Professionalism, Ethics, Communication, and Patient Safety
What the candidate must own
Know the four principles of biomedical ethics - autonomy, beneficence, non-maleficence, and justice - and how they apply to neurosurgical consent, capacity assessment, and end-of-life decisions. Understand informed consent: disclosure of material risks, alternatives, and the patient's right to refuse. Know the concept of the best interests decision for patients lacking capacity, and the role of advance directives and substitute decision-makers. Be fluent in patient safety: the surgical safety checklist, wrong-site surgery prevention, handover (SBAR), and incident reporting. Understand the duty of candour and open disclosure after an adverse event, and the management of conflicts of interest and impaired colleagues.
Traps that appear in questions
- Assuming a signed consent form is sufficient - consent is a process, not a document.
- Confusing capacity (decision-specific, at a point in time) with competence (a legal status).
- Forgetting that a patient with capacity may refuse life-saving surgery.
- Missing the duty to disclose a harmful error even if the patient does not ask.
Rule of thumb
When in doubt, ask what the patient would want if they could speak, and document the conversation. Worked example: an elderly patient with a ruptured aneurysm and capacity refuses surgery - the ethical response is to respect the refusal after confirming capacity and ensuring the decision is informed, not to override it because the team believes surgery is in their best interests.