Dr. Lee gathers a good deal of additional information about Mr. Cirillo, some of which is part of the more complete mental status examination.
- Appearance: Thin, wearing dirty sweat shirt and dirty pants
- Speech: Slow, halting
- Mood: Anxious, fearful, sad
- Affect: Concerned and frightened
- Thought form: Coherent
- Thought content: Normal
- Cognition: No gross impairments – he understands what the physician is asking him
- Perception: He is realistic in his assessment of his needs
- Insight and judgment: Insight into his predicament is good
Given this information, Dr. Lee can assess Mr. Cirillo’s competence to make certain decisions. As we know, competence is contextual. That is, one can be competent to make decisions in some parts of life but not others.
For instance, if Dr. Lee suggests that Mr. Cirillo be admitted to hospital:
- Is Mr. Cirillo competent to make this decision?
- Is he competent to make decisions about his medication (e.g., pros/cons of a certain medication)?
- If Jerry has a prolonged illness, is Mr. Cirillo competent to make decisions about where he wants to live?
- Are there any aspects of his life in which Mr. Cirillo lacks the capacity to make decisions (e.g., financial, personal issues)?