A PROSPECTIVE MULTICENTER STUDY OF COMPETENCE EVALUATIONS BY PSYCHIATRIC-CONSULTATION SERVICES

Psychiatric consultation for assessment of competency is common but in frequently studied. Past studies have used chart reviews. The authors prospectively studied 88 consecutive psychiatric consultations at 3 ce nters. Competency evaluation was performed to determine whether the pa tient could 1) sign out of the hospital against medical advice (AMA) ( N = 16); 2) give informed consent (N = 16); 3) take care of him-/herse lf (N = 33); 4) refuse medical care (N = 24); or 5) deal with other ma tters (N = 12). Patients with a favorable risk-benefit ratio were more likely to be seen in consultation compared with those with an unfavor able ratio. Patients in whom there was concordance in the assessment o f 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 who m there was disagreement between the consultee and the consultant meri ts further study.