Reasons for requests for evaluation of competency in a municipal general hospital

During the period from July through September 1989, 380 referrals to a psychiatry consultation-liaison service were reviewed. Of these patients, 25% were referred for a determination of competency, despite the fact that they often showed no evidence of mental illness. Seventy-five percent of the patients were found to be competent. Fear of medical legal consequences, physician's anxiety, lack of understanding of the rights of patients to refuse treatment, and a misunderstanding of the physician's duty when presented with such refusal seem to be the reasons for the large number of referrals.