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Psychiatric Evaluation of Mental Capacity in the General Hospital: A Significant Teaching Opportunity

Received September 19, 2008; revised October 30, 2008; accepted November 3, 2008. From Columbia University College of Physicians and Surgeons, New York, NY; New York Presbyterian Hospital (Columbia), New York, NY; and Overlook Hospital, Summit, NJ. Send correspondence and reprint requests to Donald S. Kornfeld, M.D., 622 W. 168 St., Box #341, New York, NY 10032. e-mail: dsk3{at}columbia.edu
© 2009 The Academy of Psychosomatic Medicine

BACKGROUND: Requests for evaluation of mental capacity in general hospitals have increased in frequency. OBJECTIVE: The authors sought to determine the interventions required to respond adequately and assess the initiating circumstances. METHOD: Questionnaires completed by psychiatric consultants were analyzed, and chart reviews were completed. RESULTS: Capacity evaluation alone resolved 32% of the requests; 31% required an evaluation plus additional interventions; 37% did not require a capacity evaluation. Patients threatening to leave against advice, and/or refusing treatments or procedures represented 64% of requests. Consultants successfully resolved 88% of such cases. CONCLUSION: A mental capacity evaluation alone was insufficient to resolve two-thirds of problems eliciting requests. Consultation–liaison psychiatrists can use these evaluations as teaching opportunities.

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