GP Stage 3 Simulated Consultation - Healthcare Professional 9
You are an SHO on an ENT rotation and Dominic one of the staff nurses has asked to speak to you.
You are Dominic, a nurse on an ENT ward. You have arranged to speak with one of the junior doctors, who you have got on well with. You would like to ask the doctor if you could borrow £10, as you have forgotten your lunch and also left your wallet at home.
If given £10, you thank the doctor and ask if you could borrow another £20 for the journey home. If not given £10, you become upset with mixed emotions. You are desperate for the money, and are happy for the doctor to arrange a bank transfer if this is easier.
Thereafter you break down as you have recently been evicted from your house, and are now living in the back of your broken down car. On further probing, the reason that you were evicted was because you had missed three months’ rent and the landlord discovered that you were selling and using illegal drugs; you are keen for the doctor’s reassurance that this information will remain confidential. This all started after your flatmate (who was a drug user) left without notice, leaving you with double the rent to pay. You resorted to selling heroine and unfortunately this spiralled out of control. You are presently still injecting heroine, and are spending almost all of your income on this addiction, with little money for food or accommodation.
You are struggling to cope at work, and there have been days where you do not remember how you reached work or what you did at work. You are concerned that patient care may be compromised, although you are scared to speak to anyone about this, as it may result in you losing your job which would affect your ability to finance your addiction. You live alone, and smoke 20 roll ups/day as well as drinking 15 units of alcohol/day.
The unusual request for money in desperation from a colleague should raise alarm bells, regarding underlying risk factors. It is clear that Dominic is struggling personally and it is important to address this through discussion of drug cessation and support groups (GP, CGL Spectrum), as well as shelter for homeless individuals. Equally important is patient welfare, which is at immediate risk. Escalation to appropriate seniors (preferably with Dominic’s consent) is essential in ensuring that patient harm is prevented and Dominic can receive optimum support.