Professionalism, Ethics and Clinical Judgement
Ethical framework
Expect questions testing autonomy, beneficence, non-maleficence and justice, alongside veracity, confidentiality and professional boundaries. Consent must be informed, given by someone with capacity and documented; for minors, consider competence to assent and involve the parent without excluding the child. Confidentiality yields only to specific, proportionate justifications such as safeguarding or a legal obligation, and disclosure should be limited to what is strictly necessary.
Clinical judgement under pressure
Recognise the limits of your competence and the thresholds for same-day or urgent review: sudden visual loss, painful red eye with reduced acuity, flashes and floaters with a field defect, suspected retinal detachment, giant cell arteritis symptoms, chemical injury and penetrating trauma. Where a patient declines recommended action, record the discussion, the risks explained and the agreed plan rather than simply noting "refused".
Record keeping and candour
Notes should be contemporaneous, legible, attributable and factual, distinguishing what was observed from what was reported. If something goes wrong, the duty of candour requires an honest explanation, an apology and a documented plan. Declare conflicts of interest and avoid allowing commercial pressure to influence a clinical recommendation.
Traps
Acceding to a request for a procedure outside your scope; discussing results with a relative without consent; writing a retrospective note without flagging it as such; and treating "the patient seemed happy" as proof that consent was valid.
Rule of thumb
Before any decision you are unsure of, ask: "Could I justify this in a record review six months from now, to a colleague and to the patient?" If not, document your reasoning, seek advice, or refer.