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The Rational Clinical Examination
David L. Simel, Drummond Rennie
Medical Decision-Making Capacity
Laura L. Sessums, Hanna Zembrzuska, Jeffrey L. Jackson

Sections:  Clinical Scenario, Why Is the Clinical Examination Important?, Methods, Results, Scenario Resolution, Clinical Bottom Line, References

Topics Discussed: clinical decision making, decision making, decisional capacity, incompetence, medical decision-making capacity

Excerpt: "One of your patients, a 72-year-old woman, comes to you for a preoperative evaluation for a total hip replacement. Her medical history includes early-stage Alzheimer disease. At a recent clinic visit, her husband noted his wife seemed more forgetful, and on examination, her Mini-Mental State Examination (MMSE) score was 21 out of 30 points. Today, you ask the patient what she understands about the risks and benefits of the planned procedure. She smiles and tells you it will fix her hip. When you give her information about risks and alternative treatment options, and query about her understanding, she continues to smile and replies, "It'll be okay." You wonder whether she has the capacity to make the decision to proceed with the operation...."
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