This post is simply to thank Dr Martin Brunet for being brave.
I have met Martin Brunet once. This was enough time for me to confirm the view that I have gained from our occasional communications.
Martin is a doctor who seeks to remind us how vital it is that we consider ethics.
The following is an example:
Following this BMJ publication a healthy exchange of views took place.
Below I offer my summary:
Reply by Dr Peter J. Gordon:
I commend Dr Brunet for raising the difficult subject of un-diagnosis.
Scotland, long before England, had a financially incentivised target for the “early diagnosis” of dementia. This was HEAT target 4 set for all 12 NHS Boards deployed at secondary rather than primary care level.
The Scottish Government, having reached this target, have not shied away from stating that they did “rather well” in reaching the target.
As a specialist doctor in dementia I am now facing the return of elderly individuals who were diagnosed with “early Alzheimer’s disease” but who many years on show no signs of dementia (they do not fulfil clinical diagnostic criteria for dementia and have shown no signs of progression)
These individuals have been of the understanding that they have dementia or “Alzheimer’s”. They have lived with this in some cases for 7 years or more. They have generally had post-diagnostic counselling and families and friends have also adapted to the diagnosis. Driving, autonomy, and insurance may all have been affected.
In many cases this was the direct result of an approach based on “early diagnosis” set as an incentivised target.
If we must have a target based approach (which I very much doubt), ethics must be considered from the outset.
Thank goodness for good folk like Anand, Lewis and Brunet who remind us of this.
(1) Anand, J. K 20 Dec 2014 http://www.bmj.com/content/349/bmj.g7235/rr-1
(2) L Sam Lewis. 19 Dec 2014 http://www.bmj.com/content/349/bmj.g7235/rr-0
(3) Brunet M. 18 Dec 2014 http://www.bmj.com/content/349/bmj.g7235/rr