Core IM | Internal Medicine Podcast #60 Capacity Part 1: At the Bedside Segment
9 snips
Mar 4, 2020 Dr. Andrea Kondracki, double-boarded in internal medicine and psychiatry and director of psychiatry consultation-liaison at Bellevue, walks through decision-making capacity. Short segments cover the four core elements: choice, understanding, appreciation, and reasoning. Practical tips include handling communication barriers, when to involve psychiatry, and using a brief capacity checklist.
AI Snips
Chapters
Transcript
Episode notes
COPD Patient Who Couldn’t Appreciate Risk
- Marissa LeCastro describes an older man with severe COPD who insisted on leaving despite dangerous hypoxemia.
- After hours of discussion she realized the real problem was lack of decision-making capacity, not simply an AMA discharge.
Set Up The Patient To Maximize Capacity
- When assessing capacity, optimize the setting and treat reversible causes before concluding lack of capacity.
- Attend to timing, fix hearing aids, treat delirium or intoxication, control pain, and use plain language to improve decision-making.
Require A Clear Communicated Choice
- First confirm the patient can clearly communicate a choice and stick with it long enough to act.
- Remove communication barriers, use interpreters, address aphasia or tracheostomy limits, and judge urgency when patients defer decisions.