KFP – Ethics

Isobel Hamilton, aged 72, presents with her daughter for a routine health assessment. During the assessment, you note some inconsistencies in Isobel’s history and observe her daughter speaking over her. When you ask Isobel directly about her medications, she hesitates, then looks at her daughter, who answers for her. You become concerned that Isobel may not have full autonomy over her healthcare decisions. You gently ask the daughter to step out of the room for part of the consult, but she refuses, saying that her mother ‘doesn’t mind’ and ‘can’t remember anything anyway’.

When you later speak to Isobel alone, she appears anxious and withdrawn. She says she does not want to upset her daughter and doesn’t want to make any decisions that would ’cause trouble’. You are concerned that Isobel’s capacity to consent is not being respected and that she may be subject to coercion. Cognitive screening (MMSE 28/30) suggests only mild cognitive impairment.

Medications: Atorvastatin, perindopril, calcium carbonate

Past history: Hypertension, osteoporosis

Social history: Widowed, lives with her daughter who is her primary carer

What are the most appropriate next steps in the ethical management of this patient? Select three (3) from the following list:

Abdullah Khan, aged 45, presents to your practice requesting opioid medication for ongoing lower back pain. He recently relocated from interstate and says he was previously on oxycodone, but has no documentation or medical summary to support this. You note that he is not currently linked to a My Health Record, and when asked, he becomes defensive and says his last GP was ‘useless’. On checking SafeScript, you find that Abdullah has been prescribed various opioids and benzodiazepines by multiple providers in the past six months.

He insists that only oxycodone ‘works’ and becomes agitated when you suggest alternatives. He threatens to complain to AHPRA if you don’t prescribe him ‘something strong today’.

Past history: Chronic non-specific low back pain, depression

Medications: Nil documented

What are the most appropriate ethical and clinical management steps? Select four (4) from the following list:

Melissa Tran, a 28-year-old woman, presents for a pregnancy confirmation after a positive home test. She is visibly anxious and shares that the pregnancy was unplanned. After a long pause, she tells you that she does not want to continue with the pregnancy but does not want her partner to know she is considering a termination. She asks you not to document anything about the discussion in the notes, saying she is worried he might find out.

She is otherwise healthy, has no past medical history and is not currently on any medications. She has no children. She is employed full time and lives with her partner. She discloses that he is emotionally controlling, and she fears he would become aggressive if he knew she was considering a termination.

Medications: None

Social history: Lives with long-term partner, no family locally

Obstetric history: G0P0

What are the most appropriate ethical and legal actions in this scenario? Select three (3) from the following list:

David Russo, a 67-year-old man, presents with his wife for a routine check-up. During the consultation, you ask David to step on the scales and perform a urine dipstick, as part of a health assessment. His wife quickly interjects, saying, ‘He’s fine, don’t worry about that.’ When David steps out briefly, she confides that she doesn’t want him to find out about his ‘high sugar levels’ or ‘cholesterol’, as it will ‘stress him out’. She asks you not to mention any abnormal results and says she’ll ‘take care of it with his diet’.

You recall that David has mild hypertension but no other diagnoses. His most recent pathology results, performed one month earlier, indicate newly diagnosed Type 2 diabetes and hyperlipidaemia. The pathology results have not yet been discussed with him.

Medications: Perindopril 5mg daily

Past history: Hypertension, overweight (BMI 28)

Family history: Father died of MI at 60, mother had Type 2 diabetes

What are the most appropriate ethical responses to this situation? Select three (3) from the following list:

Joshua Fielding, a 17-year-old male, presents for a general check-up. During the consultation, he discloses that he has started a sexual relationship with his 22-year-old boyfriend. He asks you not to tell his parents, who are unaware of both his sexual orientation and that he is sexually active. Joshua appears mature, well-spoken, and is clearly aware of sexual health risks. He requests STI screening and information on PrEP. You are aware that he is in Year 12, lives at home, and has no history of mental illness or cognitive impairment.

He asks again that none of this be disclosed to his parents under any circumstances.

Medications: Nil

Past history: Nil significant

Social history: Lives with both parents, in school

What are the most appropriate ethical and legal actions in this consultation? Select three (3) from the following list:

Carolyn Drew, a 48-year-old woman, presents for follow-up after recent investigations for weight loss and abdominal discomfort. You received her CT abdomen result this morning, which shows a likely pancreatic mass with liver metastases. The radiologist’s report recommends urgent oncology referral. Carolyn is cheerful during the consultation and asks if ‘everything came back fine’. She says she has a big overseas holiday planned and doesn’t want ‘bad news’ right now.

As you begin to explain the findings, she becomes visibly distressed and says, ‘I don’t want to know if it’s cancer. Just tell me if I need antibiotics or something simple. I can’t deal with anything else right now.’

Medications: None

Past history: Mild anxiety, appendectomy

Social history: Married, works full-time, planning overseas travel

What are the most appropriate ethical actions at this point in the consultation? Select three (3) from the following list:

Simon Whitmore, a 54-year-old man, presents with symptoms of fatigue and occasional night sweats. You order initial investigations, and his FBC reveals leukocytosis with abnormal lymphocytes. You suspect chronic lymphocytic leukaemia (CLL) and refer him for urgent haematology review. A week later, Simon returns with a typed letter from the haematologist confirming early-stage CLL and recommending ongoing monitoring and follow-up.

Simon is shocked and says, ‘The haematologist didn’t really explain anything. Am I dying? Should I be putting my affairs in order?’ As you begin to explain the diagnosis and prognosis, he pauses and asks, ‘Should I tell my employer about this? I’m worried they’ll sack me if they think I’m unwell.’

Medications: None

Past history: Nil of note

Social history: Works full time in a management role, married with two teenage children

What are the most appropriate ethical considerations in this situation? Select three (3) from the following list:

Nguyen Pham, a 36-year-old man, presents for his first appointment at your practice. He has limited English proficiency and attends with a friend who offers to interpret. Nguyen has recently migrated from Vietnam and has several complex health needs, including hypertension, type 2 diabetes, and chronic back pain. During the consultation, the friend interprets loosely, often summarising or answering questions on Nguyen’s behalf.

You notice that Nguyen appears confused at times and is hesitant to ask questions. When you ask if he would like an accredited interpreter, his friend quickly says, ‘He doesn’t need one. I’ve helped him at Centrelink and the bank. It’s easier this way.’

Medications: Metformin, amlodipine

Past history: Hypertension, T2DM, chronic low back pain

Social history: Lives with extended family, recently arrived in Australia, not currently working

What are the most appropriate ethical and legal actions in this scenario? Select four (4) from the following list:

Amira El-Sayed, a 15-year-old girl, presents with her mother for a check-up. During the consultation, Amira appears quiet and withdrawn. Her mother explains that Amira has been ‘moody and spending too much time on her phone’ but insists on staying in the room. When you gently ask Amira if she would like to speak alone, she nods, and her mother leaves reluctantly.

Alone, Amira discloses that she has been feeling low for several months, has self-harmed twice in the past few weeks, and is experiencing thoughts of suicide, but says she has no current plan. She begs you not to tell her parents, saying they ‘wouldn’t understand’ and would be ‘ashamed of her’.

Medications: Nil

Past history: Nil documented

Social history: Attends high school, lives with both parents, no known support networks

What are the most appropriate ethical and clinical actions? Select four (4) from the following list:

Dr Michael Sayed, a GP in your group practice, has recently returned to work after a prolonged absence. You notice over several days that he appears tired, irritable, and is taking significantly longer with patient consultations. A nurse privately raises a concern that Dr Sayed seems forgetful and has missed documenting key clinical findings. A receptionist also reports smelling alcohol on his breath during an afternoon session.

Later that day, Dr Sayed asks you to sign off on a prescription for one of his patients, saying he’s too busy to log in. You decline, but feel increasingly uncomfortable. You suspect that Dr Sayed may be impaired and that patient safety could be at risk.

Colleague role: GP in same practice

Practice setting: Suburban group general practice

What are the most appropriate actions in this situation? Select four (4) from the following list:

Ravi Nair, a 60-year-old man, presents with symptoms of mild knee osteoarthritis. During the consultation, he mentions he is interested in trying a new injectable treatment he read about online, which he says ‘has helped celebrities and sports stars.’ He asks you to arrange it through your private rooms. The treatment in question is a non-approved stem cell therapy available only through unregulated clinics. Ravi is willing to pay out-of-pocket and says he ‘trusts you to organise it’ through your ABN.

When you express concern about the lack of evidence, he says, ‘Don’t worry about the rules—everyone bends them these days.’

Medications: Paracetamol PRN

Past history: Mild OA, otherwise well

Social history: Retired engineer, married, financially comfortable

What are the most appropriate ethical and professional actions? Select three (3) from the following list:

Fiona Marshall, a 32-year-old woman, presents to your rural practice requesting a medical certificate stating she is unfit to attend court as a witness in an upcoming domestic violence case involving her ex-partner. She says, ‘I just can’t do it. I feel sick even thinking about going.’ She discloses that she has been having panic attacks and nightmares since receiving the subpoena. She has no prior psychiatric history and has not seen a psychologist, but you note signs of significant anxiety during the consultation.

She insists she is not trying to avoid responsibility but says she ‘can’t face’ being in the same room as her ex-partner. She asks that you not include the details of the case in the certificate.

Medications: None

Past history: Nil psychiatric; no regular GP

Social history: Lives alone, works casually, isolated rural area

What are the most appropriate actions in this scenario? Select three (3) from the following list:

Dr Sarah Khoo, a registrar in your practice, is seeing patients independently under supervision. During a coffee break, she casually tells you that she has started using her personal social media account to share photos and stories from her clinical days, saying it’s ‘just a way to educate people about medicine’. She has posted anonymised patient stories, including a dramatic account of a young trauma patient and a photo of her scrubs with bloodstains. She insists she hasn’t included names and that it’s all ‘inspiring stuff’.

You later see that the posts have been liked and shared widely, and that some contain details (like the town name and unusual case descriptions) that could potentially lead to patient identification in your small regional community.

Colleague role: GP registrar

Practice setting: Regional general practice with hospital duties

What are the most appropriate ethical and professional actions in this situation? Select four (4) from the following list:

Leonard Fitzpatrick, an 82-year-old man, is brought in by his son for a follow-up of his memory assessment. You previously performed an MMSE (22/30) and referred him for formal cognitive testing, which confirmed mild to moderate dementia. Today, Leonard appears cheerful and relaxed, but defers all questions to his son. When asked about his understanding of the diagnosis, Leonard says, ‘I’m not too sure, but I feel fine.’

His son is adamant that Leonard ‘doesn’t need to know’ about the dementia diagnosis, saying it would ‘just confuse him and make him upset’. He asks you to withhold the diagnosis from Leonard and to refer him to aged care services without discussing it in detail.

Medications: Aspirin, atorvastatin

Past history: Hypertension, hyperlipidaemia, mild cognitive impairment (now dementia)

Social history: Widowed, lives with son, no formal care package in place

What are the most appropriate ethical responses in this situation? Select three (3) from the following list:

Rachael Ncube, a 41-year-old woman, presents to your clinic seeking a second opinion regarding a recent diagnosis of multiple sclerosis (MS). She was told of the diagnosis by a neurologist at a public hospital three weeks ago. She reports that the neurologist ‘barely spoke’ to her and says, ‘It was all rushed—I didn’t understand what they were saying.’ She requests that you write a letter stating she does not have MS, as she plans to lodge a complaint and says the diagnosis has ‘ruined her insurance plans.’

She becomes tearful and angry, saying she feels abandoned and misunderstood. She asks if you can ‘just help her out’ by writing that she is being reassessed and that there is no confirmed diagnosis yet, even though you have reviewed the correspondence and investigations clearly supporting the MS diagnosis.

Medications: None currently

Past history: None of note

Social history: Employed part time, no children, lives alone

What are the most appropriate ethical responses in this situation? Select three (3) from the following list:

Tomislav “Tom” Petrovic, a 19-year-old university student, attends your practice requesting a copy of his childhood vaccination records. He explains that he’s applying for a study abroad program and needs proof of immunisation. When you check the Australian Immunisation Register (AIR), it lists several missing vaccines from early childhood, including MMR and DTP. Tom is surprised and says, ‘Mum always said I was fully vaccinated.’

Later that day, Tom’s mother calls the practice angrily. She demands that you do not release Tom’s records, saying, ‘He’s too young to understand the anti-vax risks. I don’t want him pressured into more vaccines.’ She insists she has always made his health decisions and expects you to respect her wishes.

Medications: Nil

Past history: Nil

Social history: Lives independently, studying law, has Medicare and ID

What are the most appropriate ethical and legal responses? Select three (3) from the following list:

Dr Emily Zhang, a GP registrar at your clinic, approaches you visibly distressed. She shares that she recently began dating one of her patients outside the clinic. The patient is a 29-year-old man whom she has seen several times over the past six months for mental health issues, including depression and anxiety. Emily says the relationship ‘just happened’ after they bumped into each other socially, but she now feels uncomfortable continuing to see him professionally. She asks whether she can continue both the relationship and care, or if she must choose between them.

Colleague role: GP registrar under supervision

Practice setting: Urban general practice

What are the most appropriate ethical and professional actions? Select three (3) from the following list:

Julie Morrison, a 57-year-old woman, presents for a routine check-up. During the consultation, she casually mentions that her brother, a local pharmacist, has been supplying her with prescription-only medications without scripts. She says, ‘It’s just easier this way—I hate going to the doctor all the time,’ and lists several medications including diazepam, tramadol, and propranolol. She adds that her brother ‘means well’ and ‘knows what she needs’.

Julie is otherwise well, and has no significant mental health or substance use history. She is surprised when you express concern, and says, ‘You’re not going to get him in trouble, are you?’

Medications: Diazepam, tramadol, propranolol (obtained without prescription)

Past history: Mild anxiety, essential tremor

Social history: Lives with husband, works part-time, no formal supports

What are the most appropriate ethical and professional responses? Select three (3) from the following list:

Ahmed Al-Masri, a 38-year-old man, attends for a workplace medical. He is applying for a position as a forklift operator and has been referred for a pre-employment medical assessment by the recruitment agency. During the consultation, you discover that Ahmed has poorly controlled type 1 diabetes with multiple recent hypoglycaemic episodes, some of which required assistance from others. When asked, he admits he has had ‘a few close calls’ at his last job operating heavy machinery, but says he ‘knows how to manage it now.’

Ahmed asks you not to include this information in your report, saying it will ‘definitely ruin’ his job chances and that he ‘needs the income.’

Medications: Insulin glargine, insulin aspart

Past history: Type 1 diabetes since childhood, recent episodes of hypoglycaemia requiring assistance

Social history: Married, two children, recently unemployed, applying for high-risk manual work

What are the most appropriate ethical and professional actions? Select three (3) from the following list:

Peter O’Connor, a 72-year-old man, presents for a skin check. During the examination, he makes several inappropriate comments about your appearance and jokes that you ‘must be too pretty to be a real doctor.’ He refers to a past female GP as ‘the hot one’ and makes lewd jokes about nurses he used to see at hospital. Despite redirecting the conversation multiple times, he continues to make suggestive remarks. You feel uncomfortable and demeaned but are unsure how to proceed without escalating the situation.

This is Peter’s first visit to the practice. He is otherwise cooperative during the examination and has no cognitive impairment or psychiatric history noted in the records.

Medications: Ramipril, simvastatin

Past history: Hypertension, hyperlipidaemia

Social history: Retired, lives alone

What are the most appropriate ethical and professional actions in this scenario? Select three (3) from the following list:

Lucy Tran, a 26-year-old woman, attends your clinic requesting a copy of her childhood vaccination record for a visa application. On reviewing the record, you note that it includes sensitive information from when Lucy was 15, disclosing a history of sexual abuse and a prior termination of pregnancy. Lucy glances over the screen and says, ‘Just email me the whole file—I need it today.’

She appears in a rush and says she plans to attach the document to her visa application for migration processing. There is no indication that she has read or is aware of the sensitive historical content in the file. She has full Medicare details and ID.

Medications: None

Past history: Sexual assault (historical), termination of pregnancy (age 15)

Social history: Lives independently, works in retail

What are the most appropriate ethical and legal responses? Select three (3) from the following list:

Janet Forrester, a 62-year-old woman, presents to discuss her advance care planning. She has recently been diagnosed with metastatic breast cancer and wishes to complete an Advance Care Directive (ACD) and appoint her daughter as her substitute decision-maker. She is clear about her values and goals, stating she does not want prolonged life-sustaining measures if her prognosis is poor. However, her husband, who accompanies her, becomes visibly upset during the conversation and insists that ‘everything must be done to keep her alive.’

He questions Janet’s competence to make such decisions, saying she is ‘emotional’ and not thinking clearly. Janet becomes quiet but later reiterates her wishes when you speak to her privately. She asks for your help to complete the necessary documents.

Medications: Tamoxifen, paracetamol

Past history: Breast cancer (now metastatic), hypertension

Social history: Married, one adult daughter, lives at home

What are the most appropriate ethical and legal actions? Select three (3) from the following list:

Daniela Rojas, a 44-year-old woman, presents for her annual health check. During routine screening, you identify moderate hypertension and advise investigation and follow-up. Daniela agrees but becomes hesitant when asked about alcohol intake. She eventually discloses that she has been drinking more heavily than usual—1 to 2 bottles of wine most nights—but pleads with you not to document it in her notes. She explains she’s in the middle of a custody dispute and worries that her ex-partner may subpoena her records to discredit her.

She insists, ‘Just leave that bit out, please. I’ll cut back—I promise.’

Medications: None

Past history: Nil major conditions noted

Social history: Lives with two school-aged children, works in hospitality, currently undergoing family court proceedings

What are the most appropriate ethical and professional actions? Select three (3) from the following list:

Anthony Bartley, a 50-year-old man, attends your clinic after recently being released from prison. He discloses a history of IV drug use but says he’s been clean for 12 months. He requests hepatitis C treatment, mental health support, and help getting back into work. He appears motivated and engaged. During the consultation, you ask about Medicare, and he tells you his card expired while in custody and hasn’t yet been renewed. He asks if you can bulk bill him anyway, or ‘just say I have a Medicare number for now.’

He adds that if the clinic charges him full price, he’ll just ‘go to emergency’ instead. Your practice has a policy of bulk billing concession card holders and Aboriginal and Torres Strait Islander patients only, unless covered by Medicare.

Medications: None

Past history: Hepatitis C (untreated), depression, opioid use disorder (in remission)

Social history: Recently released from prison, no fixed income or regular housing, currently couch surfing

What are the most appropriate ethical and professional actions in this situation? Select three (3) from the following list:

Helen Bradshaw, a 35-year-old primary school teacher, presents requesting a medical certificate for ‘burnout’. She says her job has become overwhelming and she’s taking sick leave to ‘get her head straight’. She insists you write that she has influenza, not a mental health issue, because she’s worried it might affect future job applications or professional reputation. Helen clarifies that her employer does not currently require a diagnosis on the certificate, but she doesn’t want any reference to mental health in her notes or on Medicare billing records either.

She says, ‘I just need a week off and some space. I don’t want this following me.’

Medications: None

Past history: Nil mental health conditions documented

Social history: Lives with partner, no children, teaching full-time

What are the most appropriate ethical and professional actions? Select three (3) from the following list:

Jeremy Lin, a 30-year-old man, attends your clinic for the first time and requests benzodiazepines. He says he’s just moved from interstate and has been taking alprazolam for anxiety, ‘off and on for years.’ He’s unable to provide previous prescriptions or medical summaries and is not linked to My Health Record. When you ask more questions, he becomes defensive and says, ‘If you’re not going to help me, I’ll go somewhere that will.’

You check the real-time prescription monitoring system (SafeScript) and note multiple recent prescriptions for alprazolam, diazepam, and codeine from different GPs and emergency departments. You explain that you cannot prescribe without proper records, and he becomes agitated, raising his voice and saying he’s ‘going to file a complaint.’

Medications: None currently listed in your system

Past history: Anxiety (self-reported)

Social history: Recently relocated, staying in temporary accommodation, unemployed

What are the most appropriate ethical and clinical actions? Select three (3) from the following list:

Maria Gonzalez, a 22-year-old university student, presents requesting a medical certificate for a missed exam. She reports that she felt extremely anxious and was unable to leave her house on the day of the exam. She did not consult a doctor at the time, and there is no prior mental health history in her record. She now requires documentation to submit to her faculty’s special consideration process, and asks if you can ‘just write that I was unwell that day.’

When you explain that certificates are usually issued contemporaneously, she says, ‘I really need this to pass my degree. Everyone else gets one—can’t you just backdate it?’

Medications: None

Past history: Nil significant; immunisations up to date

Social history: Lives in shared student housing, part-time work

What are the most appropriate ethical and professional actions? Select three (3) from the following list:

Dr Anil Verma, a GP in your practice, approaches you after discovering that a colleague, Dr Kate Hughes, has been regularly accessing the medical records of her ex-partner without a clinical reason. The ex-partner is not currently a patient of the practice, and Dr Verma became suspicious after noticing the same name repeatedly in the audit trail of your shared electronic records system. When asked about it, Dr Hughes admits to ‘checking in occasionally’ because she is worried her ex might be abusing prescription medication.

She insists it’s done ‘out of care’ and says, ‘I haven’t changed anything—just looking.’

Colleague role: Fellow GP in the same clinic

Practice setting: Suburban group general practice with shared records system

What are the most appropriate ethical and professional actions? Select three (3) from the following list:

Rajiv Sharma, a 68-year-old man with early-stage Parkinson’s disease, attends with his daughter, Priya, for a routine review. Rajiv is cognitively intact, managing well on current medications, and lives independently. During the consultation, Priya asks to speak to you alone. With Rajiv’s consent, he leaves the room.

Priya tells you she is worried that Rajiv is ‘in denial’ about his condition and insists you should start talking to him about aged care planning, power of attorney, and reducing his driving—even though he remains legally fit to drive. She asks you to ‘start planting the seed’ by telling him he’s deteriorating, even if you don’t believe he is, as it might ‘get him moving in the right direction.’

Medications: Levodopa-carbidopa

Past history: Parkinson’s disease, diagnosed 18 months ago; hypertension

Social history: Lives alone, drives independently, active in local community

What are the most appropriate ethical responses to Priya’s request? Select three (3) from the following list:

Jasmine Ng, a 28-year-old woman, presents to discuss fertility planning. During the consultation, she casually mentions that she recently donated eggs to her friend, a same-sex couple who underwent IVF overseas. She requests that you do not document this in her medical record, saying, ‘It’s just between us. I don’t want it coming up if I ever apply for life insurance or if my family sees it.’

Jasmine is otherwise well and not currently planning pregnancy herself, but you note that she may be at increased risk of complications (e.g. ovarian hyperstimulation syndrome) depending on the treatment she underwent. She declines to provide the name of the clinic or details of the process, stating, ‘I signed forms and had bloods done, that’s all you need to know.’

Medications: Nil

Past history: Nil significant

Social history: Works full-time, no children, in a long-term relationship

What are the most appropriate ethical responses in this situation? Select three (3) from the following list:

Michael Donnelly, a 46-year-old truck driver, presents requesting a medical clearance to return to work following a syncopal episode two weeks ago. He was admitted briefly to hospital and discharged the next day. You have received the hospital summary, which states the cause of syncope was likely vasovagal, but notes further cardiology review is pending. Michael is eager to return to work and says, ‘I can’t afford to wait for more tests. Just write the clearance and I’ll sort the rest out later.’

Michael drives heavy vehicles long distances, including overnight shifts. He insists the blackout was ‘nothing serious’ and says he hasn’t had any further symptoms.

Medications: None

Past history: Nil cardiac history

Social history: Lives with partner, full-time heavy vehicle driver, no private health cover

What are the most appropriate ethical and professional responses? Select three (3) from the following list:

Anna Papadakis, a 17-year-old high school student, presents for contraception. She is sexually active with her 19-year-old boyfriend and is seeking a long-acting reversible contraceptive (LARC). She states she does not want her parents to know, as they are strongly opposed to premarital sex and would ‘kick her out of the house’ if they found out. Anna appears mature, calm, and able to discuss the risks, benefits, and alternatives of different contraceptive options in detail.

She asks for reassurance that you will not tell her parents or include any obvious reference to contraception in the Medicare billing that might be seen on their family account.

Medications: Nil

Past history: Nil significant

Social history: Lives with parents, attends school full-time, casual work on weekends

What are the most appropriate ethical and legal actions in this situation? Select three (3) from the following list:

Thomas Wang, a 59-year-old man, presents for a new patient check. During the consultation, he casually mentions that he works as an unregistered complementary medicine practitioner and offers herbal and ‘energy healing’ services. He also says he occasionally advises clients to stop taking prescribed medications, especially antidepressants, as he believes they ‘do more harm than good.’

You express concern, and Thomas responds, ‘It’s just advice—they can take it or leave it. I’ve helped a lot of people this way.’ He asks that you don’t record any of this in his file, saying, ‘I don’t want trouble with authorities.’

Medications: None

Past history: Nil significant medical history

Social history: Self-employed, works from home, no medical qualifications

What are the most appropriate ethical and professional responses? Select three (3) from the following list:

Elaine Brooks, a 79-year-old woman, is brought in by her daughter for memory concerns. Elaine lives alone and manages most of her daily tasks but has become increasingly forgetful and confused. During the consultation, you ask Elaine if she is happy for her daughter to stay, and she agrees. Her daughter answers many questions on her behalf and later asks you privately to complete a Centrelink medical assessment form for aged care without telling Elaine, saying, ‘She’s not going to agree to it. We just need to get this process started.’

Elaine appears to understand most of the consultation, engages well, and answers appropriately when addressed directly. She denies any desire to move into care at present and states she is ‘managing fine.’

Medications: Perindopril, calcium carbonate

Past history: Osteoporosis, hypertension, mild hearing impairment

Social history: Lives alone, daughter visits weekly, receives no formal care package

What are the most appropriate ethical and professional actions? Select three (3) from the following list:

Dr Megan Joyce, a registrar at your teaching practice, asks for your advice after a recent consultation. She was seeing a regular patient, Mr Kevin Lloyd, a 63-year-old man with type 2 diabetes. At the end of the appointment, he gave her a small gift—a bottle of expensive wine—with a note saying, ‘Thank you for everything this year. You’ve been a lifesaver.’

Megan is unsure whether to accept it. She feels flattered but also uncomfortable, and worries that declining the gift may offend the patient. She asks whether she should keep it, share it with the team, or politely return it. She also wonders whether she needs to document the event at all.

Medications: Not applicable

Practice context: Suburban teaching clinic, mixed billing, team-based care

What are the most appropriate ethical and professional actions in this situation? Select three (3) from the following list:

David Samuels, a 52-year-old man, presents requesting a medical certificate for Centrelink. He has not attended your clinic before but states he has been ‘too anxious to work’ for the last three months. He explains that his last GP ‘would always give me a certificate no questions asked’ but has now retired. He does not have any documentation from previous providers and becomes frustrated when you ask about symptoms or treatment history. He insists, ‘Just write something so I can get paid.’

David appears anxious but is able to converse clearly. He declines mental health screening tools, saying he ‘doesn’t believe in labels,’ and refuses any referrals or follow-up. When told that you cannot issue a retrospective certificate without clinical evidence, he becomes angry and threatens to complain to the medical board.

Medications: None

Past history: Nil documented

Social history: Lives alone, currently unemployed, receiving JobSeeker

What are the most appropriate ethical and professional actions? Select three (3) from the following list:

Rachel Denning, a 33-year-old woman, presents for a repeat prescription of escitalopram. During the consultation, she breaks down in tears and tells you she is experiencing domestic violence. Her partner has become increasingly controlling and verbally abusive, and recently pushed her during an argument. She has no physical injuries today but is fearful he may escalate. She asks you not to write anything in her notes because he sometimes demands to read her My Health Record and Medicare history.

Rachel says she is not ready to leave the relationship and doesn’t want police involved. She just wants a safe person to talk to and asks for a mental health care plan, but wants it billed generically so it ‘doesn’t raise red flags.’

Medications: Escitalopram

Past history: Anxiety, recurrent low mood

Social history: Lives with partner, employed full-time, no children

What are the most appropriate ethical and professional actions? Select three (3) from the following list:

Christopher Lai, a 64-year-old man, presents for a follow-up of his prostate-specific antigen (PSA) test, which has risen slightly but remains within age-adjusted normal limits. You previously discussed shared decision-making about prostate cancer screening. Today, Christopher arrives with his adult son, who is very concerned. The son dominates the conversation, urging you to order an MRI and refer to a urologist ‘just to be safe.’ When you ask Christopher how he feels, he shrugs and says, ‘Whatever my son thinks is best.’

Privately, Christopher later admits he doesn’t want any further testing, stating, ‘I’m feeling fine. I’m 64, not 94. I don’t want to spend my life worrying.’

Medications: Atorvastatin, amlodipine

Past history: Hypertension, hypercholesterolaemia

Social history: Retired, lives with wife, son visits regularly

What are the most appropriate ethical responses in this situation? Select three (3) from the following list:

Dr Elise Tan, a senior GP at your clinic, approaches you about a patient she saw earlier in the week—Mr Hamid Nouri, a 39-year-old man newly diagnosed with HIV. Elise is concerned because the patient asked her not to notify his regular sexual partner, stating, ‘She’ll leave me, and I can’t handle that right now.’ Elise explained the importance of contact tracing, but he refused. He has not returned calls or followed up since the appointment. Elise feels torn and asks if she should notify the partner directly or breach confidentiality to protect others.

Medications: Initiated antiretroviral therapy via specialist clinic

Past history: Nil significant

Social history: Long-term heterosexual relationship, lives with partner, no children

What are the most appropriate ethical and legal actions in this situation? Select three (3) from the following list:

Linda Bartlett, a 48-year-old woman, presents for a Pap smear and routine check-up. During the consultation, she mentions that she recently began working as a receptionist at your practice. She says she’s excited but worried about other staff seeing her medical file. She asks if you can ‘delete anything embarrassing’ from her notes, particularly past STI treatments and a brief period of antidepressant use, saying, ‘It’s different now that I work here.’

She is otherwise well, and there are no clinical concerns during the visit. She requests that you don’t mention this conversation to anyone else and asks if her record can be hidden from staff or accessed only by doctors.

Medications: Nil

Past history: Chlamydia (treated), short-term sertraline use (3 years ago)

Social history: Lives with partner, recently employed at the clinic, no children

What are the most appropriate ethical and professional responses? Select three (3) from the following list:

Hassan Alvi, a 43-year-old man, presents requesting a copy of his full medical record. He states he is taking legal action against a former employer and needs to prove his mental health condition and time off work. You’ve seen him multiple times over the past two years for anxiety and stress-related leave, and the notes include sensitive details about his personal relationships, family violence history, and a previous suicide attempt.

Hassan asks, ‘Can you send everything straight to my lawyer today?’ He appears anxious and says, ‘I don’t have time to read through it, just send the whole thing.’

Medications: Sertraline, PRN diazepam

Past history: Generalised anxiety disorder, previous suicidal ideation (18 months ago)

Social history: Divorced, single father, casual work, involved in legal proceedings with former employer

What are the most appropriate ethical and professional actions? Select three (3) from the following list:

Amir Qureshi, a 37-year-old IT consultant, presents requesting testosterone therapy. He reports fatigue, low mood, and low libido. You review previous pathology from another clinic that shows a borderline low morning testosterone level. He has no formal diagnosis of hypogonadism and no physical signs of testosterone deficiency on examination. Amir states he has read online about ‘TRT clinics’ and says, ‘Just give me the injections—why does it have to be so complicated?’

He becomes frustrated when you raise concerns about potential risks, saying, ‘It’s my body—I’ll take responsibility.’

Medications: None

Past history: Nil significant; not on antidepressants or other medications

Social history: Lives with partner, no children, exercises regularly, no substance use

What are the most appropriate ethical and professional actions in this situation? Select three (3) from the following list:

Michelle Carter, a 61-year-old woman, presents to discuss her upcoming cosmetic surgery overseas. She plans to travel to Thailand for an abdominoplasty and breast lift, stating it’s ‘much cheaper over there.’ She asks you to complete a pre-travel medical clearance and a letter stating she is fit for surgery. You are aware that the facility is not accredited under Australian surgical standards, and Michelle has poorly controlled hypertension and obesity (BMI 34). When you raise concerns, she says, ‘I’ve already paid. Just write what they need.’

Medications: Amlodipine, indapamide

Past history: Hypertension, dyslipidaemia, past smoker

Social history: Lives with husband, semi-retired, frequent traveller

What are the most appropriate ethical and professional actions? Select three (3) from the following list:

Reza Mahmoudi, a 45-year-old man, presents requesting certification that he is medically exempt from COVID-19 vaccination. He explains that he needs this for work and travel purposes. When asked for more information, he says he has ‘bad reactions to lots of things’ and is ‘just not comfortable’ with vaccines. He denies any previous anaphylaxis, documented allergy, or contraindication recognised under ATAGI guidelines. You review his medical record and find no relevant history of adverse events or exemption criteria.

Reza becomes defensive when you explain the requirements and says, ‘You’re my doctor—you’re supposed to support me, not block me.’

Medications: None

Past history: Anxiety, mild eczema

Social history: Employed in logistics, married, no children

What are the most appropriate ethical and professional actions in this situation? Select three (3) from the following list:

Sophia James, a 29-year-old junior doctor, attends your clinic requesting help managing anxiety. She reports increasing panic symptoms, difficulty sleeping, and overwhelming stress related to her internship. She admits she’s been avoiding talking to her supervisor or seeking hospital support, as she fears this could jeopardise her registration. Sophia asks that you don’t include a mental health diagnosis in the notes and insists on paying privately so there’s ‘no Medicare record.’

She adds, ‘I just need something to take the edge off. Please don’t write anything that could come back to bite me.’

Medications: Nil

Past history: Nil formally documented; denies previous psychiatric care

Social history: Lives alone, no current relationship, recently moved for work

What are the most appropriate ethical and professional responses? Select three (3) from the following list:

Carol Tran, a 54-year-old woman, presents for ongoing management of type 2 diabetes and mild osteoarthritis. During the visit, she mentions that her adult daughter, who also attends your clinic, has recently been diagnosed with an unplanned pregnancy. Carol says, ‘She won’t tell you, but she’s planning to terminate it next week. She’s devastated. Can you please check in with her, but don’t say I told you.’

Carol’s daughter, Mia Tran (aged 22), is listed as an independent patient at your clinic. She has not discussed the pregnancy or any related concerns during her recent visits. Carol is visibly emotional and says she’s only asking because she’s worried her daughter has ‘no support.’

Medications: (Carol) Metformin, paracetamol PRN

Past history: (Carol) Type 2 diabetes, osteoarthritis

Social history: (Carol) Lives with husband, close to daughter; (Mia) lives independently

What are the most appropriate ethical and professional actions in this situation? Select three (3) from the following list:

Paul Jeffries, a 72-year-old man, presents for review of his chronic kidney disease and blood pressure management. At the end of the consultation, he casually mentions that his neighbour, who also attends your clinic, has been ‘acting strange’ and might be ‘off his meds again.’ He adds, ‘You should check in on him. I’m worried he’s getting paranoid, and he has kids at home.’

You review the neighbour’s file and note he has schizophrenia, stable on treatment, and last attended three weeks ago with no concerns. Paul insists, ‘Just give him a call or something—don’t say I said anything.’

Medications: (Paul) Ramipril, atorvastatin

Past history: Chronic kidney disease (stage 3), hypertension

Social history: Retired, lives alone, active in local men’s shed

What are the most appropriate ethical and professional actions in this situation? Select three (3) from the following list:

Daniela Russo, a 39-year-old woman, presents for a routine cervical screening test. During the consult, she shares that she recently underwent assisted reproductive treatment (ART) overseas, and is now 8 weeks pregnant with a donor embryo. She asks you not to record the pregnancy or ART details in the file, saying, ‘This is private—I haven’t even told my partner yet.’

She requests that any bloods or scans be done ‘off the record,’ and insists she will pay privately to avoid Medicare records being created. When you explain that pregnancy care requires some documentation, she becomes tearful and says, ‘I’ll lose everything if this doesn’t work. Please just help me without putting anything in the system.’

Medications: Prenatal vitamins, progesterone (self-sourced)

Past history: Secondary infertility, miscarriage at 10 weeks (2 years ago)

Social history: Lives with partner, employed full-time, undergoing fertility treatment privately overseas

What are the most appropriate ethical and professional actions? Select three (3) from the following list:

Mark Li, a 56-year-old man, presents for a WorkCover review following a back injury sustained three months ago. He has been receiving physiotherapy and is on modified duties. During the appointment, he confides that he’s started doing some off-the-books handyman work to ‘keep busy and pay the bills,’ but insists it’s ‘light stuff only.’ He asks you not to write this down and says, ‘If WorkCover finds out, they’ll cut me off.’

You note that Mark is still certified as unfit for regular duties. He declines further imaging or review and asks for another certificate stating he’s still unable to return to work.

Medications: Paracetamol, occasional ibuprofen

Past history: Chronic lower back pain, mild depression

Social history: Married, financially strained, self-employed prior to injury

What are the most appropriate ethical and professional actions in this situation? Select three (3) from the following list:

Angela Stone, a 36-year-old woman, presents with her 7-year-old son for a routine check-up. During the consultation, she quietly asks if she can speak to you alone. Once the child leaves the room, she discloses that she is in the middle of a custody dispute with her ex-partner and wants you to write a letter stating that he is ‘unstable’ and ‘not safe to be around children.’ She admits that he has no formal diagnosis and has never seen a doctor at your clinic, but insists he has ‘anger issues’ and has been acting erratically during handovers.

She is visibly distressed and says, ‘I need something from a doctor to help my case. Please, just write what I’ve told you—you don’t need to meet him.’

Medications: Nil

Past history: Mild anxiety

Social history: Lives with son, separated for 2 years, shared parenting arrangement in place

What are the most appropriate ethical and professional actions in this situation? Select three (3) from the following list: