Is there no limit to this objectionable man's weasel words? I think we all understand the concept of divide and rule and are unlikely to allow such cynical tactics to influence our determination to support our colleagues.
The current DES has already overburdened our memory services. The distinction between cognitive impairment and dementia is largely academic and the diagnosis of cognitive impairment gives no future predictive value. A study of 126 cognitively intact adults mean age 83.7 years at death found that 43% had pathology of pre clinical Alzheimers disease.
'Selling' dementia as a single entity is clearly benefiting some people. What our frail elderly patients need is better social care, housing, nursing homes, compassion and understanding. We can at least advocate for that for all - whatever the degree that their 'brain failure' is contributing to their needs.
I agree that an appropriate name for an alternative to over medicalistion would be helpful, as a way to describe options to patients and to enable them to engage in the discussion. I used to talk about 'minimal' medicine, now I use 'gentle' medicine - I am aware there is also a 'slow' medicine movement.
Really in general the key is peronalisation - bespoke options; and what that requires is time our most lacking resource.
I recently spent an hour trying to discuss with my husband the benefits or otherwise of PSA testing and diagnosis of prostatic cancer and I imagine we will need to revisit it a few times before he makes a truely informed decision.
It is even more difficult with the frail elderly multicomplex patients polyphamacied up ; an almost evidence free zone. What seems key is to discuss all the uncertainties, risks and possible benefits with the patient and their families so that decisions are made collaboratively. This seems to me to be both the right thing to do and the most likely to avoid litigation.
If agreement to stop drugs results the outcomes are often good - although the conversation addressing what good might look like could take some of the credit.
Could you explain a bit more about your Health eCard?
87% of people say they would like to die at home, surrounded by their family. In my borough 12/13 24% actually did. Clearly 'care planning' is as useful as the conversation developed by the professional enables it to be. My patients only die once and I want to feel I have done all I can to make that the kind of experience that does them justice - in contrast to many of the horrific undignified deaths I witnessed in hospital. If they become incapacitated as a potential 'best interests' decision maker, I need to be very clear about what they would have wanted, and who they would like me to talk to. If I need to tick a few boxes, in the course of having those conversations and that gets me some resource for doing the right thing all the better.