Professionalism, ethics, and communication
Domain 7 - Professionalism, ethics, and communication
This domain tests application of ethical principles, legal duties, and communication skills in real clinical dilemmas.
Core rules
- Four principles: autonomy, beneficence, non-maleficence, and justice.
- Informed consent requires capacity, disclosure of material risks and alternatives, understanding, and voluntariness.
- Capacity is decision-specific: can the patient understand, retain, weigh, and communicate a choice?
- Confidentiality is a duty with limited exceptions: consent, legal requirement, and serious public health risk.
- Use structured communication: SPIKES for breaking bad news and SBAR for handover.
Worked example
A competent adult Jehovah's Witness refuses blood transfusion before surgery. Assess capacity, explain risks and alternatives such as cell salvage, tranexamic acid, and iron, confirm the refusal is informed and voluntary, document it, and respect it. Do not give blood covertly. If the patient lacks capacity and an advance directive exists, follow it; if not, act in the patient's best interests with the team.
Traps
- Equating refusal with incapacity.
- Paternalism: deciding "for their own good".
- Breaching confidentiality in public areas or on social media.
- Accepting gifts or hospitality that create a conflict of interest.