Makindo Medical Notes

🧭 Frameworks (UK)

✅ Core Principles (teach & remember)

• 🧪 Capacity is decision-specific and time-specific; don’t assume global incapacity.
• 🎯 Patients may make unwise choices; disagreement with clinicians ≠ incapacity.
• 👐 Use the least restrictive option that achieves safety and benefit.
• 📝 Document: capacity assessment (understand/retain/weigh/communicate), risks, legal basis (Common law, MCA, or MHA), and why it’s proportionate.
• 🤝 Seek senior/psychiatry advice early if the legal route is unclear or risks are high.

🛠️ Practical “At-the-Bedside” Steps

1. ⏱️ Is it an emergency? If life/limb at immediate risk and capacity unknown → act under Common law, reassess once safe.
2. 🧠 Can they decide? Assess capacity for the specific decision (information, risks, alternatives).
3. 💡 If capacity lacking → use MCA best interests; consider LPA, advance statements, family views; restrain only if necessary & proportionate.
4. 🧩 If mental disorder drives risk to self/others → consider MHA (speak with psychiatry); treat physical problems via MCA/common law as appropriate.
5. 🔁 Review frequently: capacity can improve (e.g., after analgesia, delirium treatment, rehydration).

📊 What we often miss

• 👀 Capacity is overestimated in practice; studies suggest ~30% of acute medical inpatients and >40% psychiatric inpatients lack capacity for key decisions.
• 🧩 Delirium = mental disorder for MHA purposes, but don’t forget the MCA for physical treatment decisions.
• 🧭 If you can’t justify the legal route in one sentence, pause and phone a friend (senior/psych/legal).

🧷 Quick Safety Notes

• 🔒 Restraint must be necessary, proportionate, and recorded (aim for least restrictive; continuous observation when used).
• 📣 Communication: simplify information, use aids/interpreters, optimise hearing/vision—this may restore capacity.
• 👪 Involve family/LPA/IMCA early; they inform best interests but don’t replace proper assessment.

References

• Patients who refuse treatment – BMJ