Synopsis
Act promptly and proportionately when a clinician, system or personal health problem may put patients at risk, using local escalation and statutory speaking-up routes without stigmatising illness or attempting a private disciplinary investigation.
- Patient safety comes first: stop or modify unsafe activity, obtain urgent senior help and arrange continuity before debating blame or employment consequences.
- Raise an honestly held concern through an appropriate channel, stating observable facts, risk and prior action. You do not need proof of misconduct before protecting patients.
- A health condition or disability alone is not impaired fitness to practise. The relevant issue is its effect on safe performance, insight, support, adjustments and compliance with restrictions.
Reasoning priorities
Decide whether practice must stop or be modified now.
Consider role, task, acuity, supervision and available alternatives. Use the least restrictive measure that reliably protects patients, but do not negotiate with imminent danger.
Worked reasoning
A trainee smells alcohol on a senior surgeon who is unsteady and intends to begin an emergency operation.
- Prevent the surgeon entering safety-critical practice by summoning the theatre lead or another senior immediately. Arrange an alternative operator and continue urgent patient care; do not manage the confrontation alone if unsafe.
- Describe observable facts rather than labelling addiction. Encourage and facilitate urgent medical help, but do not let confidentiality or hierarchy override the immediate patient risk.
- Report through the clinical leadership and speaking-up route, preserve a contemporaneous record and cooperate with the appropriate occupational or employment process. Do not undertake personal testing or a covert investigation.
- Final action: ensure the clinician remains away from unsafe duty until appropriately assessed and authorised, with patients covered and the colleague offered support. Escalate externally if local leaders fail to protect patients.
- Verification: confirm the operation has safe staffing, the responsible leader accepted the concern and follow-up assessment occurred; record and re-escalate any attempted return before clearance.