The struggling colleague:
approach, resources, duty to report

Why this session

Attendings see residents in slices; peers see the trend line. That makes every intern part of the safety system for their colleagues whether they asked to be or not — and the failure modes are silence and secret-keeping, both of which feel like loyalty and function like abandonment. Physician suicide is a documented occupational concern, and the descent is usually visible to peers long before it is visible to anyone with authority. This session teaches the small, human moves that change trajectories — and the one non-negotiable.

Chiefs: bring the real phone numbers on a physical card — the physician health program, the employee assistance program, GME wellness, the crisis line. Hand it out. This session lands next to the sustainable-intern session by design; keep the focus here on the colleague, not the self.

What interns leave able to do

1. Distinguish struggling — fraying but functioning — from impaired: unsafe to practice now. Both deserve compassion; the responses differ by urgency.
2. Have the peer check-in conversation: private, specific observations, an honest question, no diagnosis.
3. Name the confidential resources and explain why self-referral protects a colleague’s career.
4. State the escalation duty when impairment and patient care intersect — and describe what actually happens after a report.

The case

Running the room

Part 1 — is it your business?

Name the hesitations honestly, because they are all real: loyalty, fear of overreacting, “who am I to judge,” fear of destroying a career, fear of being wrong. Then name the counterweight: silence is not neutral — it is a decision to let the trajectory continue.

Teach the working distinction: struggling means fraying but functioning — sleep, mood, a life crisis, burnout. Impaired means unsafe to practice now. Both deserve the same kindness; they differ in urgency, and Part 3 exists because the difference matters.

The next move is deliberately small and human: one private conversation. Not an intervention committee, not a group-chat consensus, not an anonymous report. Walk to the cafeteria.

Part 2 — the conversation

The shape of the check-in:

1. Private, unhurried, face to face — not at the workroom desk between pages.
2. Specific observations, not character: “You’ve been late twice, you snapped at Maria, you’ve stopped coming to dinner — and Thursday your eyes were red at 10 p.m. That’s not the Jordan from July.” Observations cannot be argued with the way “you seem depressed” can.
3. Then the honest question, and the silence: “How are you — really?” Count to ten. Let it be uncomfortable.
4. Listen. Don’t fix, don’t diagnose, don’t trade war stories yet. Their truth is the point of the meeting.

“They’ll fire me” — the myth that keeps people sick until they are caught instead of helped. The chiefs must deliver the truth with total credibility: self-referral protects people. State physician health programs exist precisely for this — confidential evaluation and treatment pathways, separate from the program — and physicians who come forward before an event overwhelmingly keep their careers. The career-enders are the events: the error while impaired, the arrest, the diversion. Asking for help is the exit ramp before all of them.

The resources, walked to rather than recited: the physician health program (confidential, not run by your residency), the employee assistance program (free, confidential counseling), GME wellness, a therapist or personal physician — and, in a healthy program, the PD, who would rather hear it now than later. “I’m going with you to make the call right now” is ten times the intervention a pamphlet is.

What you can promise, and what you cannot — said before it is needed, warmly and plainly: “I’ll keep this between us — but if I ever think it’s touching patients, I’ll have to tell someone, and I’d tell you first. Deal?” That promise, made in Part 2, is what makes Part 3 clean instead of a betrayal.

Also not your job: becoming Jordan’s therapist, sponsor, or secret-keeper-in-chief. Peer, bridge, friend — yes. Sole container of a crisis — no. That role has no good ending, and it is how two residents end up in trouble instead of one.

Part 3 — impairment plus patient care equals now

• Escalate now — not at noon, not after rounds, not “I’ll keep an eye on them.” The chief or attending, in person: “I need you for two minutes — it’s about Jordan.” Before Jordan touches the sickest patient or consents anyone. This is the rapid-response session’s “help early beats help late,” aimed at a colleague instead of a crash.
• You report a concern; you do not diagnose intoxication. “I smelled alcohol, the behavior is off, and I’m worried” is enough — assessment belongs to the program and the health professionals. You are the smoke detector, not the fire department.
• Demystify what happens next, because fear of this sequence is what keeps people silent: the resident is relieved of clinical duties today; the program and the physician health program evaluate; and the typical path is assessment, treatment, and a monitored return to work. Programs want their residents to make it back — the pathway exists because people do, and become excellent attendings. The report is the beginning of the rescue, not the end of the career.
• Your feelings are real too: betrayal — “you said you got help” — guilt, doubt about the smell. Report anyway; then debrief your own state with the chief. Second-victim dynamics apply to reporters too — the error session’s lesson through a different door.
• And the counterfactual, said out loud: if you say nothing and the morning goes badly — the consent botched, the sick patient mismanaged, a nurse reporting the smell instead — Jordan’s situation is worse in every dimension. And you knew at 6:40.

Common pitfalls to surface

• The “just tired” collusion — everyone saying it, nobody meaning it.
• Becoming the sole confidant for a colleague’s substance use.
• Delaying escalation because rounds are starting. The schedule never outranks an impaired clinician.
• Myth-driven silence: “telling = firing.” Repeat the truth until it bores them.
• Diagnosing instead of observing — “you’re an alcoholic” ends conversations; “I smelled alcohol and I’m worried” starts them.

Key teaching points

1. Peers notice first — you are part of the safety system.
2. Approach early, privately, with observations, not diagnoses: “here’s what I’ve seen — how are you, really?”
3. Self-referral protects careers; events end them. Walk them to the resource.
4. Promise confidentiality, never secrecy about patients — and say so up front.
5. Impairment + patient care today = the chief or attending, before rounds. Every time.

Pocket card

Variations

• Hierarchy flipped: the struggling colleague is your senior resident. The same conversation works — and chiefs exist precisely for when it doesn’t.
• The professionalism variant: the pattern is not substance or mood but integrity — a co-intern who signs out patients they never saw. Same approach conversation, same escalation logic, and the patient-safety line arrives even faster.
• The reunion version: six months later, a resident doing well on a monitoring pathway agrees — genuinely and freely — to let a de-identified version of their story close the loop. Nothing in this curriculum lands harder.

Notes

The case is a fictional composite; no resident in it is real. The evidence for why peer recognition and help-seeking anchor an intern bootcamp is in the bootcamp introduction.

This page is a teaching scenario for facilitated small-group education. Every person in it is fictional. It is not clinical or legal guidance; impairment reporting duties, physician health program structures, and licensing implications vary by state and institution — localize before teaching, with your GME office’s input. If you are struggling right now: in the United States, call or text 988. Last reviewed July 2026.