Intended for healthcare professionals

Rapid response to:

Views & Reviews Personal View

Targets for dementia diagnoses will lead to overdiagnosis

BMJ 2014; 348 doi: (Published 01 April 2014) Cite this as: BMJ 2014;348:g2224

Rapid Response:

Re: Targets for dementia diagnoses will lead to overdiagnosis

How rich a seam has been revealed by these responses! Dr Coeburgh provides a comprehensive account of one systematic disadvantage of ‘targeting’. While an intense concentration on one facet of a problem is often rewarding, it comes at the price of ignoring most others.

The same is true of any preliminary diagnosis, which at the bedside typically colours and prejudices all subsequent deliberation. In the case of ‘dementia’ the medical shorthand tends to amalgamate the symptoms of a syndrome with a disease category, causing even more mischief. In practice, some clumsy over-diagnosis is bound to be balanced by under-recognition due to the inevitable inefficiencies of human endeavour and ascertainment, the other systematic problem with aiming at, rather than to achieve, a target1,2. Is there a Bayesian treatment of making the diagnosis of dementia available, as a complement to the initiative?

1. Will E. Targets and Targeting. Am J Kid Dis 2001(2);38:411-414
2. Kay, J. Obliquity. Profile Books 2010

Competing interests: No competing interests

29 April 2014
Retired Renal Physician
ex-Leeds Teaching Hospitals
Beckett Street, Leeds