The concept of Incompetent Patients - USMLE Forums
USMLE Forums Logo
USMLE Forums         Your Reliable USMLE Online Community     Members     Posts
Home
USMLE Articles
USMLE News
USMLE Polls
USMLE Books
USMLE Apps
Go Back   USMLE Forums > USMLE Step 2 CK Forum

USMLE Step 2 CK Forum USMLE Step 2 CK Discussion Forum: Let's talk about anything related to USMLE Step 2 CK exam


Reply
 
Thread Tools Search this Thread Display Modes
  #1  
Old 05-31-2011
docoftheworld's Avatar
USMLE Forums Veteran
 
Steps History: 1 + CS
Posts: 204
Threads: 56
Thanked 42 Times in 37 Posts
Reputation: 52
Send a message via Skype™ to docoftheworld
Medicolegal and Ethics The concept of Incompetent Patients

Simply put:

What the heck is incompetence, i never understood the concept, If a patient is having meningitis and his fever is 40, and he do not want to be treated, do we consider him competent?

If he is under heroin/alcohol influence, i understand he is not competent

if he is hearing god telling him things: he is COMPETENT: so the angels tell him not to undertake the appendectomy, then u listen to him!! is that so?

Please someone help explain it to a dumb person such as myself
Reply With Quote Quick reply to this message



  #2  
Old 06-01-2011
USMLE-Syndrome's Avatar
USMLE Forums Master
 
Steps History: ---
Posts: 1,203
Threads: 180
Thanked 1,254 Times in 441 Posts
Reputation: 1268
Default

Quote:
What the heck is incompetence, i never understood the concept, If a patient is having meningitis and his fever is 40, and he do not want to be treated, do we consider him competent?
educate this patient about the harm that could cause it if hr rx in home if he refuse then Rx this patient against hill will because he is threat to health of others

Quote:
f he is under heroin/alcohol influence, i understand he is not competent
right

Quote:
if he is hearing god telling him things: he is COMPETENT: so the angels tell him not to undertake the appendectomy, then u listen to him!! is that so
he is incompetent and ask if there is any relative to sign the consent of operation
Reply With Quote Quick reply to this message
The above post was thanked by:
docoftheworld (06-02-2011)
  #3  
Old 06-01-2011
docoftheworld's Avatar
USMLE Forums Veteran
 
Steps History: 1 + CS
Posts: 204
Threads: 56
Thanked 42 Times in 37 Posts
Reputation: 52
Send a message via Skype™ to docoftheworld
Default

well you see, i am not sure about the last part: schizophrenia patients are competent ( but the issue if they hear voices/hallucinations) are they still competent?

we need more opinions here, because if a patient has delusional disorder then he is certainly competent and free to think what he wants
Reply With Quote Quick reply to this message
 
  #4  
Old 06-01-2011
1TA2B's Avatar
USMLE Forums Guru
 
Steps History: CK Only
Posts: 475
Threads: 39
Thanked 353 Times in 169 Posts
Reputation: 376
Default

You have to go through 4 steps as outlined below. So you have to make the decision individually. Hope it helps you.

A person has capacity in relation to a specific decision if they:
  • understand the information relevant to the decision
  • can retain the information, even if only for short periods
  • can use or weigh the information relevant in the decision-making process, including seeing both sides of the argument and being able to make a decision one way or the other
  • can communicate their decision by talking, using sign language or another form of communication understood by others.
__________________
Skill+Hardwork+Preparation=Success
To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts.

Reply With Quote Quick reply to this message
The above post was thanked by:
docoftheworld (06-01-2011), healer2b (06-01-2011)
  #5  
Old 06-01-2011
docoftheworld's Avatar
USMLE Forums Veteran
 
Steps History: 1 + CS
Posts: 204
Threads: 56
Thanked 42 Times in 37 Posts
Reputation: 52
Send a message via Skype™ to docoftheworld
Default

according to 1TA2B's great post:

hallucinating schizophrenics are competent, no?
Reply With Quote Quick reply to this message
  #6  
Old 06-01-2011
USMLE Forums Addict
 
Steps History: 1+CK+CS
Posts: 132
Threads: 11
Thanked 185 Times in 70 Posts
Reputation: 195
Default

Quote:
Originally Posted by 1TA2B View Post
You have to go through 4 steps as outlined below. So you have to make the decision individually. Hope it helps you.

A person has capacity in relation to a specific decision if they:
  • understand the information relevant to the decision
  • can retain the information, even if only for short periods
  • can use or weigh the information relevant in the decision-making process, including seeing both sides of the argument and being able to make a decision one way or the other
  • can communicate their decision by talking, using sign language or another form of communication understood by others.
Great post 1TA2B

It's important to note that 1TA2B's post defines capacity NOT competence.

Competence is a legal, not a medical issue.

-competency can only be determined by a legal authority, such as a court of law
-psych is solely advisory in determining competency
-psych determines the capacity of a pt to understand the consequences of treatment decisions based on exams of memory, judgment, and understanding

*evidence of incompetence includes: suidical, grossly psychotic or dysfunctional, physical or mental state that prevents simple communication
Reply With Quote Quick reply to this message
The above post was thanked by:
docoftheworld (06-01-2011)
  #7  
Old 06-01-2011
docoftheworld's Avatar
USMLE Forums Veteran
 
Steps History: 1 + CS
Posts: 204
Threads: 56
Thanked 42 Times in 37 Posts
Reputation: 52
Send a message via Skype™ to docoftheworld
Default

which leads us back to a (shizo mother off her meds, hearing angelic voices telling her the baby is the devil's child)

do we acknowledge and respect her wish?
Reply With Quote Quick reply to this message
  #8  
Old 06-01-2011
1TA2B's Avatar
USMLE Forums Guru
 
Steps History: CK Only
Posts: 475
Threads: 39
Thanked 353 Times in 169 Posts
Reputation: 376
Default

Quote:
Originally Posted by healer2b View Post
Great post 1TA2B

It's important to note that 1TA2B's post defines capacity NOT competence.

Competence is a legal, not a medical issue.

-competency can only be determined by a legal authority, such as a court of law
-psych is solely advisory in determining competency
-psych determines the capacity of a pt to understand the consequences of treatment decisions based on exams of memory, judgment, and understanding

*evidence of incompetence includes: suidical, grossly psychotic or dysfunctional, physical or mental state that prevents simple communication

Here is the statement-dittoing what healer 2b said! Usful stuff! (http://www.nami.org/Content/Microsit...Competency.doc)

"In psychiatric patients, mental status is important in the determination of legal competence, but incompetence is not a medical diagnosis, but a legal status."
__________________
Skill+Hardwork+Preparation=Success
To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts.

Reply With Quote Quick reply to this message
The above post was thanked by:
docoftheworld (06-02-2011)
  #9  
Old 06-01-2011
docoftheworld's Avatar
USMLE Forums Veteran
 
Steps History: 1 + CS
Posts: 204
Threads: 56
Thanked 42 Times in 37 Posts
Reputation: 52
Send a message via Skype™ to docoftheworld
Default

to summarize questions

1- (shizo mother off her meds, hearing angelic voices telling her the baby is the devil's child)

do we acknowledge and respect her wish?

2- if a patient is (hypotensive) and has confusion, we surely save him EVEN if he says dont save me (right? he is hypotensive isnt he? can he think rationally?)

3- does the same apply to a guy with a fever (normotensive) with temp more than 40?!

I hope i am able to communicate my concerns appropriately
Reply With Quote Quick reply to this message
  #10  
Old 06-01-2011
USMLE Forums Addict
 
Steps History: 1+CK+CS
Posts: 132
Threads: 11
Thanked 185 Times in 70 Posts
Reputation: 195
Default

Quote:
Originally Posted by 1TA2B View Post
You have to go through 4 steps as outlined below. So you have to make the decision individually. Hope it helps you.

A person has capacity in relation to a specific decision if they:
  • understand the information relevant to the decision
  • can retain the information, even if only for short periods
  • can use or weigh the information relevant in the decision-making process, including seeing both sides of the argument and being able to make a decision one way or the other
  • can communicate their decision by talking, using sign language or another form of communication understood by others.
I also want to point out one more thing about 1TA2B great definition of capacity...

"A person has capacity in relation to a specific decision if they:"

This means that capacity must be determined for every decision. It's not that a person simply has capacity or doesn't--their capacity must be determined separately for all decisions.

It's easy to see how this would be important for someone with dementia. They may have capacity to decide whether they would like to have their mammograms annually or biannually, however the complex cognition necessary to determine whether or not they want to aggressively treat their stage 4 breast cancer may be beyond their capacity if they cannot understand and retain the relevant information.
Reply With Quote Quick reply to this message
The above post was thanked by:
docoftheworld (06-02-2011)
  #11  
Old 06-01-2011
docoftheworld's Avatar
USMLE Forums Veteran
 
Steps History: 1 + CS
Posts: 204
Threads: 56
Thanked 42 Times in 37 Posts
Reputation: 52
Send a message via Skype™ to docoftheworld
Default

voila, then if a patient with dementia says he wants to die? do we respect his wishes? man i am so confused, could you provide examples to different circumstances
Reply With Quote Quick reply to this message
  #12  
Old 06-01-2011
1TA2B's Avatar
USMLE Forums Guru
 
Steps History: CK Only
Posts: 475
Threads: 39
Thanked 353 Times in 169 Posts
Reputation: 376
Default

Quote:
Originally Posted by docoftheworld View Post
voila, then if a patient with dementia says he wants to die? do we respect his wishes? man i am so confused, could you provide examples to different circumstances
It is all down to basic ethical principle-autonomy!

If one has capacity, you have to respect his/her autonomy-respect that person's wishes although what he/she wants is totally irrational!!!!
__________________
Skill+Hardwork+Preparation=Success
To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts.

Reply With Quote Quick reply to this message
The above post was thanked by:
docoftheworld (06-02-2011)
  #13  
Old 06-01-2011
docoftheworld's Avatar
USMLE Forums Veteran
 
Steps History: 1 + CS
Posts: 204
Threads: 56
Thanked 42 Times in 37 Posts
Reputation: 52
Send a message via Skype™ to docoftheworld
Default

has capacity in relation to a specific decision if they:
understand the information relevant to the decision"""


Does a demented/hypotensive/highly febrile/shizophrenic

(understand) information?
Reply With Quote Quick reply to this message
  #14  
Old 06-01-2011
USMLE Forums Addict
 
Steps History: 1+CK+CS
Posts: 132
Threads: 11
Thanked 185 Times in 70 Posts
Reputation: 195
Default

Quote:
Originally Posted by docoftheworld View Post
has capacity in relation to a specific decision if they:
understand the information relevant to the decision"""


Does a demented/hypotensive/highly febrile/shizophrenic

(understand) information?

Determining this requires talking to the patient. Not all demented/hypotensive/highly febrile/schizophrenic patients are the same. You determine whether or not they understand the relevant information by asking the patient questions and assessing their answers.
Reply With Quote Quick reply to this message
The above post was thanked by:
docoftheworld (06-02-2011)
  #15  
Old 06-01-2011
1TA2B's Avatar
USMLE Forums Guru
 
Steps History: CK Only
Posts: 475
Threads: 39
Thanked 353 Times in 169 Posts
Reputation: 376
Default

Oh I forgot to give you an example.

An elderly man who is frail with multiple comobidities including recurrent falls with a few broken bones-so he is at high risk of falling over and also more fractures, perhaps cerebral bleeds etc. He lives alone with carers coming in a few times during day time. But he is on his own night time. So let's say doctors feel that he should move into care home.

So go through 4 steps-he understands the situation well-his risks, retain the info, weigh up his risks, but he makes decision that he is just keen to go back to his own bungalow where he lives for his whole life-understand the risk involved but happy to take the risk! Then you have to respect his choice!
__________________
Skill+Hardwork+Preparation=Success
To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts.

Reply With Quote Quick reply to this message
The above post was thanked by:
docoftheworld (06-02-2011)



  #16  
Old 06-01-2011
docoftheworld's Avatar
USMLE Forums Veteran
 
Steps History: 1 + CS
Posts: 204
Threads: 56
Thanked 42 Times in 37 Posts
Reputation: 52
Send a message via Skype™ to docoftheworld
Default

usmle doesnt give you this luxury to expand

so back to our ORIGINAL question:

(shizo mother off her meds, hearing angelic voices telling her the baby is the devil's child)

do you prepare for abortion and put her on her meds? or do you Defer abortion and put her on her meds?
Reply With Quote Quick reply to this message
  #17  
Old 06-02-2011
1TA2B's Avatar
USMLE Forums Guru
 
Steps History: CK Only
Posts: 475
Threads: 39
Thanked 353 Times in 169 Posts
Reputation: 376
Default

Quote:
Originally Posted by docoftheworld View Post
usmle doesnt give you this luxury to expand

so back to our ORIGINAL question:

(shizo mother off her meds, hearing angelic voices telling her the baby is the devil's child)

do you prepare for abortion and put her on her meds? or do you Defer abortion and put her on her meds?
OK. Let's see.

Let me clarity-

A pregnant schizophrenic patient who wants to terminate her pregnancy (TOP) because she hears voices telling her that the baby is devil's child. Right!

Clearly she is mad. She needs treatment first before we proceed with TOP.
__________________
Skill+Hardwork+Preparation=Success
To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts.

Reply With Quote Quick reply to this message
The above post was thanked by:
docoftheworld (06-02-2011)
  #18  
Old 06-02-2011
docoftheworld's Avatar
USMLE Forums Veteran
 
Steps History: 1 + CS
Posts: 204
Threads: 56
Thanked 42 Times in 37 Posts
Reputation: 52
Send a message via Skype™ to docoftheworld
Default

its not as straightforward bud ... autonomy should be respected then only if the patient is on psych meds or not hearing voices?
Reply With Quote Quick reply to this message
  #19  
Old 06-02-2011
1TA2B's Avatar
USMLE Forums Guru
 
Steps History: CK Only
Posts: 475
Threads: 39
Thanked 353 Times in 169 Posts
Reputation: 376
Default

After having treatment as appropriate, need to reassess!

Probably, having baby might not be her best interest after all. However, we can't proceed with TOP for now. She doesn't have capacity or not competent either.

Any body else has any different views?

Thanks
__________________
Skill+Hardwork+Preparation=Success
To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts.

Reply With Quote Quick reply to this message
The above post was thanked by:
docoftheworld (06-02-2011)
  #20  
Old 06-02-2011
docoftheworld's Avatar
USMLE Forums Veteran
 
Steps History: 1 + CS
Posts: 204
Threads: 56
Thanked 42 Times in 37 Posts
Reputation: 52
Send a message via Skype™ to docoftheworld
Default

for the life of me, i cant remember a specific question that will make you surprised .... darn it .... well, it was about how schizophrenic patients CAN REFUSE treatment (as well as morbidly depressed ones) as part of their autonomy .... but according to our reasoning here WE SHOULD give them the medications whether they want it or not since they do not have capacity


what do u think?
Reply With Quote Quick reply to this message
  #21  
Old 06-03-2011
1TA2B's Avatar
USMLE Forums Guru
 
Steps History: CK Only
Posts: 475
Threads: 39
Thanked 353 Times in 169 Posts
Reputation: 376
Default

Quote:
Originally Posted by docoftheworld View Post
for the life of me, i cant remember a specific question that will make you surprised .... darn it .... well, it was about how schizophrenic patients CAN REFUSE treatment (as well as morbidly depressed ones) as part of their autonomy .... but according to our reasoning here WE SHOULD give them the medications whether they want it or not since they do not have capacity


what do u think?
Hi there,

The point I made was different from the one you just mentioned.

This was my understanding of the scenario-

A pregnant schizophrenic patient who wants to terminate her pregnancy (TOP) because she hears voices telling her that the baby is devil's child. Right!

So the point I made was - doctors do not need to give the treatment psychiatric patient asks for.

Now it is the different issue-giving treatment agaist the will! We call it "compulsory treatment in the UK". I must admit I don't know US law. You have to check. Here is what it is said!


Why might I be given compulsory treatment?


Whether or not you will receive compulsory treatment will depend on the type of compulsory power/order you are under. If you are on:
  • An emergency detention certificate - you can only be given treatment if it is needed urgently or if you are being treated under the Adults with Incapacity Act.
  • A short-term detention certificate - you can be given treatment without your consent.
  • A compulsory treatment order - you can be given treatment without your consent but only if the Tribunal has authorised this when making the order.
There are conditions that need to be met before these powers can be used. The wording of these conditions varies slightly depending on the type of order, but they are that:
  • You have a mental disorder
  • Medical treatment is available which could stop your condition getting worse, or help treat some of your symptoms
  • If that medical treatment was not provided, there would be a significant risk to you or to others
  • Because of your mental disorder, your ability to make decisions about medical treatment is significantly impaired
  • The use of compulsory powers is necessary.
Hope it helps!
__________________
Skill+Hardwork+Preparation=Success
To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts.

Reply With Quote Quick reply to this message
The above post was thanked by:
docoftheworld (06-03-2011)
  #22  
Old 06-03-2011
docoftheworld's Avatar
USMLE Forums Veteran
 
Steps History: 1 + CS
Posts: 204
Threads: 56
Thanked 42 Times in 37 Posts
Reputation: 52
Send a message via Skype™ to docoftheworld
Default

This definitely does not apply to US/USMLE purposes:

There are 2 concepts on the line here:

1- If a shizophrenic patient hearing voices telling him that he should NOT be treated (for any medical condition that he is having, including the schizophrenia itself!! (although those patients lack insight, so the latter is not an issue) anyways, if a schizophrenic having appendicits and the voices are telling him NOT to be treated: then my understanding is that YOU RESPECT his wishes!!!! although it sounds insane!! tahts my understanding, and i am sad that members of the forum are not discussing this with us, because its important

2- a baby inside the mother is (the mother property) so if she wants abortion because she (feels like it) (if not in a controversial state or what not) then also, her wishes should be respected


from 1+2--> i got that we should go on with the abortion .....

i hope my question is clear now

Cheers
Reply With Quote Quick reply to this message
  #23  
Old 06-03-2011
docoftheworld's Avatar
USMLE Forums Veteran
 
Steps History: 1 + CS
Posts: 204
Threads: 56
Thanked 42 Times in 37 Posts
Reputation: 52
Send a message via Skype™ to docoftheworld
Default Prognostic Factor in Breast Cancer

wrong place
Reply With Quote Quick reply to this message
  #24  
Old 06-04-2011
1TA2B's Avatar
USMLE Forums Guru
 
Steps History: CK Only
Posts: 475
Threads: 39
Thanked 353 Times in 169 Posts
Reputation: 376
Default

Quote:
Originally Posted by docoftheworld View Post
This definitely does not apply to US/USMLE purposes:

There are 2 concepts on the line here:

1- If a shizophrenic patient hearing voices telling him that he should NOT be treated (for any medical condition that he is having, including the schizophrenia itself!! (although those patients lack insight, so the latter is not an issue) anyways, if a schizophrenic having appendicits and the voices are telling him NOT to be treated: then my understanding is that YOU RESPECT his wishes!!!! although it sounds insane!! tahts my understanding, and i am sad that members of the forum are not discussing this with us, because its important

2- a baby inside the mother is (the mother property) so if she wants abortion because she (feels like it) (if not in a controversial state or what not) then also, her wishes should be respected


from 1+2--> i got that we should go on with the abortion .....

i hope my question is clear now

Cheers
Agree that is important medico-legal case!

What is the source of this question? Is it the answer?
__________________
Skill+Hardwork+Preparation=Success
To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts.

Reply With Quote Quick reply to this message



Reply

Tags
MedicoLegal-Ethics

Quick Reply
Message:
Options

Register Now

In order to be able to post messages on the USMLE Forums forums, you must first register.
Please enter your desired user name, your email address and other required details in the form below.
User Name:
Password
Please enter a password for your user account. Note that passwords are case-sensitive.
Password:
Confirm Password:
Email Address
Please enter a valid email address for yourself.
Email Address:
Medical School
Choose "---" if you don't want to tell. AMG for US & Canadian medical schools. IMG for all other medical schools.
USMLE Steps History
What steps finished! Example: 1+CK+CS+3 = Passed Step 1, Step 2 CK, Step 2 CS, and Step 3.

Choose "---" if you don't want to tell.

Favorite USMLE Books
What USMLE books you really think are useful. Leave blank if you don't want to tell.
Location
Where you live. Leave blank if you don't want to tell.

Log-in

Human Verification

In order to verify that you are a human and not a spam bot, please enter the answer into the following box below based on the instructions contained in the graphic.



Thread Tools Search this Thread
Search this Thread:

Advanced Search
Display Modes


Similar Threads
Thread Thread Starter Forum Replies Last Post
Osteomyleitis in sickle cell patients: HouseWannabe USMLE Step 1 Forum 9 05-15-2016 04:28 AM
Visual reflexes concept lemontea88 USMLE Step 1 Forum 5 12-06-2012 01:35 PM
A-a gradient concept kemoo USMLE Step 1 Forum 4 04-30-2011 06:51 PM
Glaucoma Concept. donofitaly USMLE Step 1 Forum 1 02-19-2011 03:59 PM
Patients' Autonomy. DrSeddik USMLE Step 1 Bits & Pieces 3 01-26-2010 03:15 AM

RSS Feed
Find Us on Facebook
vBulletin Security provided by vBSecurity v2.2.2 (Pro) - vBulletin Mods & Addons Copyright © 2017 DragonByte Technologies Ltd.

USMLE® & other trade marks belong to their respective owners, read full disclaimer
USMLE Forums created under Creative Commons 3.0 License. (2009-2014)