The Role of Decision-Making Capacity in Gathering Collateral Information

AbstractPsychiatric disorders usually do not have characteristic physical exam findings, imaging, or lab values. Psychiatrists therefore diagnose and treat patients largely based on reported or observed behavior, which makes collateral information from a patient's close contacts especially pertinent to an accurate diagnosis. The American Psychiatric Association considers communication with patients' supports a best practice when the patient provides informed consent or does not object to the communication. However, situations arise in which a patient's objection to such communication is the product of impaired decision-making and the benefits of obtaining collateral information represent best practice. In this article a framework for addressing these situations is proposed using a full decisional capacity evaluation, followed by an alternate decision-making process by concurrence from a second physician. It is recommended that a patient's refusal to allow the gathering of collateral information should be addressed exactly like refusals for other diagnostic or treatment interventions.