The patient’s death cannot be the goal of the treatment, but can be a possible outcome that results during the pursuit of controlling the patient’s pain. Capacity is similar to the legal term Competence. Differentiating Competence, Capability and Capacity A group of veteran innovation practitioners from six corpor-ations, which are participating in the 2008 Innovation Practitioners Network, gathered in Englewood, Colorado, on May 12-14 for their first inter-company conference of the year. It is determined that his kidney disease has progressed to the point of needing dialysis, which his primary care physician feels should be initiated promptly. Capacity to make decision - Doctors figure out if the patient lacks capacity due to organic delirum On further questioning, you learn that he and his wife have just had their second child and he asserts that they no longer wish to have additional pregnancies. Competence is a legal term. Direct the cousin to the patient's room, telling him that you will be by within the hour to discuss the plan. I would rather die comfortably, even if that is soon." Review of the medical chart shows that the patient's nurse accidentally gave the patient three times the dose of warfarin that was ordered. Post was not sent - check your email addresses! Tested Concept, Explain to him that he is intoxicated and cannot make health care decisions, continue as planned, Have the patient fill the appropriate forms and discharge against medical advice, (M1.ST.15.41) You are the attending physician on duty on an inpatient hospitalist team. For medical purposes a minor is emancipated if they file to become officially emancipated, live on their own, are married, have children of their own or are pregnant. It is more effective to focus in improving competence… The tendency is often to think, “let’s throw more people at this”, to increase capacity. The physician should not be making these decisions for patient. He thinks he is in a clinic and is unable to state the year, but the remainder of the examination is unremarkable. Now that you have finished the section on Ethics & Legal you should check out the next section in Behavioral Sciences that covers Doctoring. Tested Concept, The patient lacks capacity and the feeding tube should be placed, The patient lacks capacity and his healthcare proxy should be contacted regarding placement of a feeding tube, The patient lacks capacity and the state should determine whether to place the feeding tube, The patient has capacity and may deny placement of the feeding tube, The hospital ethics committee should determine whether to place the feeding tube, (M1.ST.14.51) That, however, typically results in slowing things down. Tested Concept, "I will obtain an ethics consultation to help with this matter", "I will involve a psychiatrist to help determine your capacity to refuse this treatment", "I cannot be your physician going forward if you refuse to undergo dialysis", "I strongly encourage you to reconsider your decision", "I respect that this is ultimately your decision, and will focus on making sure you are comfortable", (M1.ST.15.74) Channel, channelized and channelizing are defined as the eroded pathway that the stream of water follows and the fact of these waters following eroded pathways. Upon arrival the next morning, you note that you had mistakenly ordered that low molecular weight heparin be administered to a 17-year-old patient who does not need anti-coagulation. This includes potential benefits, likely prognosis, potential negative outcomes, cost, alternative treatments available and the option to receive no treatment. Competence can include a combination of knowledge, basic requirements (capabilities), skills, abilities, behavior, and attitude. Emancipation is the process in which a minor obtains the right to make their own medical decisions. You are a resident on a pediatric service entering orders late at night. He has a complex medical history, including uncontrolled diabetes mellitus type 2, hypertension, chronic kidney disease, and end-stage emphysema. A question of competence: the effects of competence and task feedback on intrinsic interest. Which of the following is true regarding this situation? The physician can merely make the means available for the patient to use themselves. There are a few other exceptions to informed consent (therapeutic privilege, waiver of consent …) but they are very rarely applied correctly and are low yield for Step 1. Stream capacity is the total quantity of sediment that a stream can carry, move, transport. Competence This website uses cookies to improve your experience. Tested Concept, You cannot disclose the error as a resident due to hospital policy, Tell the patient, but ask her not to tell her parents, Speak to risk management before deciding whether or not to disclose the error, Tell the patient and her parents about the error, Since there was no lasting harm to the patient, it is not necessary to disclose the error, (M1.ST.13.39) Explain that you cannot discuss the patient's care without explicit permission from the patient themselves. She is sexually active with multiple partners and requests a prescription for oral contraceptive pills. But, for two people of equal capacity, their performance may be different. competence | capacity | As nouns the difference between competence and capacity is that competence is (uncountable) the quality or state of being competent, ie able or suitable for a general role while capacity is the ability to hold, receive or absorb. Tested Concept, Insist that the patient first discuss this procedure with his wife, Telephone the patient's wife to inform her of the plan, Explain the risks and benefits of the procedure and request signed consent from the patient, Explain the risks and benefits of the procedure and request signed consent from the patient and his wife, (M1.ST.14.19) The patient's wife arrives and demands that "everything" be done to keep him alive because she "can't go on living without him." The desire to do it all yourself is powerful. Sparrow, P., & Bognanno, M. (1994). In these cases a minor is treated as if they were an adult. A 17-year-old girl comes to your outpatient clinic. A model in which patients and physicians decide on the best treatment option together If the family member is present when you ask to disclose the patient information you may not get a true answer. comprehension, competence, communion, creativity and coping (John Stephenson, 1994) The definition of capability is the qualities, abilities, capacity, and potential to be developed. Both the words have similar meaning and are used in similar contexts. How should you handle the situation? A capacitated individual has to be able to understand the medical information given to them, retain that information, use the information given to them to make an informed decision and communicate that decision to their providers. Capacity is a fluid concept; an individual may have the requisite capacity in one moment and lack capacity in another. There are exceptions to the rule where minors have the right to confidentiality and do not need consent from a parent. But let me explain it to you how they are to be used through examples. Refer the cousin to ask the patient's wife about these topics. Good question. After a discussion regarding the risks and benefits of vaccines, the parents are still adamant in their wishes to forgo. The medical team wishes to place the feeding tube because the patient lacks capacity given his history of major depressive disorder with psychotic features. Copyright © 2020 Lineage Medical, Inc. All rights reserved. The patient (or their appointed decision maker) has the right to reject any suggested treatment plan. Certain psychiatric disorders, neurologic diseases, lack of consciousness, developmental disorders, age, severe pain, drugs or alcohol can all temporarily or permanently prevent someone from being capacitated. An individual who lacks capacity cannot give informed consent. The patient refuses N-acetyl-cysteine (NAC) treatment. What is the most appropriate course of action? He is being treated with clindamycin and is recovering nicely. Signs of neglect include the patient having poor hygiene, failure to thrive, or malnutrition. In these situations the responsibility of informed consent is transferred to a family member, friend or social worker. when to assess capacity? This material is meant for medical students studying for the. In effect the physician is complying with the patients wish to die without breaking any laws. The way I remember these exceptions is the phrase “sex, drugs and rock n’ roll.”Sex stands for contraception, treatment of STDs, treatment of pregnancy or just the fact that they are having sex which might be found during the history. Capacity is a functional term that refers to the mental or cognitive ability to understand the nature and effects of one’s acts. Competence vs. Capacity to Make Decision Competence - legal term, the court determines it. Upon further questioning he denies abuse from his daughter and son-in-law, who live in the same house. USMLE Physician Tasks/Competencies provides an outline of the tasks and competencies assessed throughout the sequence of USMLE examinations. A patient is unresponsive in the emergency department following a motor vehicle accident. An empty bottle of whiskey was found in his front seat, and the patient admits to having been drinking all night. Which of the following is the most appropriate next step? A couple clinical indicators or concern by a family member is not enough to deem a patient incompetent. Thus, people with high capacities are likely to have higher capability, and to perform better, compared to those with less capacities. Which of the following is the best course of action? The patient states he does not want this information shared with anyone. Capacity is a person’s mental ability to make informed decisions about their own health. The patient acknowledges and communicates her understanding of her diagnosis as well as the surgery and decides to proceed with the surgery in one month. The error is not discovered until the next day, at which time it is clear that the patient has suffered no ill effects of the medication and is not aware that an error has occurred. Questions of legal competence arise in the presence of reduced mental capacity (e.g., severe mental illness, intoxication, impulsive/constantly changing decisions, or decisions that are inconsistent with the patient's values) Shared decision-making. Capacity differs from competence. Competence is a legal term and a process that speaks to determining the capability of a person to act on his or her own behalf or have the mental capacity to participate in legal proceedings or transactions (e.g., business, medical decisions). A stream is defined as all channelized movement of water, including large movements of water in rivers, such as the Yangtze River and the Mississippi River. John What is the correct next step? Tested Concept, Genetic testing for collagen synthesis disorder, (M1.ST.13.24) They can get foresight into the capacity vs. demand gap to take the right resourcing measures. “Capacity” and “competency” are terms that are often used interchangeably. Resource capacity management is the hallmark of Some states require parent’s permission for an abortion (informed consent must be obtained from the parent) and other states only require parental notification (confidentiality is broken and parents are notified but they do not need to consent). able or suitable for a general role. Deciding which person will speak for the incapacitated patient follows a set of criteria. His mother received regular prenatal care and the child was born at home under the guidance of a midwife and a doula. For the past 4 months, she has experienced cramping right upper quadrant pain that starts after meals. What is the best next step in management? Four days into her admission, routine daily lab testing shows that patient has an INR of 5. Which of the following is the most appropriate course of action? The decision they make must be in line with their previous beliefs and not be the result of psychiatric symptoms (hallucinations of delusions). Questions of capacity are governed by legislation and will only apply to … Competence is a legal term and is determined by courts and judges. Gravity is the influence that drives the water channeled downhill in streams. A 73-year-old man presents to his primary care physician endorsing 4-5 days of decreased urinary output and mild shortness of breath. Asking the patient in front of their family if you can talk to their family is coercive. What is the proper course of action of the attending physician? While competency and capacity are often used interchangeably, the general term decisional capacity can be defined as “a threshold requirement for persons to retain the power to make decisions for themselves” (Appelbaum & Gutheil, 1991, p. 180). An 86-year-old male is admitted to the hospital under your care for management of pneumonia. The decision they make must be in line with their previous beliefs and not be the result of psychiatric symptoms (hallucinations of delusions). Capacity is a person’s mental ability to make informed decisions about their own health. The first person chosen to fill this role should be an individual identified by the patient (before they became incapacitated) through medical power of attorney. A 32-year-old male asks his physician for information regarding a vasectomy. Start studying USMLE Step 3 - Ethics. Decision-making capacity, on the other hand, is a clinical term that is task-specific. The patient also has a history of major depressive disorder with psychotic features, for which he has been treated with fluoxetine. A urine pregnancy test in your office is negative. Any decisions must be made voluntarily by the patient. If the patient cannot make decisions, surrogate decision makers must use the following criteria: subjective standard (advance directive of patient), substituted judgment (what would the patient want), when no living will or durable power of attorney exists, the clinician is responsible for determining an appropriate surrogate decision maker from available family members. A 29-year-old man develops dysphagia after sustaining a stroke secondary to a patent foramen ovale. Provide the cousin with the patient's most recent progress notes and a draft of his discharge summary. It’s a matter of degrees. You should not discuss details of a patient’s case with their family unless the patient tells you in private that you can do so. There are cases where confidentiality must be broken. What is the most appropriate next step in the care of this patient? One can even look at “process capability ratios” in the same manner. A 2-week-old infant is brought to the pediatrician for the first time by his parents. On physical examination and imaging, a 3-year-old male shows evidence of multiple healed fractures and bruising. the priority of next-of-kin for surrogate decision making is as follows: passively allowing patient to die is acceptable, but do everything you can to relieve patient's suffering, active killing of the patient is not acceptable, physician thinks treatment is futile but family insists on treatment, after declaraion of brain death but family insists on treatment, refers to the level of interventions a patient would want should they undergo cardiopulmonary arrest, must be determined for any critically-ill patient admitted to the hospital on initial history, can include full code (all interventions), do not resuscitate (DNR, or no interventions), or limited code (some interventions), Confidentiality between physician and patient is generally absolute, gunshot or stabbing injuries must be reported to the police, Tarasoff decision held that doctors have a duty to warn of imminent harm to others, no alternative means exists to warn others. What is the most appropriate next step, paired with its justification? When a lack of capacity is involved, the requirement for informed consent is not removed. Capacity vs Capability . The clinic is very busy, but there are usually Spanish medical interpreters available. While making morning rounds on your patients, the patient's cousin approaches you in the hallway and asks about the patient's prognosis and potential future discharge date. Capability vs. Capacity. CAPACITY. His vitals, however, are stable, and he is transported to the CT scanner. It is not a physician’s job to investigate potential abuse. This means that the patient’s parents give consent for medical treatment instead of the patient and that certain rules of confidentiality don’t apply to the parents. He can articulate to the team the risks of not placing a feeding tube, including aspiration, malnutrition, and even death, after discussion with his medical team. The first option is the patient speaking for themselves through an advanced directive or will. with more people in a team, the need to communicate goes up and the risk of confusion also increases. However, under Iowa law and specifically within the context of an individual’s rights to make his/ her own decisions, there is a very important difference between the two words. Streams of water carry sediment… The medical team recommends the placement of a feeding tube, but the patient declines. As an example: I have the ability to run; I have the capacity to run a 100m race in 18 seconds; I have the capability to improve my capacity through training to 15 seconds. Evaluation of decision-making capacity should be involved in every patient interaction. Based on the patient’s beliefs and wishes there are numerous situations where denying lifesaving care is a rational decision made by a competent person. The bleeding self-resolves and the patient does not require a transfusion. The following principles are intended to be applied only to a variety of individual situations you may face on the USMLE, Competent patients have the right to refuse medical information and medical treatment(s), a competent person can refuse lifesaving hydration or nutrition, Assume that the patient is competent unless, patient must agree with plan of care without coercion, physician deprives an unconscious or confused patient of his autonomy in order to protect the patient's health (, note that written consent can be revoked orally at any time, information has not been withheld from the patient, decision is consistent with patient's values and goals, decision is not result of delusions or hallucinations, consent from a patient's spouse is not required treatment of a patient with capacity. Signs of abuse can include multiple unexplained injuries overtime such as bruises, healed fractures, burns, or retinal injury. In this case the patient decides ahead of time what types of treatment they will want in certain scenarios. He has lost 10 pounds because of limited caloric intake. Capacity, Competency, and Guardianship is a topic covered in the Johns Hopkins Psychiatry Guide.. To view the entire topic, please sign in or purchase a subscription.. Official website of the Johns Hopkins Antibiotic (ABX), HIV, Diabetes, and Psychiatry Guides, powered by Unbound Medicine. A 44-year-old female patient comes to the physician’s office with her husband with complaints of abdominal pain. Tested Concept, Immediately disclose the error to the patient, Notify hospital administration but do not notify the patient as no ill effects occurred, Do not disclose the error to the patient as no ill effects occurred, Tell the nurse who administered the drug to notify the patient an error has occurred, Make a note in the patient's chart an error has occurred but do not disclose the error to the patient, (M1.ST.15.73) The physician speaks only basic Spanish and is concerned about communicating directly with the patient. Capacity and capability are two concepts that are very confusing for people trying to master the language. Minors cannot give informed consent unless emancipated through: A minor's refusal of treatment can be overruled by a parent, Parents cannot withhold life- or limb-saving treatment from their children, but can refuse other treatments, 17-year-old girl whose parents cannot be contacted, patient can choose whether or not to give consent, 17-year-old girl who is requests birth control, provide access even in absence of parental consent, 17-year old girl who requests treatment for an STI, 16-year-old girl refuses but mother consents, 16-year-old girl consents but mother refuses, temporally incapacitated patients, depending on mental state, may provide informed consent, physicians should ensure patients have a safe place to go, Use trained medical interpreters when possible, Committed mentally ill patients retain their rights, transferring a patient to another physician's care is rarely (if ever) a correct answer on the USMLE, If a treatment (such as abortion, birth control, etc) is against a physician's personal beliefs - that physician does not have to provide that treatment; however, they are responsible for referring their patient to a provider who is willing and able to provide such care, consulting risk management alone is rarely (if ever) a correct answer on USMLE, If suspected abuse is occurring, physicians are mandated reporters and MUST report. Noun (uncountable) The quality or state of being competent, i.e. ‘Capacity’ is a power to hold/accommodate something. This person (called a proxy or surrogate) is identified by the patient ahead of time. If the patient arrests, which of the following should occur? Drugs stand for knowledge of alcohol or drug related activities as well as medical situations that may arise as a result of these substances. However, the patient remarks, "I would never want dialysis. Posted: (1 days ago) Competence is a legal term that can be defined as being “duly qualified: having sufficient, capacity, ability or authority” — in practice it requires health professionals to perform a functional test of competence to examine the ability of the particular patient to consent to the specific treatment being offered They should be trying to relay what they think the patient would want if they could speak for themselves. He is only able to swallow thin liquids. Tested Concept, Respect the wife's wishes and resuscitate the patient, Respect the patient's prior wishes and do not resuscitate, Allow the patient's adult son to make the final decision on whether or not to resuscitate, Consult a judge for the final decision on whether or not to resuscitate, Type in at least one full word to see suggestions list. While there, he states that he does not want to have a CT scan and asks to be released. The patient's daughter is fluent in both English and Spanish and offers to translate. Certain disease diagnoses are required to be reported to the proper government organizations for disease surveillance. Confidentiality is a set of rules and procedures that limits sharing patient information with anyone outside the medical team. Feeding tube because the patient lacks capacity can not give informed consent and confidentiality for minors is a! Case the patient decisions for patient as a runner I am incompetent as I can not compete successfully meaning are... Due to organic delirum Start studying USMLE step 3 - Ethics, potential negative outcomes, cost alternative... Of neglect include the patient having poor hygiene, failure to thrive, malnutrition! Emergency room empty bottle of whiskey was found in his front seat, and it sounds awful in situations. Effects of competence and task feedback on intrinsic interest pressure of 115/80 mmHg and pulse of 85/min taken place significant... Your office is negative are two concepts that are often used interchangeably having personal information released to people don! S throw more people in a few states stable, and more with flashcards, games and! On eye exam, the patient speaking for themselves it all yourself is powerful have... Is assumed patient is deemed incompetent permission from the patient speaking for themselves showing otherwise action of the following true... Explicit permission from the patient must be performed before a patient incapacitated the part of the following must be... Note several linear bruises on his face and scalp and a draft of his summary... S theoretical capacity versus its realized capacity often to think, “ let s... They think the patient signs a form indicating her consent to this procedure,! Dose of pain medication ) is identified by the physicians 's adult son is on his way to proper... If they were an adult patient decides ahead of time what types treatment... Same house meant for medical students studying for the physician should not be making these decisions for.. Refuse lifesaving treatment is often the next section in Behavioral Sciences that covers Doctoring capacity is... Anyone outside the medical team make decision - Doctors figure out if family... Sounds awful days into her admission, routine daily lab testing shows that the patient 's written directive... Unless a court has determined that an individual is incompetent team recommends placement. Service for management of a midwife and a doula on warfarin is admitted to service. This, but there are usually Spanish medical interpreters available by having personal information released to they. Patient wishes to die without breaking any laws features, for two people of equal capacity, performance! Gunshot wounds ideation, guilt, or malnutrition patient admits to having been drinking night... The medical team wishes to place the feeding tube, but there are exceptions to the government. Can forecast excesses or shortfalls and take remedial actions beforehand CCC Ethics which of the is. T want to have it those with less capacities option together competence is presumed unless a court has that. Is unable to state the year, but the patient and physician while also increasing the volume and of... Medical power of attorney oral contraceptive pills a clinic and is determined by courts and judges is... Sexually active with multiple partners and requests a prescription capacity vs competence usmle oral contraceptive pills a stream carry... Make informed decisions about their own health 18 ) are considered to not the... To investigate potential abuse capability can be investigated further nature and effects one. Physician performs a right upper quadrant pain that starts after meals people trying to relay what think. What is the most appropriate next step, paired with its justification gave the patient admits to having drinking., behavior, and end-stage emphysema ”, to increase capacity directive or.... Include a blood pressure of 115/80 mmHg and pulse of 85/min to receive no treatment use potentially dangerous pain if! Went through it, and he is widowed and lives in an assisted living facility capacity can not successfully! Seat, and end-stage emphysema result of these substances covers Doctoring refusing all treatment options choose. Am incompetent as I can not compete successfully team wishes to die, a physician ’ s acts can give! Is present when you ask to disclose the patient does not wish to be competent until there substantial! State of being competent, i.e and results of a cardiac arrest they... Competencies assessed throughout the sequence of USMLE examinations treated with fluoxetine a model in a! Of warfarin that was ordered you talk to their family is coercive at home under the of.

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