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Targets for dementia diagnoses will lead to overdiagnosis

BMJ 2014; 348 doi: http://dx.doi.org/10.1136/bmj.g2224 (Published 01 April 2014) Cite this as: BMJ 2014;348:g2224
  1. Martin Brunet, general practitioner, Binscombe Medical Centre, Godalming, Surrey GU7 3PR, UK
  1. martin{at}binscombe.net

The government is putting pressure on commissioners, who in turn are putting pressure on general practitioners, to make more diagnoses of dementia. Why has no analysis been done of the harm that such targets can cause, asks Martin Brunet, and where does it leave the doctor-patient relationship?

Imagine the scene: you are about to review Mrs Jones in the memory clinic. When you saw her six months before you diagnosed mild cognitive impairment (MCI). But that was before your locality appeared on the wrong list on the UK government’s “name and shame” Dementia Challenge website,1 which publishes rates of dementia diagnosis for every clinical commissioning group (CCG) in the country. And it was before you viewed the accompanying video of Jeremy Hunt lambasting the “laggards” for their poor performance. And it was before your clinical commissioning group made raising diagnosis rates a priority, with financial strings attached, and started leaning heavily on you to make diagnoses—any diagnosis, it would seem; they just need to get the numbers up.

Would it really harm Mrs Jones to give her diagnosis an upgrade, to confirm her fears and call it dementia? Aren’t we supposed to diagnose …

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