Patient safety, communication and ethics in general practice
This domain tests consent, confidentiality, capacity and the everyday systems that stop small clinics from harming patients - plus how you talk when something has already gone wrong.
Core rules
- Informed consent needs capacity, adequate information (material risks, alternatives, consequences of doing nothing) and voluntariness. Document what was discussed.
- Confidentiality: disclose only with consent or where the law requires it, such as statutory notification of infectious disease or a court order. Family members have no automatic right to information.
- The Mental Capacity Act presumes capacity and makes it decision-specific. Test understanding, retention, weighing and communication. If capacity is lacking, decide in best interests, taking into account any donee of a lasting power of attorney.
- Minors: parental consent is generally required below 18; assess maturity, encourage family involvement, and protect confidentiality where appropriate. Emergency treatment may proceed without consent.
- Open disclosure: when harm occurs, tell the patient, explain what happened, apologise, and report through the clinic's incident process.
Worked example
A 72-year-old woman with mild dementia is newly diagnosed with a malignancy. Her daughter asks you not to tell her. Reasoning: a dementia diagnosis is not incapacity. Assess her capacity for this specific decision; if she can understand and weigh the information, she has the right to know and the daughter's request cannot override it. Explore the family's cultural concern, offer a supported conversation with the daughter present, and document the capacity assessment and discussion.
Traps
- Equating dementia with lacking capacity.
- Disclosing results to a spouse simply because they asked.
- Accepting a relative's consent on behalf of a capable adult.
- Promising outcomes, or concealing a prescribing error to protect the clinic.