•You are called to obtain surgical consent from an 84-year-old man who is hospitalized after suffering a right femoral neck fracture, for repair of that fracture. The patient has a long history of multi-infarct dementia and major depression. He lives with his daughter and her husband. They report to you that he lost his footing while walking and suffered a fall. There was no loss of consciousness and no evidence by history that the fall was syncopal in nature. You read the psychiatric evaluation in his chart that notes that the patient, despite some dementia, confusion, and odd mannerisms, is competent to make his own medical decisions and fully understands the nature of his condition. When you enter the room to obtain consent from the patient for surgery, he responds with situation-inappropriate responses, fails to make eye contact with you, and is not oriented to place or time. The patient has no power of attorney or health care proxy listed in his medical record. The most appropriate course of action is to •
A. call a family member to consent for the patient •
B. consent the patient for surgery, he has been cleared by psychiatry •
C. consent the patient for surgery with a note explaining his condition in the chart •
D. do not consent the patient for surgery •
E. perform your own competency test on this patient
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E. perform your own competency test on this patient
e
c
D
E
e
D, What is this ‘own competency test’!??!? Pt if disoriented & not eligible for consent!
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Should be E i think.
Dr Red, please tell us the answer
E. Delirium is present. This can be due to polypharmacy.
U need to do the Confussion Assesment Scale
A
when patient not in position of taking decision and have no power of attorney then decision of the NEXT KEEN is required
child>parents>relatives>
E
A- use substituted judgement when in doubt which would be next of kin.
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A is the answer
A is the answer
d
Dr Red please explain!
a because patient seems to be in competant to take decisions if not then you should seek second opinion .
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