Professional Practice: Ethics, Communication, Safety and Guidelines
Consent, capacity, confidentiality
Valid consent requires capacity, adequate information and voluntariness; document discussion of risks, alternatives, and the option of doing nothing. Assume capacity unless there is reason to doubt it, and support decision-making. Share information on a need-to-know basis; disclose without consent only where the law requires it or where there is a serious public safety risk. Clinical photographs are personal data - obtain explicit consent and store securely.
Prescribing safety
Isotretinoin: pregnancy prevention programme, monthly pregnancy tests where conception is possible, and monitoring of lipids and liver function. Methotrexate is weekly, not daily - daily dosing is a classic never event; folic acid cover and blood monitoring are standard. Biologics: screen for tuberculosis, hepatitis B and C, and HIV before starting. Systemic steroids: warn about adrenal suppression, taper, and issue a steroid card.
Communication and safety-netting
Explain diagnoses in plain language, use teach-back, and give written safety-netting advice: what to look for and when to seek help. In teledermatology, state the limitations of image quality and keep a face-to-face route for uncertain lesions. Use structured handover and record non-attendance.
Guideline-based care
Know the source of your practice - BAD, NICE, EADV and local formularies - and be able to justify any deviation. Audit and significant event analysis turn complaints into improvement.
Traps
- Choosing the clinically "best" option in an ethics item that ignores consent.
- Missing the prescribing error: daily methotrexate, or isotretinoin without contraception.
- Breaching confidentiality when a relative asks in a scenario.
- Failing to document advice given.
Rule of thumb
When an ethics item is ambiguous, choose the option that preserves patient autonomy, clear documentation and the minimum necessary disclosure.