Mental Competency + Multiple Problems Flashcards
What pts are at risk of cognitive impairment
Dementia
Stroke
Severe mental illness
Head injury
What are subtle changes in function
Family concerns
Med errors
Repetitive questions
Decline in hygiene
How to assess capacity
Understand
Appreciate
Elements of consent
Must be related to treatment
Must be informed
Must be voluntary
Must not be obtained through fraud
Emergency treatment without consent is possible when…
Not possible to communicate relevant info to pt d/t language barrier or disability
Steps have been taken to find means of communicating but none found
Delay will prolong pt’s suffering or put them at risk of serious harm
No reason to believe the pt doesn’t want to the treatment
SDM in order of authority
Guardian
Attorney for personal care
Representative appointed by consent and capacity board
Spouse or partner
Child, parent
Parent with right of access only
Sibling
Any other relative
Public guardian or trustee
What are the 4 C’s of capacity?
Context - understand situation?
Choices - understand options?
Consequences - understand ramifications of each option?
Consistency - fluctuate in understanding?
What to do If pt refuses capacity assessment
Document refusal
Continue to engage in safe care
Revisit when indicated
Pursue SDM if indicated
How to provide involuntary treatment
Initiate certification process
Collaborate with colleagues + family
Document + communicate according to legal requirements
Help pt + family understand why it is necessary
Clarify continuing role in care of patient
Manage emotional impact on pt and possible effects on pt-physician relationship
Indigenous health - poorer outcomes
Health is poorer in chronic disease, avoidable mortality, suicide, substance use and smoking
Life expectancy for indigenous people
Life expectancy lower by 5-11 yrs
Barriers to screening for indigenous people
Inappropriate sample collection methods
Lack of appropriate and culturally tailored educational materials
Physical barriers to accessing care
Limited local availability of PCPs
Difficulties gaining entry into the system
Confidentiality issues
Strategies to improve healthcare provision to indigenous people
Shared decision making w/ discussion of values and preferences and time to reflect/ speak to elders
Foundation of trust
Linking services to indigenous communities
Self reflective practice
Empowering indigenous people
