Professional Practice, Ethics, and Communication
Domain 7 tests the professional and interpersonal layer: ethics, consent, scope of practice, communication, and documentation.
Ethical principles
Autonomy (the patient's informed choice governs), beneficence, non-maleficence, justice (fair access and equitable treatment), veracity, and confidentiality. When a patient declines evidence-based advice, the ethical response is to document informed refusal, preserve the relationship, and offer harm-reduction options - not to override autonomy.
Consent, competence, scope
Informed consent requires capacity, disclosure of risks/benefits/alternatives, and voluntariness. Practise only within your scope and competence; refer when a case exceeds either. Disclose conflicts of interest (industry sponsorship, product endorsement).
Communication that changes behaviour
Motivational interviewing uses OARS - open questions, affirmations, reflections, summaries - with empathy, developing discrepancy, rolling with resistance, and supporting self-efficacy. Avoid the righting reflex: arguing raises resistance. Use teach-back ("tell me how you'll use this at home") instead of "do you understand?". Plain language, 3–5 key messages, and a written plan support health literacy. Work with trained interpreters rather than family members, and practise cultural humility rather than inferring a "typical" diet from an ethnic label.
Documentation
Use a consistent format (ADIME: assessment, diagnosis, intervention, monitoring/evaluation). Record what was measured, the PES statement, the intervention, goals, who is responsible, and follow-up. Document education delivered, the patient's response, and any refusal.
Research and privacy
Human-subject research requires IRB approval and adherence to respect for persons, beneficence, and justice; protect identifiable data (HIPAA), and disclose conflicts and adverse events.
Worked example
A patient with newly diagnosed type 2 diabetes says, "I'm not giving up rice - my whole family eats it." Arguing is the trap. Reasoning: autonomy plus MI - reflect ("rice matters to your family meals"), then negotiate a measurable change (smaller rice portion at two meals, add protein and vegetables), set a 2-week follow-up, and document the agreed plan and the patient's stated readiness. The outcome measured is adherence, not compliance with a script.
Traps
Confusing beneficence with paternalism; treating "non-adherent" as a personality trait rather than a plan mismatch; using a family member as interpreter for consent; giving advice without checking understanding; documenting opinions instead of measurable findings.