Professionalism, Ethics, and Legal Considerations
What the domain tests
This domain tests scope of practice, consent, confidentiality, negligence, mandated reporting, and professional boundaries, usually through scenarios where the correct action is to decline, verify, or report.
Core rules
- The standard of care is what a reasonably prudent professional with similar training would do in similar circumstances. Scope of practice is set by state law and employer policy; when a task falls outside it, decline and refer.
- Negligence requires four elements: duty, breach of duty, causation, and damages. All four must be proven.
- Informed consent requires capacity, disclosure of risks, benefits, and alternatives, comprehension, and voluntariness. The provider obtains consent; you may witness the signature. Minors generally need a parent or guardian, with exceptions such as emancipated minors and certain sensitive services.
- Confidentiality yields only in specific situations: patient authorization, treatment/payment/operations, required reporting (child abuse, elder abuse, some communicable diseases, wounds from violence), and court orders.
- Mandated reporters must report suspected abuse in good faith, and most states protect the reporter's identity.
- Advance directives, including living wills and durable powers of attorney for health care, take effect when the patient loses capacity.
- Incident reports go to risk management, not into the medical record; document the facts of the event objectively in the chart without blame.
- Professional boundaries: no personal relationships, no social media contact, no significant gifts, and no discussion of patients online even without names.
Worked example
A patient's adult daughter demands his HIV status. Reasoning: HIPAA and state law restrict HIV-related information even from family. Unless the patient has authorized release in writing or the daughter holds a valid health care power of attorney, you decline and offer to relay a message to the provider.
Traps that cost marks
- Giving medical advice outside your role because the patient asked directly.
- Assuming a spouse automatically receives information.
- Documenting an opinion about a patient's character.
- Posting a de-identified case that is still recognizable.