On eye exam, the child's irises appear blue, and results of a fundoscopic exam are shown in Image A. One can even look at “process capability ratios” in the same manner. You are a resident on a pediatric service entering orders late at night. For example, if a process has the capacity to output 100 units per hour, but only realizes 90 units per hour, then the process capability would be 90/100 or 90%. The medical team wishes to place the feeding tube because the patient lacks capacity given his history of major depressive disorder with psychotic features. What is the best course of action for the physician? Capacity is similar to the legal term Competence. Just report a potential case and allow properly trained authorities to determine what is going on. The desire to do it all yourself is powerful. While there, he states that he does not want to have a CT scan and asks to be released. A 79-year-old male presents to your office for his annual flu shot. Capacity and Competence • LITFL Medical B • CCC Ethics. So a physician could use the medically appropriate amount of a pain medication even if the patient’s respirations are likely to be suppressed. John This material is meant for medical students studying for the. Using Capacity planning, resource managers can forecast excesses or shortfalls and take remedial actions beforehand. Competence is a legal term and is determined by courts and judges. On physical examination and imaging, a 3-year-old male shows evidence of multiple healed fractures and bruising. AST and ALT levels are approximately 2500 U/L. A 29-year-old man develops dysphagia after sustaining a stroke secondary to a patent foramen ovale. 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. Patients are assumed to be competent until there is substantial proof showing otherwise. Physicians not only have to make sure they tell their patient’s all of this information but also that their patients understand it. In these situations you provide needed care until the patient becomes competent or the family can be contacted. A 73-year-old man presents to his primary care physician endorsing 4-5 days of decreased urinary output and mild shortness of breath. Discussing comfort care with the patient if they refuse lifesaving treatment is often the next step. However, there are an infinite number of different scenarios that cannot all be outlined by the patient so a person is also needed to speak for the patient. An empty bottle of whiskey was found in his front seat, and the patient admits to having been drinking all night. And in these cases the physician cannot be the one to administer the drug directly. Sorry, your blog cannot share posts by email. If the patient arrests, which of the following should occur? How should you handle the situation? It is not a physician’s job to investigate potential abuse. The child appears well. In these cases a minor is treated as if they were an adult. A thorough examination of the patient must be performed before a patient is deemed incompetent. A judicial declaration of incompetence may be global, or it may be limited (e.g., to financial matters, personal care, or medical decisions). The patient (or their appointed decision maker) has the right to reject any suggested treatment plan. Tested Concept, Seek a court order to deliver the vaccines against the wishes of the parents, Give any scheduled vaccines during that visit against the will of the parents, Document the visit, specifically the detailing of risks and benefits and the parents' refusal of treatment, (M1.ST.13.5) CAPACITY. Four days into her admission, routine daily lab testing shows that patient has an INR of 5. This is because of the similarities in the meanings of these two words and also because of the fact that these words are used in similar contexts. “Capacity” and “competency” are terms that are often used interchangeably. 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. 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. (M1.ST.15.11) Physical exam is unremarkable. A 33-year-old man is brought by ambulance to the emergency room after being a passenger in a motor vehicle accident. 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. You don’t have to definitely determine abuse has taken place. A patient is unresponsive in the emergency department following a motor vehicle accident. Vital signs include a blood pressure of 115/80 mmHg and pulse of 85/min. 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. Explain that you cannot discuss the patient's care without explicit permission from the patient themselves. After discussing the patient's wishes further, which of the following is the most appropriate response on the part of the physician? Upon further questioning he denies abuse from his daughter and son-in-law, who live in the same house. The patient's adult son is on his way to the hospital.

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