Patient Safety, Ethics, and Professionalism
What this domain tests
Consent validity, surgical safety systems, prophylaxis protocols, and ethical reasoning in scenarios involving disclosure, confidentiality and conflict of interest.
Consent and ethics
- Valid consent requires capacity (understanding, retention, communicating a choice), adequate disclosure of material risks, discussion of alternatives including no treatment, voluntariness, and documentation. A signature alone does not establish validity; a patient may withdraw consent at any point.
- Egyptian law and Medical Syndicate regulations require documented informed consent, and additional guardian consent with the child's assent for minors.
- Four principles: autonomy, beneficence, non-maleficence, justice. Photography requires specific consent covering storage, teaching and publication; identifying images on social media breach confidentiality.
- Disclose harm honestly after an adverse event, apologise, explain what will be done, and document. Ghost surgery and undisclosed industry payments are professionalism failures.
Safety systems
- WHO checklist: sign in before induction, time out before incision, sign out before leaving theatre.
- Surgical site infection: chlorhexidine-alcohol skin prep, clippers not razors, antibiotic within 60 minutes of incision (vancomycin 120 minutes), redosing at twice the drug half-life or after about 1500 mL blood loss, normothermia, glycaemic control.
- VTE: stratify with Caprini and provide mechanical plus pharmacological prophylaxis in high-risk body contouring.
- Local anaesthetic systemic toxicity: stop injection, 100% oxygen, benzodiazepine for seizures, 20% lipid emulsion 1.5 mL/kg bolus then 0.25 mL/kg/min infusion.
- Operating theatre fire triad: oxidiser, ignition source, fuel. Let alcohol-based preparations dry fully and avoid pooling.
Worked example
A retained swab is found on a postoperative radiograph after abdominoplasty. Reasoning: this is a never event. The immediate duties are to inform the patient honestly and treat; then report through the incident system, perform root cause analysis (count procedure, staff turnover, urgency), and change the system - standardised counts, radiograph for high-risk cases, and a briefing that empowers any team member to halt closure.
Traps
- Equating a signed form with valid consent.
- Discussing or posting identifiable patient photographs without specific consent.
- Forgetting intraoperative antibiotic redosing in long cases.
- Failing to disclose an error, or disclosing it without documentation.
- Assuming a colleague's impairment is not your professional responsibility.