You want to approach a difficult situation like this confidently. Your ability to be direct and find a compromise, like removing the colleague from the situation, is vital as you answer this question.

"As a physician, my most important obligation is to my patients, so this situation simply wouldn't fly with me. Physicians need to be of sound mind and body when performing an exam or procedure, so I would immediately work to remove my colleague from this situation. I would tell them I smelled the alcohol and express how disappointed I was that they were drinking before undertaking such important work. I would need to make my colleague understand the gravity of the situation. If my colleague wouldn't remove themselves willingly, I would do what was necessary. That includes calling hospital security and informing the administration.

From there, I would continue with the procedure as planned. Following that, I would follow the institution's policies regarding reporting drinking on the job. This behavior is unacceptable, and reporting would be a priority. But knowing that the colleague is likely my friend and someone I care for, I would want to sit down with them and get to the root cause. If I suspected alcoholism, I would try to get the help they need. If a personal problem caused the need to drink, I would be a listening ear to help them. It would be important to get my friend and colleague help and get them back on the job where they are needed."

As you role-play in this scenario, start by making the colleague comfortable with your approach. Whether this is through small talk or discussing the procedure is up to you. You'll then want to get directly to the issue by letting the colleague know you smelled alcohol in their bottle. Open the conversation and give them the option to determine the next steps. If they are unwilling to remove themselves from the procedure, you should make it clear that you would advise them to take the rest of the day off. Explain that having a conversation with your colleague about their state of mind and getting them help is important to you as a friend and colleague. Of course, you will also be expected to follow any mandatory reporting procedures by the institution.