MRCPsych Clinical Practice & Ethical Standards 3 — Questions and Answers
Question 1: A psychiatrist develops a romantic attraction to a current patient. What is the most ethical course of action?
- Continue treatment but disclose the feelings to the patient
- Seek supervision, consider transferring care, and not act on the feelings (Correct answer)
- Wait until the therapeutic relationship ends before pursuing any contact
- Discuss with the patient whether they share the feelings
Correct answer: Seek supervision, consider transferring care, and not act on the feelings
Professional boundaries require seeking supervision and arranging transfer of care; romantic involvement with current or recent patients is a serious boundary violation.
Question 2: A patient with treatment-resistant depression asks about electroconvulsive therapy (ECT). They have capacity and consent. However, their advance decision refuses ECT. What governs?
- The current capacitous consent overrides the advance decision (Correct answer)
- The advance decision remains binding as it was made with capacity and is specific to ECT
- The next of kin must decide because of the conflicting documents
- The clinician can proceed with ECT based on best interests alone
Correct answer: The current capacitous consent overrides the advance decision
A current capacitous decision overrides a prior advance decision; the patient's present consent is legally and ethically authoritative.
Question 3: Which ethical principle is primarily invoked when a psychiatrist withholds a patient's address from an aggressive ex-partner who presents at the clinic?
- Autonomy
- Justice
- Non-maleficence (Correct answer)
- Beneficence
Correct answer: Non-maleficence
Non-maleficence—the duty to avoid harm—justifies protecting confidential information when disclosure could endanger the patient.
Question 4: A newly admitted inpatient with bipolar disorder is prescribed lithium. Which monitoring is mandatory before initiation?
- Liver function tests and full blood count only
- Renal function, thyroid function, ECG, and pregnancy test where applicable (Correct answer)
- Blood glucose and HbA1c only
- EEG and serum calcium only
Correct answer: Renal function, thyroid function, ECG, and pregnancy test where applicable
Pre-lithium baseline must include renal function (lithium is renally excreted), thyroid function, ECG, and pregnancy test in women of childbearing age per NICE guidelines.
Question 5: A community psychiatric nurse breaches patient confidentiality by discussing a case with a neighbour. Under which framework is this primarily a regulatory concern?
- Mental Health Act 1983
- Nursing and Midwifery Council Code (Correct answer)
- Mental Capacity Act 2005
- Health and Safety at Work Act 1974
Correct answer: Nursing and Midwifery Council Code
The NMC Code sets professional standards for nurses including confidentiality; breaches are investigated as fitness-to-practise matters by the NMC.
Question 6: In a risk assessment, a patient denies suicidal ideation but their carer reports giving away possessions and saying goodbyes. How should the clinician weight this information?
- Dismiss carer information as hearsay and rely solely on the patient interview
- Integrate collateral information as it may reveal risk concealed in direct interview (Correct answer)
- Document only what the patient reports to preserve therapeutic alliance
- Discharge the patient as they have denied suicidal ideation
Correct answer: Integrate collateral information as it may reveal risk concealed in direct interview
Collateral history is a vital component of risk assessment; behavioural indicators from carers can reveal risk that patients deliberately conceal.
Question 7: A patient detained under Section 2 of the Mental Health Act appeals to the Mental Health Tribunal. What is the psychiatrist's role?
- Act as the patient's legal advocate at the tribunal
- Provide a written clinical report and give oral evidence if required (Correct answer)
- Decide whether detention continues without tribunal involvement
- Refuse to participate as the tribunal is a legal body
Correct answer: Provide a written clinical report and give oral evidence if required
The Responsible Clinician must provide a written report and may give evidence; the tribunal is an independent body that decides on continued detention.
MRCPsych Clinical Practice & Ethical Standards 3
A psychiatrist develops a romantic attraction to a current patient.
What is the most ethical course of action?