Difficult colleague scenarios are among the most frequently asked questions in NHS interviews. They test your ability to balance patient safety with professional relationships, your knowledge of escalation pathways, and your emotional intelligence. The SPIES framework (Seek Information, Patient Safety, Initiative, Escalate, Support) is the gold-standard approach for these questions.
Scenario Type 1: The Colleague Who Is Consistently Late
This is the most commonly reported JCF interview scenario. SPIES approach: Seek Information — is there a pattern or is this a one-off? Are there personal circumstances (childcare issues, health problems, transport difficulties)? Patient Safety — is their lateness affecting patient care (delayed handovers, uncovered ward)? If so, this must be addressed. Initiative — have a private, non-judgmental conversation. “I’ve noticed you’ve been arriving late recently. Is everything okay? Is there anything I can help with?” Escalate — if the conversation does not resolve the issue, or if there is a pattern, inform your consultant or clinical supervisor. If patient safety is compromised, this may also require an incident report via Datix. Support — signpost to occupational health, flexible working arrangements, or pastoral support. Reference: GMC Good Medical Practice 2024 Domain 3 requires doctors to “take prompt action if you think that patient safety, dignity or comfort is being compromised.”
Scenario Type 2: Suspected Substance Misuse
This is a high-stakes scenario that tests whether you prioritise patient safety above personal loyalty. SPIES approach: Seek Information — what have you actually observed? (slurred speech, unsteadiness, alcohol on breath, erratic behaviour). Be specific about what you have seen rather than relying on rumour. Patient Safety — if you believe the colleague is impaired, they must be removed from clinical duties immediately. This is non-negotiable. You should not allow a potentially intoxicated doctor to continue seeing patients. Initiative — approach the colleague privately and express your concern. Do not be confrontational, but be direct: “I’m concerned about you today. I don’t think it’s safe for you to be seeing patients right now.” Escalate — inform your consultant or the most senior doctor available immediately. If they are not available, contact the on-call consultant or medical director. This may also require a Datix report and may trigger a formal investigation. Support — this is where your answer should demonstrate compassion. Substance misuse is often linked to burnout, mental health difficulties, or personal crisis. The GMC Practitioner Health Programme and the BMA Doctor Support Service provide confidential support. Signpost the colleague to these services.
Key GMC reference: GMC Good Medical Practice 2024, paragraph 75: “You must take prompt action if you think that patient safety, dignity or comfort is or may be seriously compromised.” This applies regardless of the seniority of the colleague involved.
Scenario Type 3: A Senior Doctor Making a Clinical Error
This scenario specifically tests whether you have the courage and professionalism to challenge a more senior colleague when patient safety is at risk. This is a situation where many junior doctors feel uncomfortable, but the GMC is explicit: seniority does not override patient safety. SPIES approach: Seek Information — are you certain the senior has made an error? Could you be mistaken? (but do not use uncertainty as a reason to stay silent if you genuinely believe there is a patient safety issue). Patient Safety — if the error could harm the patient, you must act. Initiative — raise the concern directly with the senior in a respectful, professional manner. Use a questioning approach rather than an accusatory one: “Excuse me, I just wanted to check — I noticed the prescription says X, but I thought the guideline recommends Y. Could we double-check?” Escalate — if the senior dismisses your concern and you still believe the patient is at risk, you have a duty to escalate further. Contact another consultant, the clinical director, or use the trust’s Freedom to Speak Up Guardian. Document your concern. Support — recognise that everyone makes mistakes, and the goal is to ensure patient safety, not to punish the individual.
Scenario Type 4: Colleague Behaving Rudely to Staff or Patients
This tests your understanding of workplace culture and the 2024 updates to GMC Good Medical Practice, which now include explicit guidance on creating “respectful, fair, and compassionate workplaces” (Domain 3). SPIES approach: Seek Information — what did you actually witness? Initiative — if it is safe to do so, address the behaviour at the time: “I don’t think that comment was appropriate. Can we speak privately?” Escalate — if the behaviour is serious (bullying, harassment, discriminatory language), this must be escalated formally. Document what you witnessed, when, and who was present. Support — check on the person who was targeted by the behaviour and offer support.
- Exercise: Practise answering 4 difficult colleague scenarios aloud using SPIES, timing yourself to 2–3 minutes each.
- Resource: Difficult Colleague Scenario Cards (8 scenarios with model SPIES answers).