Professional Practice, Ethics, and Healthcare Systems
Domain 8: Professional Practice, Ethics, and Healthcare Systems
This domain tests scope of practice, consent, documentation, and ethical decision-making within orthopaedic care.
Core rules
- Practice within state scope and institutional privileges; know when collaboration or referral is required.
- Informed consent requires capacity, voluntariness, disclosure of risks, benefits, and alternatives, and documentation. Assess capacity, do not assume it from age or diagnosis.
- When a patient lacks capacity, follow the legal hierarchy for surrogate decision-making and emergency exceptions.
- Ethical principles: autonomy, beneficence, nonmaleficence, and justice. Conflicts may involve industry relationships, resource allocation, or patient requests for futile treatment.
- Documentation should be timely, factual, and specific; include informed consent discussions, neurovascular exams, and patient nonadherence.
- HIPAA governs protected health information; minimum necessary applies. Report suspected abuse per mandatory reporting law.
- Quality and reimbursement increasingly depend on metrics such as surgical site infection, readmission, and patient-reported outcomes.
Worked example
An older adult with mild cognitive impairment refuses surgery for a displaced fracture. Do not accept a daughter's signature alone. Assess decision-making capacity; if absent, identify the legal surrogate and follow state law, documenting the reasoning.
Traps
Treating a surrogate's consent as automatically valid; documenting "patient understands" without specifics; and allowing industry gifts to influence device choice.