Lesson 4.1: Ethical Foundations and Good Medical Practice
Everything in PLAB 2 ethics is anchored in two things: the four pillars of medical ethics and the GMC's Good Medical Practice (2024 edition). You do not need to quote paragraphs, you need to think like a doctor who has internalised these principles.
The Four Pillars of Medical Ethics
| Pillar | What It Means in Practice |
|---|---|
| Autonomy | The patient has the right to make decisions about their own care, including decisions you disagree with. Informed consent and shared decision-making are expressions of this principle. |
| Beneficence | Act in the patient's best interests. Every clinical decision should be aimed at doing good for the patient. |
| Non-maleficence | First, do no harm. Weigh the risks of an intervention against its benefits. This includes avoiding unnecessary investigations, treatments, or disclosures. |
| Justice | Treat all patients fairly and equitably. Allocate resources justly. Do not discriminate. Consider the impact of your decisions on the wider public. |
GMC Good Medical Practice 2024 — Four Domains
The 2024 edition introduced a stronger emphasis on respectful, inclusive workplaces and tackling discrimination. These changes are embedded throughout the exam.
| Domain | What It Means in Practice |
|---|---|
| 1. Knowledge, skills and performance | Be competent. Keep up to date. Recognise your limits and ask for help. Reflect on your practice and respond constructively to feedback. |
| 2. Safety and quality | Raise concerns without delay. Report errors and near-misses. Contribute to a culture of safety and improvement. |
| 3. Communication, partnership and teamwork | Listen to patients. Share information. Work cooperatively with colleagues. Support those who raise concerns. |
| 4. Maintaining trust | Be honest, act with integrity, maintain appropriate professional boundaries. Never discriminate or abuse your position. |
The revised guidance explicitly requires doctors to actively challenge discrimination, harassment, and bullying, not merely avoid engaging in it. This applies to colleagues, patients, and the broader workplace culture.
Duties of a Doctor — Core Checklist
- Make the care of your patient your first concern.
- Protect and promote the health of patients and the public.
- Treat patients as individuals and respect their dignity and autonomy.
- Be honest and open, do not hide mistakes.
- Act without delay if you think patient safety is at risk.
- Never abuse your position as a doctor.
Ethics Is Tested in Every Station
| Station Type | Ethical Element Being Assessed |
|---|---|
| History taking | Non-judgmental language, patient-centred approach, not making assumptions |
| Examination | Obtaining consent before touching the patient; offering a chaperone for intimate examinations |
| Management | Shared decision-making; respecting the patient's right to decline |
| Prescribing | Explaining material risks; not prescribing under pressure when clinically inappropriate |
| Emergency | Staying within your scope; escalating appropriately; not acting beyond your competence |
| Colleague scenarios | Patient safety over professional loyalty; raising concerns in the correct way |