A clinician suspects a colleague is repeatedly showing up late and appears intoxicated. What is the appropriate initial step?

• A. Ignore concerns to avoid confrontation.
• B. Report concerns through established supervision/reporting mechanisms and prioritize patient safety; offer support to the colleague.
• C. Confront the colleague privately and demand they leave.
• D. Wait for the next performance review.

Answer: (B)

Recognizing impairment and safeguarding patients is the focus. The appropriate initial step is to report concerns through the institution’s established supervision or reporting mechanisms and prioritize patient safety, while offering support to the colleague.

This approach ensures patient welfare takes priority, while also providing a formal path to assess the situation objectively. Following proper channels helps involve the right people (supervisors, medical directors, or human resources) who can evaluate the colleague, determine risk, and arrange appropriate support or treatment if needed. It also preserves confidentiality and due process, reducing the chance of unfair accusations and giving the colleague a chance to receive help through programs like employee assistance or rehabilitation services.

Confronting the colleague privately and demanding they leave bypasses formal evaluation, can damage professional relationships, and may not address underlying issues. Waiting for a performance review or ignoring concerns delays necessary action and could expose patients to risk. In all cases, if there is an immediate threat to patient safety, interim actions to protect patients should be taken in line with policy, while the concern is formally addressed.