November 6, 2006

Consulting Psychiatry on Admission of the Patient to Evaluate for Competency – Part 1

In this litigious age malpractice attorneys search the informed consent process for mistakes by treating surgeons for evidence of liability or negligence. One area where surgeons can get into trouble is the confusion concerning competency and mental status.

A patient is considered competent to consent to a procedure based on two essential criteria. First, the patient must be able to comprehend the risks and benefits of both undergoing and not undergoing the procedure. Thus, an acutely delirious patient may not be able to properly consent to a procedure as a result of his or her state of cognitive compromise. Conversely, an initially competent patient who grants consent for a procedure and who then becomes delirious before the procedure can nonetheless appropriately be brought to the operating room.

Second, the patient must be in a state that allows him or her to make meaningful choices. Using this criterion, a patient may be cogent and oriented to time and place but may still not be considered competent.

Examples of this include serious psychiatric conditions such as major depression, bipolar disease, and schizophrenia. In these patients, their expressed wishes may be compelled by their active illness and therefore are not a true choice that accurately reflects their beliefs and desires if they were not in a suicidal or manic state.

Copyright 2006

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1 Comments to “November 6, 2006”

  1. Dr. A says:

    Great review of these legal definitions. Primary care docs (like me) also have difficulties with medical decision making especially if there is a question whether a patient can take care of him/herself at home and whether they can make that medical decision. Great post – await part 2.