Communication, Ethics, Record Keeping and Primary Health Centre Procedures
Domain overview
This domain tests communication, ethics, record keeping and routine PHC procedures. It rewards respectful, confidential practice and records that can be defended later.
Core rules and concepts
Communication: use the patient's language, avoid jargon, listen without interrupting and confirm understanding with teach-back. Explain diagnosis, treatment and danger signs. Consent must be informed and voluntary; for procedures, explain benefits, risks and alternatives. Confidentiality is a legal and ethical duty; HIV status is protected under the HIV/AIDS (Prevention and Control) Act, 2017 and should not be disclosed without consent.
Ethical principles: autonomy, beneficence, non-maleficence and justice. Work within your scope; refer when a condition exceeds PHC capability.
Records: complete the OPD register, laboratory register, drug stock register, birth and death register, referral slip and immunisation card. Write legibly in ink, include date and time, and correct errors with a single line, initials and date - never overwrite or use correction fluid. Keep records in a locked place and release information only to authorised persons.
PHC procedures: registration, vital signs, triage, immunisation according to the national schedule, dressing, ORS dispensing and referral. Notifiable diseases such as polio, measles, diphtheria, pertussis, tetanus, tuberculosis, dengue and cholera must be reported promptly through the prescribed channel.
Worked example
A patient with suspected tuberculosis refuses referral for a chest X-ray and sputum test. Explain the reason, the risk of untreated disease and the free services available. If he still refuses, document an informed refusal with the date, time, advice given and, where possible, a witness signature. Continue to offer care and a follow-up appointment. Do not coerce him, and do not disclose his status to neighbours or employers.
Traps that cost marks
Sharing patient information casually; obtaining consent with a blank or unsigned form; writing over an error; omitting the time of attendance; and failing to report a notifiable disease.