title: Risk management for the emergency physician: competency and decision-making capacity, informed consent, and refusal of care against medical advice.
abstract: This article focuses on those times that the emergency physician (EP) and patient do not agree on a treatment option. Attention is placed on the risk management issues relevant to the patient's unexpected choice. Emphasis is placed on determining a patient's competency or capability of making clinical decisions, with particular focus on the EP deciding that patient competency requires a formal evaluation. The EP should have a strategy for assessing clinical decision-making capability and an understanding of what circumstances should act as a trigger for considering such an assessment. Attention to documentation issues around informed consent, common barriers to consent, refusal of care, and ED discharge against medical advice are examined.
authors.affiliation: Department of Emergency Medicine, Boston Medical Center, Boston University School of Medicine, Dowling 1 South, 1 Boston Medical Center Place, Boston, MA 02118, USA. magauran@bu.edu
authors.forename: Brendan G
authors.initials: BG
authors.lastname: Magauran
mesh_terms: D003657:Decision Making; D004635:Emergency Medicine / Q000331:legislation & jurisprudence*; D006801:Humans; D007258:Informed Consent / Q000331:legislation & jurisprudence*; D008318:Malpractice / Q000331:legislation & jurisprudence; D016743:Mental Competency / Q000331:legislation & jurisprudence*; D028701:Patient Rights / Q000331:legislation & jurisprudence; D012308:Risk Management; D016312:Treatment Refusal / Q000331:legislation & jurisprudence*; D014481:United States