Dementia

If dementia is so much like cancer, does Hunt wish to shame GPs over performance there too?

There are many reasons why diagnosis rates of dementia in primary care might vary, irrespective of the skill of the primary care clinician.

Some groups of patients, particularly in certain ethnic classes, might be unwilling to seek a diagnosis; or might be dissuaded from seeking a diagnosis from family members or friends.

Some people may be genuinely frightened to seek a diagnosis of dementia, for fear for consequences such as losing a driving licence or losing friends.

In certain areas, such as with a local population with a high incidence of diabetes, high blood pressure or high cholesterol, there might be high rates of vascular dementias.

That’s why a ‘regional map‘ of diagnosis in rates for dementia is far too simplistic. The idea is that you might shop around to avoid those places were diagnosis rates are ‘unacceptably low’, but diagnosis rates may be low in certain places of their own accord.

Ultimately, you should wish for a national system for specialist services which includes a mechanism to confirm the diagnosis, and proper post-diagnosis support perhaps including specialist nurses.

The steady stream of meticulously choreographed public meetings for the #G8dementia and latterly #G7dementia have seen a battalion of comparisons made between dementia and cancer.

And indeed it’s been previously remarked upon that people are trying not to talk openly about dementia, in a similar way to how cancer used to be avoided as a conversation topic.

Our success in ‘treating cancer’ has come from improvements in treating various types of cancer, e.g. bone, blood, lung, brain.

To talk of a ‘cure for dementia’ is meaningless as there are about a hundred different types of dementia, with Alzheimer’s disease the most common worldwide.

Cancers, like dementias, have their own natural history. Indeed, primary care physicians have spotted cancers missed by hospital physicians.

A policy to ‘name and shame’ GPs ‘who miss cancer’ implies a fault of GPs, as if they are not competent enough to detect cancer. This is all too reminiscent of the very loud criticism by non clinicians of clinicians, complaining that they either do not know how to diagnosis dementia, or withhold the diagnosis deliberately.

Such a policy can so clearly have unintended consequences, not least contributing to the destruction of the morale of the workforce. At worst, GPs might refer all suspect cancers indiscriminately for specialist review, such that hospital medicine is flooded with new cases; so the sheer numbers of low probability cases might flood out high priority cases for management.

Without extra funding going into the NHS, it’s like putting a large bag of sugar into a small jam jar. The system is being set up to fail.

Likewise, the evidence underlying the claim that resources have been put into primary care or into specialist clinics which can confirm a likely diagnosis of dementia is far from clear. Ultimately, a diagnosis of dementia needs more than a few ten minute chats, and reflect substantially more than memory problems.

Specialists in dementia have access to facilities not easily available to primary care, namely EEG, MRI, CT, psychology, a lumbar puncture, for complicated cases of dementia. And there are some presentations of dementia which benefit from specialist hands, such as the progressive primary aphasia spectrum of cases.

Jeremy Hunt has proved convincingly that talk is cheap, but reassuringly the public are not falling for this scam.

I would like to leave the last word to a specialist in cancer (an ‘oncologist’), instead.

cancer

 

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