Consulting Psychiatry on Admission of the Patient to Evaluate for Competency – Part 2
One strategy for surgeons to avoid cancelled cases and successful litigation by malpractice attorneys over competency issues is to carefully review medications and ask about a psychiatric history before the perioperative period. If the patient reports a significant number or dose of psychiatric medications, previous psychiatric history, or dementia or brain injury, consideration should be given to having a trained professional interview the patient for competency. In this situation, the surgeon must also simultaneously seek out next-of-kin, guardians, or powers-of-attorney.
One final note is that in a true emergency situation where competency issues are ambiguous, a surgeon’s good intentions are usually honored and generally not subject to successful litigation. However, a psychiatric consult should be obtained in any nonemergency case in which competency issues are not straightforward.
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