Adopt a Non-Accusatory Tone
* Calmly explain what I observed and ask for their explanation

Offer support
* Acknowledge potential challenges (e.g. stress, mental health) and offer help

Be Firm if Needed
* Emphasize patient safety and explain the need for escalation if unresolved

Encourage Self-Reporting
* Urge them to report the matter themselves but clarify that I will escalate if necessary

Question 3

How would you escalate the issue?

The examiners will want to hear both that you are likely to behave professionally but also that you are a human being who understands the nuances and difficulties posed by the scenario.

Answer 3

Escalation pathway
* Escalate first to the most senior person in your team (e.g. consultant/supervisor)
* If unavailable, the registrar’s clinical or educational supervisor

Alternative options
- if these avenues not appropriate for any reson, escalate to local clinical director or training programme director

Legal and Professional Obligations
* I may be ultimately required to raise this with the GMC or consult with my indemnity provider for guidance on legal and professional steps

Question 4

How might patient safety be affected?

In ethical scenarios, it is always important to actively consider and discuss risks to patient safety as a key priority to ensure the examiners are clearly aware that this would be your first thought.

Answer 4

Impaired judgement
* The reg could be under influence whilst working and their clinical judgement and skills could be compromised, leading to errors

Work Sustainability
* Addiction may render their working life unsustainable, leading to unplanned abscences and staffing shortages

Early escalation to senior clinicians will be important to ensure adequate medical cover to maintain patient safety on the ward and review any decisions that the doctor may have taken whilst under the influence

Question 5

How could you support your colleague?

Answer 5

Offer personal support
* Be empathetic and provide a non-judgemental space for them to share their challenges

Signpost professional help
* Recommend contacting occulational health or their GP for tailored support

Specialist Resources
* Direct them to services specifically for doctors, as they could provide a more tailored and understanding approach