Professionalism, ethics and law
What the exam asks
This domain tests GMC expectations and UK statute applied to realistic dilemmas: consent, capacity, confidentiality, and honesty after harm.
Core rules
- Good Medical Practice (2024) has four domains: knowledge, skills and development; patients, partnership and communication; colleagues, culture and safety; trust and professionalism. It requires candour, patient-centred care and acting on safety concerns.
- Capacity: the Mental Capacity Act 2005 (England and Wales) presumes capacity; assess understanding, retention, use and communication. Act in best interests, choose the least restrictive option, and involve an IMCA where appropriate. Scotland uses the Adults with Incapacity (Scotland) Act 2000.
- Consent: valid consent is voluntary, informed and given by someone with capacity. Montgomery v Lanarkshire set the standard as material risk judged by the patient, not Bolam.
- Children: under 16, Gillick/Fraser competence applies; 16-17 year olds are presumed competent to consent; refusing life-saving treatment is treated differently from consenting to it.
- Mental Health Act 1983: section 2 is 28 days for assessment, section 3 six months for treatment; section 5(2) holds a voluntary inpatient for 72 hours; section 136 is a place of safety.
- Confidentiality: share only with consent, or where the public interest in preventing serious harm outweighs it - tell the patient unless that creates risk. Advise the DVLA about conditions affecting driving; if the patient refuses, you may disclose.
Worked example
A 15-year-old asks for contraception and says her parents must not know. Assess Gillick competence, explore coercion and safeguarding, and prescribe if she is competent, documenting the reasoning. Refusing care would be wrong, but so would ignoring the safeguarding question.
Traps
Treating an informal patient as if detained; letting a relative override a valid advance decision; breaching confidentiality 'for the notes'; apologising without explaining what went wrong.