From the Research
I would immediately report my concerns about the consultant's apparent intoxication to the clinical director or medical director, as this presents a serious patient safety risk. I would explain that we have an urgent case of an incarcerated inguinal hernia requiring surgery, and that I believe the consultant is not fit to operate. While waiting for a response from senior management, I would arrange for another available consultant to take over the case, as an incarcerated hernia requires prompt surgical intervention to prevent bowel strangulation and necrosis, as highlighted in studies such as 1 and 2. If no other consultant is immediately available, I would consider transferring the patient to another hospital with appropriate surgical coverage. Throughout this process, I would document all my actions and observations objectively in the medical record. This approach follows NHS guidelines on managing concerns about a colleague's fitness to practice, which prioritize patient safety above all else. The situation requires immediate action because alcohol impairment significantly affects surgical judgment, technical skills, and decision-making capacity, putting the patient at unacceptable risk. While this may create temporary interpersonal tension, my professional duty of care to the patient must take precedence. It's also worth noting that the most recent study 3 suggests that laparoscopic hernioplasty provides a safe and effective operating technique for patients with incarcerated inguinal hernia, but this does not change the fact that the consultant's intoxication is the primary concern that needs to be addressed. Additionally, a very recent case report 4 highlights the complexity of diagnosing and treating incarcerated inguinal hernias, further emphasizing the need for a competent and sober consultant to handle the case.