Colleague Impairment: Duty to Patients and to Colleagues

You can smell alcohol on the registrar and the ward round starts in ten minutes. Or a colleague has been shaking, forgetting things, snapping at people, and last week they got a dose wrong. Or a friend on your course keeps turning up to placement in a state that everyone has noticed and nobody has mentioned.

This is one of the most reliable scenario families in the circuit, and the reason is simple. It puts two obligations you genuinely hold into direct conflict and watches which one you abandon under pressure.

Two duties, and the two ways to fail

You owe patients safety. You also owe your colleague, who is a person with an illness or a crisis, something better than being discarded. Candidates typically drop one of these and do it very confidently.

The cold failure sounds decisive. Patient safety comes first, I would report them immediately, end of story. It is not wrong about the priority. It is wrong about everything else, because it treats a colleague as a hazard to be removed rather than someone who probably needs help, and it usually skips every step that would have made the outcome better for everybody.

The soft failure sounds kind. They are clearly going through a lot, I would check in and support them and keep an eye on things. That answer has quietly decided that a patient can absorb the risk while you preserve a friendship. Loyalty that stops at the door of the ward is not loyalty, it is avoidance.

The station wants the answer that does both, in the right order. Like most ethical stations in Australian MMIs, it is graded on the reasoning you make visible, not on landing the single approved sentence.

What impairment means, and what it does not

Impairment, in this context, means a health condition that affects a person's capacity to practise safely. Substance use, mental illness, physical illness, cognitive change. It is a health issue with a safety consequence.

That distinction matters in your answer, because it separates this family from misconduct. Someone who is unwell needs treatment and, while unwell, needs to be kept away from situations where they could hurt someone. Someone who is behaving dishonestly needs something quite different. Candidates who blur the two end up sounding punitive about an illness, which is exactly the instinct medicine has spent decades trying to get out of its own workforce.

It also differs from a bad day. Everyone is tired, everyone is short sometimes. The signal you are looking for is a pattern, or a single episode serious enough to be unsafe on its own.

The first question is always about now

Before any conversation, any escalation, any consideration of anyone's feelings, answer one thing out loud: is a patient at risk right now?

If yes, the immediate action is to stop the unsafe thing happening. That does not mean a public denunciation. It means the colleague does not take that list, prescribe that dose, or drive that car, and it means telling someone with the authority to make that stick. Everything else follows afterwards.

If no, you have time, and time changes what good behaviour looks like. Saying which situation you think you are in is worth doing explicitly, because it shows the assessor your priorities are ordered rather than merely listed.

The conversation, if there is room for one

Where the situation is not immediately dangerous, talking to the person first is usually right, and most candidates describe it far too vaguely. Say what you would actually do.

• Privately, not in a corridor and not in front of the team.
• From observation rather than accusation. I have noticed you seem exhausted and I have been worried about you, rather than people are saying you have a drinking problem.
• With the safety issue named, not hinted at. You cannot have a useful conversation while pretending the reason for it is social.
• Offering a route rather than an ultimatum. Occupational health, a general practitioner of their own, a supervisor, a practitioner support service.
• Honestly about limits. I would rather you take this to your supervisor yourself, and I need you to know I cannot leave it if nothing changes.

That last line is the one that impresses. It is compassionate and it is not a bluff, and it means you never have to escalate behind someone's back.

Escalation and the regulator

In Australia, registered practitioners have legal obligations to notify the regulator about a colleague in defined circumstances, and there are support services designed specifically for unwell practitioners. New Zealand has its own framework. The thresholds and the wording are set by the regulator, they are revised, and an interview is not a law exam.

So gesture at it accurately and modestly. There are mandatory reporting obligations in some circumstances and I would want to know exactly where that threshold sits before acting on my own. That is a better answer than a confidently wrong recitation, and it is also what a sensible junior would really do.

Remember you are usually being placed at the bottom of a hierarchy. A student or intern is not expected to run an investigation. You are expected to notice, to not stay silent, and to hand it to someone who can act. Saying you would speak to your supervisor is not passing the buck when the buck genuinely belongs to them.

Traps

• Making yourself the supervisor. Covering their shifts, checking their prescriptions, monitoring them. Well meant, unsustainable, and it delays the help they need.
• Certainty without evidence. You smelled something, you did not run a test. Describe what you observed and let the process establish the rest.
• Making it about your own discomfort. The awkwardness of the conversation is real and it is not a factor in the decision.
• Forgetting the patients already seen. If someone has been unsafe for weeks, there may be care to review, and almost nobody mentions it.

Handling the follow up

Expect pressure. What if they beg you not to tell anyone. What if they are your closest friend. What if you are wrong and you have ruined a career. Panels tend to push harder and longer on these than station circuits do, which our comparison of MMI and panel interviews in Australia explains, so prepare a position you can actually hold.

The answer to being wrong is the strongest one available: raising a concern is not an accusation, systems exist to assess it properly, and the alternative is a profession where everyone waits for certainty while patients absorb the risk. Say that calmly and the follow up stops being frightening.

Practising it

Run the same scenario three ways: patient at immediate risk, a worrying pattern with no emergency, and a colleague who denies everything. The priorities do not change, the actions do. You will find variants of all three in our collection of common MMI interview questions in Australia.

Then say it out loud under a clock, because the warmth in this answer lives in your tone and disappears the moment you get nervous. MasterMed's live AI interviewer runs timed MMI stations and marks you against a rubric, so you can check whether you sounded like someone this colleague would be relieved to have found them. The first speaking station is free on the trial, no card, and the trial never converts by itself.