Can you promise a colleague you will keep it confidential?

No. A promise of silence cannot survive paragraph 51's requirement to put patient safety first. Be honest at the start of the conversation that you may need to raise it, and explain why, rather than agreeing and then going back on it.

Do you need proof before raising a concern?

No. GMC Raising and acting on concerns about patient safety paragraph 10 says you do not need to wait for proof, and that you can justify raising a concern if you do so honestly, on reasonable belief and through appropriate channels, even if you are mistaken.

Who do you raise a concern with first?

Paragraph 13 says to raise it first with your manager or an appropriate officer of your organisation, such as the consultant in charge of the team, the clinical or medical director, or a named person in your training organisation if you are a trainee.

When would you go to the GMC directly?

Paragraph 16 names three situations: where you cannot raise it locally because you believe the responsible person or body is part of the problem, where you have raised it locally and are not satisfied with the action taken, and where there is an immediate serious risk to patients.

Where can a struggling doctor get help?

Through their educational or clinical supervisor, occupational health, their defence body, the BMA or royal college, and NHS Practitioner Health, which describes itself as a free, confidential NHS primary care mental health and addiction service for health and care professionals and accepts self-referrals.

The Struggling Colleague — IMT Interview Ethics Station Answer

Q: Do you have to report a colleague you are worried about?

Paragraph 75 says that if you have concerns a colleague may not be fit to practise and may be putting patients at risk, you must ask for advice from a colleague, your defence body, or the GMC, and if you are still concerned you must report it in line with workplace policy.

A struggling colleague scenario at the IMT interview asks whether you can hold two duties at once. GMC Good medical practice 2024 puts them in a single paragraph, and the answer is to say both out loud and then act on the second.

Key takeaways

GMC Good medical practice 2024 paragraph 51 says you must be compassionate towards colleagues who have problems with their performance or health, but you must put patient safety first at all times.
Paragraph 75 says you must act promptly if you think that patient safety or dignity is, or may be, seriously compromised, and that if you have concerns a colleague may not be fit to practise and may be putting patients at risk, you must ask for advice from a colleague, your defence body, or the GMC.
The same paragraph says that if you are still concerned after that advice, you must report it in line with your workplace policy and the GMC's guidance on raising and acting on concerns.
GMC Raising and acting on concerns about patient safety paragraph 10 says you do not need to wait for proof: you can justify raising a concern if you do so honestly, on the basis of reasonable belief and through appropriate channels, even if you are mistaken.
Paragraph 13 of that guidance says to raise the concern first with your manager or an appropriate officer, such as the consultant in charge of the team, the clinical or medical director, or, if you are in training, a named person in your training organisation.
Paragraph 63 of Good medical practice 2024 says you should be willing to offer professional support to colleagues, for example through mentoring, coaching, teaching or training.

What is the principle when a colleague is struggling?

The principle with a struggling colleague is that compassion and patient safety are not alternatives. GMC Good medical practice 2024 paragraph 51 requires both, and states which one takes priority when they collide.

Say the paragraph as it is written. You must be compassionate towards colleagues who have problems with their performance or health, but you must put patient safety first at all times.

Paragraph 48 sits underneath it, requiring you to treat colleagues with kindness, courtesy and respect, and defining colleagues as anyone you work with, whether or not they are a medical professional.

What framework does the GMC give you?

The framework for a struggling colleague runs across two pieces of GMC guidance: Good medical practice 2024 for the duty, and Raising and acting on concerns about patient safety for the mechanism.

Paragraph 7 of the raising concerns guidance sets the duty broadly. All medical professionals have a duty to raise concerns where they believe patient safety or care is being compromised by the practice of colleagues or by systems, policies and procedures.

Paragraph 10 says your duty to put patients' interests first and act to protect them overrides personal and professional loyalties.
Paragraph 12 says that if patients may be at risk of death or serious harm, report immediately, and do not delay because you cannot put the matter right yourself.
Paragraph 14 says be clear, honest and objective about the reason for your concern, acknowledging any personal grievance but focusing on patient safety.
Paragraph 15 says keep a record of your concern and any steps you have taken to deal with it.
Paragraph 8 says you must not enter into agreements that prevent or restrict you from raising concerns about patient safety.

When does concern about a colleague become a patient safety concern?

Concern about a struggling colleague becomes a patient safety concern at the point in paragraph 75 of Good medical practice 2024: when you think patient safety or dignity is, or may be, seriously compromised.

The wording is deliberately low. It is not that you know, and it is not that harm has happened; the trigger is that you think safety may be seriously compromised, and the duty is to act promptly.

Where the concern is that a colleague may not be fit to practise and may be putting patients at risk, you must ask for advice from a colleague, your defence body, or the GMC, and report it if you remain concerned.

What is the worked scenario, answered aloud?

A fellow IMT trainee has arrived late three times this week, has made two prescribing errors, and you smell alcohol on their breath at handover. Said aloud, here is how to answer it.

I would deal with the immediate patient safety issue first. I would make sure the patients they are responsible for this shift are safe and reviewed, because that is what paragraph 75 asks me to do promptly.

I would then speak to my colleague privately and without accusation, telling them what I have observed and asking whether they are all right. Paragraph 51 asks me to be compassionate, and paragraph 50 asks me to be accessible.

I would not agree to keep it between us. Alcohol on a working doctor's breath is a concern that a colleague may not be fit to practise, and paragraph 75 says I must seek advice and then report it if I am still concerned.

I would take that advice from my consultant or educational supervisor, and if I were unsure I would also ring my defence body, which paragraph 18 of the raising concerns guidance names as a source of advice alongside the GMC's confidential helpline, my royal college and the BMA.

I would then raise it with the consultant in charge of the team or the clinical director, following paragraph 13, and I would record what I saw, when, and what I did, following paragraph 15.

What support exists for a struggling colleague?

Naming the support routes is what turns a struggling colleague answer from a report into a plan. The GMC expects both things: the concern raised, and the colleague helped.

The educational and clinical supervisor, and the training programme director, who can change a rota, a placement or a supervision level.
Occupational health, where a health problem is affecting performance.
NHS Practitioner Health, which describes itself as a free, confidential NHS primary care mental health and addiction service with expertise in treating health and care professionals, and which takes self-referrals.
Paragraph 63 of Good medical practice 2024, which asks you to be willing to offer professional support to colleagues through mentoring, coaching, teaching or training, and notes this matters most for those new to practice in the UK, returning from time away, or who cannot easily access support.

How do you escalate, and to whom?

Escalation in a struggling colleague scenario runs locally first. Paragraph 13 of the raising concerns guidance asks you to raise the concern with your manager or an appropriate officer of the organisation wherever possible.

The consultant in charge of the team, the clinical or medical director, or a practice partner.
A named person in your training organisation if you are a doctor in training.
Paragraph 16 sends you to a regulator such as the GMC in three situations: where you believe the responsible person or body is part of the problem, where local channels have not produced adequate action, or where there is an immediate serious risk to patients and the regulator has the power to act.
Paragraph 12 asks for immediate reporting where patients may be at risk of death or serious harm, without waiting to put things right yourself.

What does the panel listen for in a struggling colleague answer?

The panel listens for whether you can be kind and firm in the same answer. A struggling colleague station separates candidates who protect the colleague from candidates who protect the patient and then support the colleague.

That you secure patient safety first, and say so as a concrete action rather than a sentiment.
That you speak to the colleague directly before you speak about them.
That you name who you would ask for advice, including your defence body.
That you say you would not promise confidentiality you cannot keep.
That you document what you saw and what you did.
That you offer a support route by name rather than saying you would signpost them.

The ethics, professionalism and governance area is scored 1 to 5 by each of two interviewers and weighted 1.2, inside a station whose communication mark is weighted 1.6, so the tone of this answer carries more marks than its content.

What is the trap in a struggling colleague scenario?

The trap in a struggling colleague scenario is the promise. The colleague asks you to keep it quiet, and a candidate who agrees has breached paragraph 51's second sentence before the station has finished.

The mirror-image trap is going straight to the GMC. Paragraph 13 asks you to raise the concern locally wherever possible, and jumping to the regulator reads as a failure to understand the route rather than as courage.

A third trap is waiting for certainty. Paragraph 10 of the raising concerns guidance is explicit that you do not need to wait for proof, and that raising a concern honestly and on reasonable belief is justified even if you turn out to be mistaken.

What if the struggling colleague is you?

If the struggling colleague is you, Good medical practice 2024 gives the same answer with the compassion pointed inwards. Paragraph 78 says you should try to take care of your own health and wellbeing, recognising if you may not be fit for work.

The same paragraph says you should seek independent professional advice about your fitness for work rather than relying on your own assessment, and paragraph 77 says you should avoid seeking medical care from a family member or anyone you work closely with.

Paragraph 79 is the firm one. If your judgement or performance could be affected by a condition or its treatment, you must consult a suitably qualified professional and follow their advice about any changes to your practice, and you must not rely on your own assessment of the risk to patients.

How this comes up at the IMT interview

At the IMT interview, the struggling colleague is a station 1 ethics, professionalism and governance scenario of up to five minutes, given after the six-minute exploration of your application that opens with a two-minute presentation.

It also appears indirectly in station 2, when the scenario turns and the reason a task was not done is that a colleague is not coping, and you have to decide what to say at handover.

internalmedicineinterview's bank of 361 IMT questions across 56 scenarios includes ethics-station scenarios with AI-marked spoken practice, so you can hear whether you sounded compassionate and still said the hard sentence.

The Struggling Colleague