Professionalism
What the exam tests
This domain covers consent, capacity, confidentiality, duty of candour, professional boundaries and conflicts of interest.
Core rules
- Valid consent requires capacity, adequate information and voluntariness. The Montgomery standard requires disclosure of material risks a reasonable patient would want to know.
- Assess capacity using the Mental Capacity Act principles: presume capacity, support decision-making, and act in the patient's best interests if capacity is lacking.
- A competent adult may refuse treatment, even if the decision seems unwise; document the discussion.
- Gillick competence applies to minors who can understand the decision.
- Maintain confidentiality except when disclosure is required by law or necessary to protect a serious risk.
- Apply the duty of candour: apologise, explain what happened and describe what will be done.
Worked example
A competent adult with a necrotic foot refuses amputation after a full explanation of the risks. Capacity is confirmed, the decision is respected, and the discussion is documented. A second opinion and palliative support are offered without coercion.
Traps
Equating old age with incapacity; breaching confidentiality in public areas; failing to declare a conflict of interest; and making a disclosure without consent when no legal exception applies.