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Dementia targets will lead to overdiagnosis

Pressure to increase diagnoses will also undermine relationships with patients

Louise Prime

Wednesday, 02 April 2014

The Government pressure on commissioners to push GPs to make more dementia diagnoses could lead to overdiagnosis and harm patients, warns a Surrey GP. In his Personal view*, published today on bmj.com, Dr Martin Brunet writes that targets for diagnosis threaten to undermine GPs’ relationships with their patients. He is also worried that the idea of diagnosis targets, “a highly successful strategy for politicians and industry”, could spread to others areas of medicine.

Dr Brunet is concerned that there has been no analysis of the potential harm caused by targets for diagnosis, and that there is ‘an obvious danger’ that perverse behaviours and outcomes will result from putting patient need second to meeting quotas. He writes: “The making of a diagnosis is a key moment in a patient’s journey. It can bring great benefit by opening the door to effective treatments and support as well as giving a much needed explanation for worrying symptoms. But it can also bring great harm if incorrect.”

He insists that a patient’s best interests should be the only factor influencing a doctor’s decision to make a diagnosis, and abhors the idea “that doctors should be motivated by self interest, such as personal or corporate gain”, which he warns would undermine the basis of their relationship with patients.

Dr Brunet notes that NHS England prefers to talk about ‘goals’ or ‘ambitions’, perhaps because the word target would be ‘too inflammatory’. But he suggests that a CCG ‘desperate’ to remove itself from a list of the ten worst in the country for diagnosis rates, could be tempted to turn a goal into a financial target. He points out that Herefordshire CCG has a target for dementia diagnosis rates as one of its local measures within the quality premium payment, and when it wrote to local GPs it referred to losing income if it missed ‘these targets’.

Herefordshire CCG chair Dr Andy Watts rejected claims that its drive to increase detection was financially driven. He said: “Detection rates in the county have been historically low and that is something we need to correct for the sake of patients and the people who care for them ... This is about patients and not about money."

Dr Brunet concludes: “If we fail to question their [diagnosis target rates]’ validity, the ethical concerns that underpin the making of a diagnosis and the danger of overdiagnosis, then we risk replication of this strategy in other areas of medicine. The diagnosis must always belong only to the patient, and never to government, policy makers, or commissioners. An urgent debate is needed before this gets out of hand.”

But the Alzheimer's Society disagreed that any GP would risk compromising their relationship with patients just to meet targets, and insisted that diagnosis was in people's best interests. They said: "It is disappointing to hear that there are still some clinicians questioning the benefits of diagnosing dementia. It is not a case of ticking boxes - people with dementia have a right to know. Without a diagnosis they are left in the dark without access to treatments, support and information."

* BMJ 2014;348:g2224 doi:10.1136/bmj.g2224

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