title: Physician assessment of patient competence.
abstract: OBJECTIVE
  To determine if physicians know and can apply the legal standard for determining competence; to determine if physician assessment of competence varies by physician age or specialty.
  
  
  METHODS
  Mail survey with specific questions about a patient scenario and general questions about the law.
  
  
  METHODS
  2100 randomly selected Massachusetts internists, surgeons, and psychiatrists.
  
  
  METHODS
  In Part I, the survey presented a scenario adapted from a court case that involved an elderly woman's refusing lifesaving surgery. The scenario was divided into three sections: the medical history, the patient's rationale, and a psychiatrist's opinion that the patient was incompetent. Respondents were not told that an appellate court later decided the psychiatrist applied the wrong standard of competence and the patient was indeed competent. Respondents were asked whether the patient was competent, whom they would consult, and how they would respond. Part II posed a series of theoretical questions about competence. Group differences were tested by chi-square.
  
  
  RESULTS
  Surveys were returned by 823 (41%) of the sample. In Part I, before the psychiatrist's opinion, 58% thought the patient was competent, 92% would consult a psychiatrist to help assess competence, and only 17% would to go to court. After the psychiatrist's opinion, only 30% thought she was competent and 55% would go to court. In Part II, 89% knew the correct standard for competence; however, most incorrectly responded that conditions such as dementia and psychosis establish incompetence. Psychiatrists performed significantly better on theoretical, but frequently worse on scenario, questions.
  
  
  CONCLUSIONS
  Physicians in general, and psychiatrists in particular, know the standard for competence but may apply it incorrectly. This suggests that the common clinical practice of relying on expert medical opinion may introduce bias and produce inaccurate results that undermine patient autonomy.
authors.affiliation: Geriatrics Section, University Hospital, Boston, MA 02118.
authors.forename: L J
authors.initials: LJ
authors.lastname: Markson
authors.forename: D C
authors.initials: DC
authors.lastname: Kern
authors.forename: G J
authors.initials: GJ
authors.lastname: Annas
authors.forename: L H
authors.initials: LH
authors.lastname: Glantz
mesh_terms: D000367:Age Factors; D000368:Aged; D003625:Data Collection; D005260:Female; D013502:General Surgery; D015577:Geriatric Assessment; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007258:Informed Consent; D007388:Internal Medicine / Q000592:standards; D008297:Male; D008404:Massachusetts; D016743:Mental Competency / Q000331:legislation & jurisprudence*; D028642:Persons with Psychiatric Disorders; D016544:Patient Simulation; D026684:Personal Autonomy; D010820:Physicians / Q000523:psychology / Q000592:standards*; D011570:Psychiatry / Q000592:standards; D016312:Treatment Refusal