SHM's Clinical Quick Talks-Capacity

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The Society of Hospital Medicine has provided an overview of capacity, which refers to a patient's ability to make and communicate medical decisions. Capacity is specific to each decision and can fluctuate with changes in the patient's clinical situation. Unlike capacity, competency refers to a global determination of the ability to make all decisions and is determined in court. Any medical provider can assess capacity for individual medical decisions, and evaluations should be conducted in the patient's native language with the help of a professional interpreter if necessary. Hospitalist teams should consult Psychiatry if they are unsure about a patient's capacity or if there are substantial risks involved in the patient's decision. <br /><br />The clinical evaluation of capacity involves four criteria. Firstly, the patient must clearly and consistently communicate their choice. Secondly, they must understand the medical information related to the decision, including their condition and the medical issue concerning them. Thirdly, they should appreciate the risks and benefits of their decision and understand the potential consequences if they do not follow the medical team's recommendation. Finally, the patient should demonstrate a logical reason for their decision, even if it may not align with the medical team's perspective.<br /><br />If the patient meets all four criteria, they have the capacity to make the medical decision in question. However, if they do not meet any of these criteria, they do not have the capacity and cannot refuse or consent to the specific intervention. In this case, a surrogate decision maker must be identified to make the decision on behalf of the patient.<br /><br />Key clinical pearls include distinguishing capacity from competency and ensuring that the patient communicates a clear and consistent choice, understands medical information, appreciates risks and benefits, and demonstrates a rational reason for their decision.<br /><br />References:<br />- Appelbaum, P. S., & Grisso, T. (1988). Assessing patients' capacities to consent to treatment. New England Journal of Medicine, 319(25), 1635-1638.<br />- Appelbaum, P.S. (2007). Assessment of patients' competence to consent to treatment. New England Journal of Medicine, 357(18), 1834-1840.

Asset Subtitle

Cynthia Glickman, Yingcheng “Elaine” Xu, Erica Schramm, Puneet Sahota

Keywords

Society of Hospital Medicine

capacity

patient's ability

medical decisions

competency

clinical evaluation

four criteria

surrogate decision maker

distinguishing capacity from competency

patient communication