Clinicians Often Fail to Recognize Patients Who Lack Decision-Making Capacity

Physicians often ask patients to make complex choices about diagnostic studies or treatments. Medical decision-making capacity includes a patient's ability to understand relevant information and appreciate the consequences of a decision. Physicians frequently lack formal training in assessing patients' capacity and regularly fail to identify patients who are incapable of making informed choices.

Researchers reviewed more than 40 high-quality prospective studies of inpatients, outpatients, and healthy controls in which medical decision-making capacity was evaluated with various instruments; patients with severe psychiatric illness were excluded. Incapacity (as judged by a gold standard of forensic or expert psychiatric evaluation) was common …