Professional, Ethical, and Practice Management Issues
What you must understand
Professional practice includes informed consent, capacity assessment, confidentiality, and end-of-life decision-making. Understand the elements of informed consent (indication, risks, benefits, alternatives, and the patient's right to refuse) and when surrogate decision-makers apply. Learn about advance directives, DNR orders in the perioperative period, and how to reconcile patient wishes with surgical needs. Understand quality and safety: incident reporting, root-cause analysis, and the culture of safety. Know billing and documentation basics, supervision and scope-of-practice rules, and the importance of accurate records. Recognize conflict-of-interest and professionalism expectations.
Traps in questions
Common traps: assuming a DNR order is automatically suspended for surgery (it should be discussed and individualized, often with a plan for reinstatement); confusing capacity with competence (capacity is a clinical determination, competence is legal); and assuming informed consent can be obtained from a surrogate without assessing the patient's capacity first. Watch for questions about disclosing errors - honesty and disclosure are expected. Also, documentation should be contemporaneous and objective.
Rule of thumb
For any ethical dilemma, ask: What does the patient want (autonomy), what is medically indicated (beneficence/nonmaleficence), and what is fair (justice)? When in doubt, discuss, document, and involve the patient or surrogate.
Worked example: A patient with a DNR order needs urgent surgery. Discuss the order preoperatively, agree on a perioperative plan (e.g., suspend during anesthesia but reinstate afterward), and document the decision.