Professionalism, Ethics, and Communication
This domain tests judgment under competing obligations: consent, confidentiality, scope, honesty, and communication that patients can act on.
Consent and capacity
Valid informed consent requires capacity, disclosure of risks, benefits, and alternatives, and voluntariness. Document what was discussed and the patient's decision. A patient with capacity may refuse dilation or referral; document the discussion, the risks explained, and the safety-net advice, and do not abandon them.
Confidentiality
Share only the minimum necessary information. Disclosures without consent are limited to specific situations such as suspected abuse, certain communicable disease reporting, or a court order. Avoid discussing patients in corridors, lifts, or on social media; images can be identifiable even when names are removed.
Communication that works
Use plain language and teach-back: ask the patient to explain the plan in their own words. Motivational interviewing, using open questions, affirmation, reflection, and summarising, supports behaviour change better than instruction alone. When breaking bad news, prepare, use a warning shot, give information in small chunks, and check understanding.
Worked example
A patient refuses a referral for a suspicious disc. Reasoning: explore the reason, correct misunderstanding, explain the risk of vision loss, offer a second opinion, document capacity and refusal, and arrange a defined review. Signing the patient out of the practice is neither ethical nor required.
Traps that cost marks
Documenting consent you did not obtain; posting a recognisable clinical photograph; giving specific advice to a patient who contacts you through social media; failing to act on an impaired colleague.