Dr Nick Summerton: Unrealistic to claim that dementia can soon be cured

IN a previous column, I described the challenges I face as a GP in managing my patients with dementia. I had written five letters to my local consultant psychiatrists about patients, who I felt required some specialist input, and obtained five identical replies: “Thank you for your referral. Currently, due to the high demands on the service, it is not possible to review patients routinely on anti-dementia medication.”

Consequently, I was delighted to receive a letter from a psychiatrist about the re-assessment of one of my patients with dementia. Alas, it then went on to explain that the specialist had held a conversation with the community psychiatric nurse (CPN) who, in turn, had had a telephone discussion with the manager at the care home in which my patient was resident. In short the patient had not actually been seen at all!

Subsequently, chatting to the family and the patient, we all agreed that the ‘virtual’ review could probably have been conducted more cost-effectively by a psychiatrist resident somewhere else in the world, such as India, without the need for the CPN to act as an intermediary between the patient, carer and specialist.

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Moreover, there are risks inherent in this ‘virtual’ approach to care. In one instance, I was relayed a treatment change from the psychiatrist through the CPN and, subsequently, via the family.

Unfortunately, during this process, the recommended drug dose was magnified 10 times and, if I had not spotted the error, the patient would have come to serious harm.

According to the Health Secretary, fewer than half of the estimated 670,000 people in England suffering from dementia are being diagnosed because GPs fear stigmatising their patients.

This is simply not the case. The reason that my local area – the East Riding of Yorkshire – has the worst figures for diagnosis, at 38.5 per cent, is that many non-specialists, such as myself, are wary of labelling a patient with a condition when we have great reservations about the subsequent diagnostic and treatment pathways. It is certainly no coincidence that the East Riding also enjoys the lowest spend per head on mental health services.

Just as undiagnosed dementia causes harm by preventing patients accessing services, so misdiagnosed dementia can also cause great distress both to the patient and to their family.

A specialist in dementia care recently wrote about a patient who had been diagnosed with dementia by a social worker after he became confused. His wife struggled to look after him at home and reluctantly agreed for him to be placed in a care home. And there he would have stayed if his wife, worried by the lack of medical input, had not paid privately for a consultant to see him. The consultant discovered that her husband’s confusion came on after his Parkinson’s medication had been increased. When the dose was reduced, the confusion disappeared and he was able to return home.

At the G8 summit last week, David Cameron claimed that dementia could be cured within 12 years, and announced a doubling in UK funding – to £66m – for research into the disease.

The analogies between Cameron’s approach to dementia and President Nixon’s war on cancer nearly 43 years ago are remarkable. Both are ridiculously unrealistic based on over-optimistic views about research and an extra-ordinarily simplistic understanding about the conditions they are facing.

There are numerous sub-types of dementia and politicians, NHS managers and, equally worrying, many non-specialists seeking to make the diagnosis are often ignorant of these. In short dementia is merely an umbrella term for a variety of conditions that affect memory and thinking.

As a GP, I might be able to make a very tentative diagnosis of vascular-type dementia (due to poor blood flow to parts of the brain) but I have no idea how to distinguish this from other rarer types such as Lewy body dementia that requires a completely different treatment approach.

In areas of uncertainty about care, I always think what I would like doing for my parents, wife or children. Thus I would ask you, if your wife, husband or parents develop a memory disturbance, would I like them to be diagnosed with dementia by a nurse, a psychologist, a social worker, an occupational therapists, a GP like me – or by an individual who has not only trained as a doctor but also spent several years undergoing higher professional training in dementia diagnosis and care?

I agree that it is excellent to put the spotlight on dementia. However, as a GP in East Yorkshire, all I really want is better access to a specialist. Let’s get the basics right; the gimmicks can wait.

* Dr Nick Summerton is a GP in East Yorkshire.