Innovations In Clinical Neuroscience

MAR-APR 2017

A peer-reviewed, evidence-based journal for clinicians in the field of neuroscience

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R I S K M A N A G E - Innovations in CLINICAL NEUROSCIENCE [ V O L U M E 1 4 , N U M B E R 3 – 4 , M A R C H – A P R I L 2 0 1 7 ] 41 QUESTION I am a psychiatrist who treats adult patients. I've noticed recently that I'm seeing a larger number of senior patients, and I have concerns about adequately meeting their needs and also avoiding risk. Do you have any suggestions for better managing an older patient population? ANSWER Given the aging baby-boomer population and the shortage of geriatric psychiatrists, more psychiatrists will find themselves being asked to see older patients and being exposed to the particular professional liability risks related to treating elderly patients. Therapeutic interventions require special attention to ensure the safety of elderly patients. Set forth below are four areas of consideration when treating elderly patients. Recognize that an elderly patient's capacity to give informed consent to treatment may be impaired. Generally speaking, a person may be said to possess capacity if he or she can communicate a choice, understand the relevant information, appreciate the medical consequences of the situation, and reason about treatment choices. 1 Capacity is often a fluid concept. Unless unconscious, a patient's capacity may vary from day to day or even hour to hour. It may fluctuate as a function of the natural course of his or her illness, response to treatment, psychodynamic factors, metabolic status, intercurrent illnesses, or the effect of medications. 2 A patient may lack the capacity to make some decisions but not others. For example, a patient may lack the capacity to manage his or her financial affairs but be perfectly capable of understanding and consenting to medical treatment. Or a patient may be able to execute some medical decisions, such as agreeing to take medication, but not others. The question then becomes whether the patient possesses the capacity to make a specific treatment decision. Assess your patient's ability to give informed consent, which may include a cognitive workup. There are two ways in which to assess capacity: by conducting a clinical interview or by using a formal assessment tool. When assessing capacity through the use of a clinical interview, it may also be necessary to conduct a physical examination, obtain lab work, and to consult with other healthcare providers who have previously treated the patient as well as family members. The clinical interview should contain components which allow you to do the following: • Determine the ability of the patient to understand the proposed treatment and possible treatment alternatives Risk Management This ongoing column is dedicated to providing information to our readers on managing legal risks associated with medical practice. We invite questions from our readers. The answers are provided by PRMS, Inc. (www.prms.com), a manager of medical professional liability insurance programs with services that include risk management consultation, education and onsite risk management audits, and other resources to healthcare providers to help improve patient outcomes and reduce professional liability risk. The answers published in this column represent those of only one risk management consulting company. Other risk management consulting companies or insurance carriers may provide different advice, and readers should take this into consideration. The information in this column does not constitute legal advice. For legal advice, contact your personal attorney. Note: The information and recommendations in this article are applicable to physicians and other healthcare professionals so "clinician" is used to indicate all treatment team members. Managing Your Aging Patient Population by Ann L. McNary, JD Innov Clin Neurosci. 2017;14(3–4)41–44

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