Clin Med
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Mental capacity is required for an adult to make autonomous treatment choices. This review highlights recent legal and clinical developments in the field. The recent English Mental Capacity Act 2005 is described and compared with mental health legislation. ⋯ Such research indicates firstly that capacity can reliably be assessed; secondly, that among general hospital inpatients, approximately one-third may lack capacity; and thirdly, that mental incapacity in this setting is mainly driven by cognitive impairment caused by delirium or dementia. This is contrasted with psychiatric inpatients, where the problem is no more frequent, but mainly relates to psychotic illness. The article finishes with some general guidance as to how to assess mental capacity in the general hospital.
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There is a long history of problems in the relationship between doctors and managers. The reasons for this stem from the values of each group and the effect that these have on their views on a number of key aspects of healthcare and its delivery. ⋯ Both groups have skills and knowledge vital to the other, so each needs to recognise the strengths of the other and find ways to develop a productive partnership. Clinical work can be improved by the application of management techniques, and management would benefit from more clinical leadership.
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Whilst patients and doctors each bring a collection of rights and responsibilities with them into the consulting room, these parties must not be seen in isolation. The government of the day and its representatives have an absolute right to influence the future direction of the health service but they also have very grave responsibilities.