Home > Aging, Dementia risk, Diagnosis, Early recognition, Medical issues, Public awareness > GPs Speak Out About Dementia Screening

GPs Speak Out About Dementia Screening

In the last few months, the British government has been making tremendous strides in its efforts to care for its citizens who have dementia.  Prime Minister Cameron has made this one of his priorities, and I have to say I commend him for it.  But this morning I read a couple of articles about some concerns, expressed by some of that country’s physicians, that perhaps this concern is going a bit too far.

General practitioners are being encouraged to ask all patients over the age of 60 about their memories.  Any patient who admits to having some concerns is then to be encouraged to participate in a screening for dementia risk.  However, some GPs have indicated their concern that this will discourage some persons from going to their doctors, even if they are experiencing potentially serious health problems, for fear of being diagnosed with dementia.  They argue that dementia is a life-changing diagnosis that is the most feared by people in England over the age of 55.

The Dementia Case Finding Programme, as this initiative is called, will pay physicians for asking their patients about their memory during examinations, regardless of the presenting complaint.  Those physicians who attached their names to the letter of concern argued that this policy would divert funds that would better be used for caring for persons who already have dementia, instead channeling it toward those who may have minor cognitive changes but who are otherwise managing quite well.

Dr. Martin Brunet, a Surrey GP who chaired the group of concerned physicians, stated that the country’s memory clinics are already kept quite busy with people who are seeking dementia assessments.  This programme could overtax that process, by throwing in persons who may not actually need such an assessment.  He also pointed out that it calls for actively seeking out persons who may not actually be looking for help.  Dr. Iona Heath, former president of the Royal College of GPs, expressed a concern that this programme will lead to “obsessive diagnosis,” turning people into patients that may actually do just fine if left to their own resources.

On the other side of the argument, Dr. Jill Rasmussen (an advisor to the Alzheimer’s Society) and other doctors argue that objecting to the government’s recommendations can add fuel to feed the stigma that already exists surrounding dementia.  They stated that there may be as many as 400,000 persons with dementia who are as yet undiagnosed, and who could potentially be denied appropriate treatment if not recognized.  Andrew Chigley, of the Alzheimer’s Society, also stated argued to the importance of helping GPs recognize the presence of dementia risk early, and thus taking a proactive approach to helping those with the disease have a better quality of life for as long as possible.

Speaking as someone who is not a citizen of the U.K., and who is not a doctor, I find this exchange very stimulating.  I can see both sides of the argument.  On the one hand, I certainly agree that we should be educating our physicians on the recognition of cognitive impairments in the very earliest stages, especially in light of recent advances in research.  The earlier we recognize that a problem exists, the sooner we can start the process of holding back the progression of the disease, and helping those who are diagnosed live with the highest possible quality of life for as long as possible.  And, too, we are now recognizing that there are some forms of dementia that are either completely or partially reversible if recognized early enough.

On the other hand, though, I’m not entirely sure that a mandatory screening process is the way to go.  I would like to think that a good GP will know his patients well enough, and have sufficient clinical skills, to recognize risk factors when they are present, and to recommend and encourage further exploration of those factors.  The same thing goes for diabetes, heart disease, and many other health conditions.  We’re not doing nearly what we could do, when it comes to identifying those who need help, but I’m not sure mandating screening protocols for any health condition is the way to go.  I’m much more in favor of educating our medical professionals, as well as our general public.

What do you think?

(Read more here.)

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