How does a general practitioner assess capacity of their patient during an appointment?
- Do they ask them questions about who they are and where they are?
- Test their memory?
- Ask them questions about their personality e.g. hobbies etc?
Please feel free to explain in more depth as I lack the experience in this area of practise.
I suggest you have a look at this resource about the Mental Capacity Act.
GP will ask,some questions regarding their physical health,the patient”s views,the patient”s understanding of the information given by the GP,the recall of the information given,the informed decision regarding their treatment/investigations etc,is the patient able to know the consequences of their decision to give consent or refuse the result of it & finally is the patient able to communicate their decision etc.Any one assessing the capacity has to know what is the decision to make & when etc.Every one must be able to do this 4questions screening,the main important thing is if it is Surgery,the Surgeon needs to do it,if it is Cardiac etc who is the final decision maker for what.
Ok thank you Sarada.
This is a dialogue between a GP and a patient about capacity based on what you have written - if you have time please feel free to read below and answer my question at the end.
GP: How are you feeling physically today?
Patient: I’m feeling fine apart from this headache that I’ve been getting of late.
GP: How long has this been going on for?
Patient: It’s been happening for the last few months.
GP: What happens when you get a headache?
Patient: I feel dizzy, sick, pain on the right side and very sick sometimes.
GP: This could be a number reasons - It’s best we book in a referral for a CT scan just to be safe -would you like me to book a referral for you?
Patient: Personally, I’m not too keen on radiation - I’d rather treat this naturally with paracetamols and rest; then wait until it resolves. However, if I need more assistance - I will consider the scan.
GP: Due to the nature of your symptoms - if we leave this further it could end up causing you more harm than good - do you understand this?
Patient: Yes, I’m aware. But I feel right now the best decision for me is to wait maybe a few weeks before I go for the scan.
Is this exchange the type of communication that would be present between a doctor and a patient regarding capacity?
If it is concerning someone’s mental health would they be given the same dialogue as above?
How you go about it will depend on what decision you are concerned about them not being able to make an informed decision thus the question of capacity arising.
Remember the starting point is presumption of capacity.
My question is directly linked to whether a GP can register a patient into the mental health act process e.g. an assessment without their consent even if it is clear they have capacity to disagree?
Yes,if the GP thinks there are risks to the patient/family/public etc.
Thanks Sarada. Three more questions.
Before the GP can bypass a patient’s consent - must they by law have clear proof that the patient is a risk to themselves or others?
What type of risk behaviours are GPs looking at when bypassing a patient’s consent?
If the GP has seen signs of a risk by the patient - forces them into getting assessed - should the GP still explain thoroughly what the patient must expect during and after this assessment considering the patient still has capacity to understand?
The important thing is is patient Suicidal,is patient has delusions of harming others/harming themselves,is the patient carrying knives/weapons,has the patient already threatened the public etc.
I would imagine no patient will directly say they have any intention to hurt themselves or others.
The physician must have to ask them direct questions about their feelings and thoughts related to their mental health in order to attain the necessary information to put them through an assessment - am I right in this?
GP: How are you feeling today?
GP: How has your mood been of late?
Patient: Up and sometimes down.
GP: What do you mean by ‘up and down’?
Patient: Sometimes I feel down when I go for a walk and see some puppies - then suddenly joyful seeing some cats.
GP: What is it about pets that affects your mood?
Won’t do another transcript haha. But it would have to be a similar discussion to the above - otherwise if they do not carry out any line of questioning like this - it becomes a violation of the patient’s human rights; to put them into an assessment process based on personal judgement - as it states in the GMC guidebook and capacity act 2005 - the GP must presume their patient has capacity. It’s the GPs role to appropriately spend time to investigate whether this is or not the case.
The Mental Health Act is not capacity-based. A GP (or others) can make a referral for a Mental Health Act assessment if in their professional opinion there is risk to the person’s health, or safety, or others may be at risk (and that this is caused by a mental disorder). This can be done with or without the consent of the individual concerned.
One would hope that the GP (or other professional) had attempted to maximise the person’s involvement in and cooperation with the process, but this is not always fully possible.
Why would this not always be fully possible?
Also I probably wasn’t clear - I was referring to a physician referring you to the community mental health team for an assessment - not under the mental health act.
So this would be a few levels below. Would then the patient’s capacity be in play in order to make an informed choice?
A referral to the community team would normally only be with consent. I agree this is significantly different to a referral for a Mental Health Act assessment.