Psychiatry · USMLE Step 1

USMLE Behavioral Science and Biostatistics

Non-clinical psychosocial topics tested on USMLE Step 1 including physician-patient ethics, informed consent, and health care delivery concepts, distinct from clinical psychiatric diagnosis.

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What are the four required elements of valid informed consent?
Disclosure of information, patient understanding, voluntariness, and decision-making capacity.
Under what circumstance can a physician treat a patient without obtaining informed consent?
A life-threatening emergency in which the patient cannot give consent and no surrogate is available.
What is therapeutic privilege?
Withholding certain information from a patient when disclosing it would likely cause serious psychological harm.
What happens to the informed consent requirement if a patient explicitly waives their right to be informed?
The physician may proceed with treatment without giving the usual detailed disclosure.
Who gives informed consent for a patient who lacks decision-making capacity and has no advance directive?
A surrogate decision-maker, typically a legally authorized family member.
Who determines whether a patient has decision-making capacity?
The treating physician.
Who determines whether a patient is legally competent?
A judge, in a court of law.
List the criteria that make a minor legally emancipated.
Being married, serving in the military, being self-supporting and living independently, or having a child of their own.
For which categories of care can a minor consent to treatment without parental involvement?
Sexually transmitted infections, pregnancy-related care, substance abuse treatment, and emergency care.
When a patient has no advance directive, who is generally first in line to act as surrogate decision-maker?
The patient's spouse.
What is a living will?
A written advance directive stating what treatments a patient does or does not want if they become unable to communicate.
What is a durable power of attorney for health care?
A legal document naming a specific person to make medical decisions for a patient who becomes incapacitated.
What does the Tarasoff ruling establish about a therapist's duty when a patient makes a credible threat against an identifiable person?
The therapist has a duty to warn and protect the identified potential victim, which can override confidentiality.
Is suspected child abuse an exception to physician-patient confidentiality?
Yes, physicians are legally required to report suspected child abuse regardless of patient consent.
What is the ethical principle of beneficence?
The obligation to act in the best interest of the patient.

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