Hey everyone, Shreya here. This summer we're going to revisit the best of core I am, and this episode

on capacity is timeless. In fact, I've probably sent this episode out to almost every teaching

team I've been on since it comes up so often.

So without further ado, let's listen to some audio gold.

He wasn't my first patient to try to leave against medical advice, but he was the first patient who I thought would actually die if he walked out the door.

He was an older man with advanced COPD, and he was hospitalized with such a severe pneumonia that he nearly ended up intubated.

At the time that I met him, he was on max settings of high-flow nasal cannula,

requesting politely but firmly to go home.

I told him how concerned I was, pointed out that his oxygen levels dropped to the 70s every time he took off his oxygen, but nothing I said was getting through.

He just kept telling me, I'll be fine, Doc. I'll be fine. This was an unsettling case for me, and this patient

was part of the reason we ended up doing an episode on AMA discharges. But after months of thinking

about this case, I realized the real issue wasn't that he wanted to leave against medical advice.

The issue was that despite an hour of talking, an hour of discussing risks and benefits in every way I could imagine, we still couldn't seem to understand

each other. The issue was that he didn't have capacity to leave, and that's what we want to talk about today. I'm Margot, in Internal Medicine resident at NYU.

I'm Tamar. I also trained in Internal Medicine at NYU and I'm now a post-doc in the Division of Medical Ethics.

And I'm Joffer, a Humatology Oncology Fellow at UCLA.

The capacity assessment is the process by which we decide whether a patient is able to make their own medical decisions.

To really do justice to this topic, we have a two-part episode for you.

In this first episode, we'll go through the fundamentals of the capacity assessment with Dr Andrea

Kondraki who we were grateful to have on our podcast. I'm like I'm trying to

infiltrate your podcast with like all the random psych things. Dr Kondraki is

double-boarded in internal medicine and psychiatry and works at Bellevue Hospital as the director of the psychiatry consultation liaison division as well as the psychiatry medical service.

...