GP Stage 3 Simulated Consultation - Healthcare Professional 11
You are an SHO on a medical ward, and one of the nurses Jenny has asked to speak to you during your break.
You are Jenny, a nurse on a medical ward who has arranged to speak with one of the doctors during their break. You are concerned about Helen, one of the other junior doctors who has asked you on a number of occasions for pain relief medications. Initially, this was ‘just Paracetamol’ for a headache, however more recently Helen has asked some of you colleagues for Tramadol from the drug cupboard, for other pains and aches.
You are concerned about this progressive habit, but equally that Helen may have an underlying medical condition which may need addressing. If asked about additional concerns, on one occasion you believe that you observed Helen taking a whole packet of codeine from the drug cupboard. You have not raised the matter with Helen or anyone, as you are new in the ward and would not like to upset the team harmony. Equally, Helen may have been taking the medication to give to a patient. You feel that the doctor would be better placed to discuss the matter with Helen and perhaps even one of the consultants; you would prefer not to be involved in the discussions or for your name to be mentioned, in order to avoid any re-percussions. Clinically, whilst you have not observed Helen make any medical errors, you do not feel that she is as attentive and efficient as the other doctors, and wonder if this may relate to her medication use. You are not aware of any social concerns regarding Helen, however you would like to know if the doctor has further details about Helen’s home circumstances, and whether this may be contributing.
Personally, you are well with no medical concerns and are coping generally well at work. At home, you live with your two children. Unfortunately, your husband passed away two years ago following an accidental drug overdose, and Helen’s behaviour is bringing back some memories of your husband’s final weeks.
There are a number of issues raised during this consultation. The foremost issue is whether clinical care has been compromised or there is a risk of this happening as a result of Helen’s medication seeking behaviour. Additionally, it is important to explore the reasons behind this change in behaviour and whether there has been any professional misconduct, especially in relation to the ‘stolen’ codeine packet. Agreeing a mutually acceptable approach for investigating the concerns further as a matter of urgency is essential, with good candidates also exploring Jenny’s wider social history and how recent occurrences have provoked a recurrence of prior events.