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A Prospective Multicenter Study of Competency Evaluations by Psychiatric Consultation Services

Received January 30, 1997; revised March 7, 1997; accepted May 5, 1997. From the Department of Psychiatry, SUNY Health Science Center at Syracuse, Syracuse, New York; Hartford Hospital, Hartford, Baystate Medical Center, Springfield, MA; the Tufts University School of Medicine, Boston, MA; and the Massachusetts General Hospital, Boston, MA. Address reprint requests to Dr. Masand, Department of Psychiatry, SUNY Health Science Center at Syracuse, 750 East Adams Street, Syracuse, NY 13210.

Psychiatric consultation for assessment of competency is common but infrequently studied. Past studies have used chart reviews. The authors prospectively studied 88 consecutive psychiatric consultations at 3 centers. Competency evaluation was performed to determine whether the patient could 1) sign out of the hospital against medical advice (AMA) (N=16); 2) give informed consent (N=16); 3) take care of him-/herself (N=33); 4) refuse medical care (N=24); or 5) deal with other matters (N=12). Patients with a favorable risk-benefit ratio were more likely to be seen in consultation compared with those with an unfavorable ratio. Patients in whom there was concordance in the assessment of the psychiatric consultant and the referring physician (N=61) were more likely to be male, single, to have psychotropics recommended, to sign out AMA, and to be discharged from the hospital. Patients in whom there was disagreement between the consultee and the consultant merits further study.

Key Words: Competency Evaluations • Patient Assessment • Consultation

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