How to Handle an Attending Under the Influence: A Guide for Medical Residency Interviews 🩺

Ethical questions often pose significant challenges during residency interviews. One such dilemma is handling a scenario where your attending physician appears to be under the influence of alcohol or drugs. Here's a practical framework to craft a thoughtful response, emphasizing professionalism, patient safety, and institutional policies.

The Scenario

Imagine you’re in morning rounds. Dr. Smith, an attending, seems unusually relaxed, slurring his words, and struggling with balance. You recall a social event the previous evening, raising suspicions about potential alcohol use.

Now, you're faced with a critical question: How do you handle this situation?

Framework for Your Response:

1. Prioritize Patient Safety First 🛡️

The immediate concern is the well-being of patients. Make it clear that safeguarding patient care is your top priority.

Sample Response:

"If I suspect that an attending is under the influence, my first thought is ensuring patient safety. I would observe discreetly to confirm my concerns without jumping to conclusions."

2. Gather Additional Observations 👀

Jumping to conclusions can backfire. Take time to observe the attending's behavior more closely to validate your suspicions.

Key Point:
Avoid making assumptions based on limited evidence. Look for consistent signs of impairment before escalating the issue.

3. Seek Peer Input Discreetly 🤝

Involving a colleague, such as a senior resident, can help confirm your observations. Discuss concerns subtly and confidentially.

Approach Example:

"I would check with a senior resident or team member to see if they noticed similar behavior, ensuring I’m not overreacting."

4. Report to the Appropriate Authority 🔒

Once you’ve confirmed the issue, escalate it to someone in a position of authority, such as a chief resident, program director, or supervisor.

How to Phrase It:

"I would confidentially report my concerns to a supervisor, emphasizing the need for immediate attention to avoid compromising patient care."

5. Avoid Direct Confrontation 🚫

Directly addressing an impaired attending can lead to conflict and complicate the situation. Let leadership handle the conversation.

Why This Matters:

Confronting a superior while they’re under the influence may escalate tensions and reduce the chances of a constructive outcome.

6. Maintain Professionalism and Discretion 🤫

Rumors and gossip can harm reputations and undermine trust. Keep the matter confidential to protect all parties involved.

Reminder:
"Refrain from discussing the issue with colleagues beyond those involved. Upholding confidentiality is critical."

Dos and Don’ts

✅ Dos:

• Emphasize Patient Safety: Always frame your response around protecting patients.
• Act Respectfully: Approach the situation with professionalism and empathy.
• Follow Protocol: Be aware of your institution’s policies for reporting such incidents.

❌ Don’ts:

• Jump to Conclusions: Ensure your concerns are based on observable facts.
• Confront the Attending: Leave this to leadership to handle appropriately.
• Spread Rumors: Gossiping about the incident can harm your credibility and professionalism.

Final Thoughts

Handling ethical dilemmas like this requires a balance of discretion, respect, and a steadfast commitment to patient safety. By following these steps, you can demonstrate your integrity and maturity during residency interviews, setting yourself apart as a thoughtful, responsible candidate.

If you want to watch this video CLICK HERE to access it.

If you need more help, you can check out our program HERE.