Medical Ethics, Professionalism and Communication Skills
Ethics, professionalism and communication tests consent, capacity, confidentiality, truth-telling, boundaries and response to error. The exam rewards reasoning about competing duties, not slogans.
Core rules
- Valid consent requires capacity, adequate information, voluntariness and a decision-specific discussion.
- Capacity is presumed in adults; assess understanding, retention, reasoning and communication.
- Confidentiality can be breached only where justified by law or serious public risk, and minimally.
- Breaking bad news should be planned: prepare, elicit understanding, share information, respond to emotion and agree next steps.
- Professional boundaries include avoiding conflicts of interest, inappropriate relationships and misleading claims.
- Document the discussion, the patient’s decision and any limits of confidentiality.
- Chaperones and privacy protect dignity during examinations.
Worked example
A 16-year-old asks that her pregnancy test result not be told to her parents. The reasoning: explore her understanding, safety and support; explain confidentiality and its limits if there is abuse or serious risk. With capacity and no safeguarding concern, respect confidentiality while encouraging family involvement. Assess Gillick-type competence according to local law. Do not promise absolute secrecy before knowing the facts.
Traps
Equating refusal with incapacity; disclosing to relatives without consent; giving false reassurance after an error; using jargon to obtain “consent”; and paternalistically overriding a capable adolescent.