Doctors at the British Medical Association (BMA) recently reached a unanimous decision at the annual representatives meeting of BMA at Belfast, deeming an early dementia diagnosis pointless until followed up by health support for patients. The majority vote went in the favor of the motion, “Government’s drive for early diagnosis of dementia without the corresponding support for those who receive such a diagnosis is pointless.”
According to the motion supporters, an early diagnosis of dementia did no good to the patient if it was not facilitated by the required medical support. This early diagnosis would be helpful only if early disease detection was followed by a treatment. Otherwise, the treatment only increases anxiety amongst people who have been diagnosed with the ailment. The proceedings of the BMA meeting were published in British Medical Journal (BMJ) on June 27.
Dementia is marked by progressive decline of one’s mental abilities which upon reaching advanced stages can become a life-limiting condition.
The motion was promoted by GP, Alex Freeman who pointed out the gravity of the disease and the limited access available for high quality palliative care. She added that an early diagnosis of dementia does not promise a better future for the patient. In fact, diagnosis is merely the first step towards counteracting the disease. Therefore, improvement in one’s health can only occur if treatments are offered after the diagnosis.
Tim Yates, a junior doctor, talked in favor of the motion and commented on how the diagnosis statistics have reversed for dementia after the Dementia Identification Scheme was introduced by National Health Society, England (NHS) in October 2014. Earlier, the rate of dementia diagnosis was low but since the implementation of the scheme, diagnosis rates increased at an exponential rate.
This scheme was a part of a £5 million health plan aimed at improving general clinical practices to identify people with dementia.
This initiative was introduced to meet two primary aims. Firstly, the NHS desired an improved detection of dementia in registered patients, aiming at maintaining population-wide dementia records in the UK. Secondly, it aimed to ensure that all patients who were diagnosed with dementia had their primary care records updated, which would help patients cope with their ailment. Accordingly, access to timely treatments and health support was presumed to improve upon better health record keeping. Furthermore, an early detection of the disease was also associated with providing support to the patient and family to better plan the patient’s future course of life.
The initiative brought with it an additional monetary incentive for doctors to increase their efficacy at diagnosing dementia. Facing extensive criticism, the scheme paid general physicians an amount of £55 for each additional diagnosis of dementia which was termed as unethical as the assigned incentive with additional new patient diagnosis could encourage doctors to over-diagnose some patients. The rising allegations eventually caused the scheme to be discontinued in March 2015.
Deputy Chair of BMA’s General Practitioners’ committee, Richard Vautrey, said that patients with suspected dementia are to be referred to memory clinics within one to two weeks of initial detection. To their dismay, however, patients in many cases have to wait for six months for an appointment after they are diagnosed with dementia. Due to the consistent progression of dementia and delayed access to support, helpless patients are eventually left unattended.
Vautrey further added, “To live with the uncertainty of a dementia diagnosis is unacceptable. Getting a diagnosis should be the gateway to a whole range of support.”
He highlighted that achieving an increased number of diagnoses for a condition is not a measure of success for a health system if it is not backed by adequate treatment and support services.
The support services for dementia are of an utmost importance. Along with cognitive therapies and treatments provided to the patients themselves, prior training is given to caregivers to help the patient cope with their ailment.
The meeting emphasized upon the fact that mere quantity does not reflect a good quality health service provision.
Another limitation of the scheme was also found that in the few cases where treatment is provided to dementia diagnosed patients on time, the focus of the treatment modality is on drugs but not on costly support service provisions for them. This again renders the patients who had an added financial constraint to bear, helpless, in addition to the lack of support from the government.