Professional Practice, Ethics, Advocacy, and Health Policy
This domain tests ethical reasoning, legal boundaries, and advocacy within pediatric primary care.
Core rules
- Consent and assent: parents or guardians give consent; children provide developmentally appropriate assent, generally from about age 7.
- Confidentiality in adolescence: many states allow minors to consent to confidential services such as sexually transmitted infection testing, contraception, and mental health care. Know your state law and explain its limits, including billing and explanation-of-benefits disclosures.
- Mandated reporting: report reasonable suspicion of abuse or neglect to child protective services; you do not need proof, and you do not need parental permission. Tell the family when it is safe to do so.
- Scope of practice: practice within state licensure, collaborative agreements, and institutional policy.
- Advocacy: address social determinants, insurance barriers, school services, and access; support policies that improve child health.
- Health policy literacy: know Medicaid and CHIP, EPSDT benefits, immunization requirements and exemptions, and early intervention entitlements.
Worked example
A 15-year-old requests confidential testing for chlamydia. Reasoning: confirm state law permits minor consent, explain what will and will not be shared, and address the risk that an insurance explanation of benefits could disclose the visit. Offer confidential contact information and discuss partner notification and treatment.
Traps
Promising absolute confidentiality; breaching adolescent confidentiality through billing; delaying a mandated report to investigate yourself; practicing outside scope; allowing insurance status to block urgent care.