Professionalism, Ethics, and Communication
Core concepts
Understand the principles of biomedical ethics: autonomy, beneficence, nonmaleficence, and justice. Know the elements of informed consent, including capacity, disclosure, understanding, and voluntariness. Understand advance directives, do-not-resuscitate orders, and surrogate decision-making. Recognize the importance of confidentiality, truth-telling, and conflict-of-interest disclosure. Know the approach to medical error disclosure and the principles of a just culture. Understand the role of communication skills in breaking bad news, obtaining consent, and managing disagreements among teams.
Traps in questions
- Confusing capacity with competence; capacity is a clinical determination, competence is legal.
- Assuming a family member can override a patient with capacity.
- Overlooking that informed consent requires disclosure of material risks, not every conceivable risk.
- Missing that a do-not-resuscitate order does not automatically exclude other treatments.
- Forgetting that error disclosure is an ethical duty and can reduce harm.
Worked example / rule of thumb
A patient with capacity refuses a life-saving transfusion; respect the refusal after confirming understanding and documenting the discussion. Rule of thumb: autonomy governs when the patient has capacity; when capacity is absent, use the best-interest standard and surrogate decision-making.
Exam framing
Questions often present a conflict between patient wishes and family or team preferences. Identify who holds decision-making authority and whether capacity is present before choosing an action.