Professionalism, Ethics, Communication and Patient Safety
What this domain tests
This domain tests consent, capacity, confidentiality, truth-telling and safer systems of care. Questions present a conflict - a relative demanding information, a colleague's error, a request for treatment with no evidence - and expect a defensible professional response.
Core rules
- Valid consent requires capacity, adequate information and voluntariness. Capacity means the patient can understand, retain, weigh and communicate a decision. If capacity is absent, act in the patient's best interests under the relevant national legal framework (guardianship, lasting power of attorney, or best-interests decision-making) rather than on a relative's instruction.
- Disclosure of material risk follows the patient-centred standard: information a reasonable person in that patient's position would want, including alternatives and the option of no treatment.
- Confidentiality applies after death and covers identifiable data; disclose only with consent, legal obligation or an overriding public interest. Data protection rules (GDPR in Europe) classify health data as a special category.
- Breaking bad news: use the SPIKES sequence - Setting, Perception, Invitation, Knowledge, Emotions with empathy, Strategy and summary.
- Patient safety: chemotherapy prescribing requires independent double-checking, correct BSA and renal function, and route verification - wrong-route administration of intrathecal chemotherapy is a never event. Use SBAR for handover and the WHO surgical safety checklist before procedures.
- Duty of candour: when an error causes harm, tell the patient promptly, apologise, explain what happened and what will be done.
Worked example
A patient with newly diagnosed pancreatic cancer asks for 'the truth, but not in front of my wife'. Reasoning: his request is an invitation-based communication preference, not a demand to withhold all information. Explore why he wants to filter information, confirm what his wife already knows and what he wants shared, and record this explicitly. Do not collude in deception, and do not override his autonomy by forcing disclosure in front of his wife.
Traps
Accepting a relative's decision for a capacitous patient because the family agrees; giving a prognosis as certain when it is probabilistic; concealing a colleague's error to protect the team; discussing identifiable cases on social media.