Transition To Residency · Year 4 · from Transition To Residency
Case 2: Supporting a Struggling Colleague
Clinical Image
Source: Wikipedia - Peer support - CC BY-SA 4.0
Case Presentation
A 27-year-old male surgery intern notices concerning changes in his co-intern over the past month. Previously energetic and engaged, she now appears disheveled, has lost weight, and often smells of alcohol in the morning. She has made several near-miss errors including wrong-site marking (caught during timeout) and incorrect antibiotic dosing. Yesterday, she made a comment about "not caring if she woke up tomorrow." Recognizing these as warning signs, the intern approaches her privately after rounds. He expresses non-judgmental concern: "I've noticed you seem to be going through something really difficult. I'm worried about you. Can we talk?" She initially deflects but then breaks down, revealing that her fiance ended their engagement, she has been drinking heavily to cope, and she has been having thoughts of suicide without a specific plan. The intern listens without trying to fix the situation, validates her pain, and expresses that he cares about her. He explains that given her mention of suicidal thoughts, he needs to escalate this to get her proper help. He walks with her to the program director's office. The program director activates the physician health program, arranges immediate psychiatric evaluation, and ensures she does not return to clinical duties until cleared. The intern's timely recognition and appropriate escalation may have saved his colleague's life.
Key Learning Points
- Recognizing signs of struggling in colleagues includes performance changes, behavioral changes, appearance changes, and verbal expressions of hopelessness or self-harm
- Approaching a struggling colleague requires private conversation, non-judgmental expression of concern, listening without fixing, and offering support
- Escalation to program leadership or emergency resources is mandatory when colleagues express suicidal ideation, show signs of substance impairment, or raise patient safety concerns