Discussing treatment options and risks with medical patients who have psychiatric problems

Discussing medical treatment options and risks becomes a more complicated task when patients have psychiatric problems. Such patients may perceive risk and judge options differently from usual, they raise special issues about informed consent and competency, and they may present special needs and stresses in the physician-patient relationship. This article addresses how to approach such treatment discussions within the framework of 3 content areas of the medical interview (medical decision making, informed consent, and the physician-patient relationship) and 2 formal techniques of the interview (exploration and assertion). Clinical research regarding how psychiatric problems may affect each of these areas of concern is reviewed. Ultimately, the goal of understanding such variations--and of possessing methods to address them in discussing treatment options and risks--is to help the patient be as free as possible from the burden of biases or distortions in making his or her decisions and to promote the best fit between the patient's wishes and the physician's medical judgment.