#71 Capacity Part 2, Voluntarism & Difficult Scenarios: At the Bedside Segment

Core IM | Internal Medicine Podcast

Core IM Team

Mental Health, Education, Health & Fitness, Medicine

4.8 • 1K Ratings

🗓️ 22 July 2020

⏱️ 31 minutes

🔗️ Recording | iTunes | RSS

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Summary

What goes into decision making? What are the invisible tugs that may keep patients from acting in line with their values? Why isn't it part of the formal capacity assessment? Show notes, Transcript and References: https://www.coreimpodcast.com/2020/07/22/capacity-2-0-and-voluntarism/ Get CME-MOC credit with ACP: https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im Time Stamps: * 2:57 Defining voluntarism * 5:36 Four elements that influence voluntarism * 10:26 How do you incorporate voluntarism into the capacity assessment? * 16:11 Discussions with uncooperative patients * 19:14 Protecting unrepresented patients * 21:30 Clinician perspective * 25:06 Moral distress Tags: medical humanities, ethics, psychiatry, IM Core, CoreIM Find the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840 Advertising Inquiries: https://redcircle.com/brands Privacy & Opt-Out: https://redcircle.com/privacy

Transcript

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0:00.0	Hi everyone this Coriam episode will count for
0:02.8	Sammy Credit with the American College of Physicians.
0:05.6	We'll link the exact URL in the show notes so click on the link
0:08.8	answer three questions and get CME Credit.
0:11.3	And with that, let's dive into this thought-provoking topic.
0:17.0	I want to revisit a case we talked about almost a year ago in our episode on Discharges
0:22.3	Against Medical Advice.
0:24.0	This was a young man with a history of IV drug use who came in with high fevers and was found to be
0:29.1	backed a remake. When I first walked into his room, I tried to explain our concern that he had endocarditis, a life-threatening infection of the heart valves.
0:38.0	But he told me that he had to go home.
0:40.0	His mother was having some legal trouble, he said, but he had huge pupils and he just kept yawning.
0:47.0	I was worried that he was withdrawing from heroin and that his desire to use again was driving his plan to leave.
0:54.0	But he turned down my offer of methadone.
0:57.0	He showed me that he understood the risks of leaving,
1:00.0	that he appreciated that he could die if left untreated, and he had a perfectly logical reasoning process.
1:06.0	So he signed himself out AMA, and he left.
1:12.0	A lot of questions can linger after a tough capacity evaluation.
1:16.0	What about patients who show that they have capacity but seem to be pressured into a choice?
1:21.0	What happens if the patient fails the capacity evaluation?
1:25.2	What happens next? Can we let this patient decide what happens with their body or do we
1:30.2	take that right away? I won't pretend we hold all the answers,
1:34.4	but we wanted a space to explore them.
	...

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