Posted by: Tony Copperfield18 September 2014
Ah, excellent, I thought, as I read about the new lifetime dementia risk tool which can be used to calculate an individual’s ‘brain age’. After all, most of my patients appear to have the mental age of a truculent toddler, so anything that appears to accelerate their mental functioning by a decade or two can’t be bad.
But then I read that we might use this tool to ‘scare’ patients into lifestyle action. Well, now, that’s an interesting concept. Let’s use a non-evidence based approach and a technique that would get you thrown out of the CSA to terrify/depress punters in the hope that, instead of going straight out and chucking themselves off the nearest bridge, they’ll bin the fags and start chomping muesli.
OK, yes, occasionally I do use shock and awe in my patients. The diabetic smoker. The cirrhotic drinker. And so on. In other words, judiciously. But deploying a so-called ‘dementia calculator’ would suggest that the real tool in the consultation is the one crunching the numbers.
Ah, but the ends justify the means, the supporters will say. OK, we don’t really know the effects of these tactics. And we don’t really know what causes dementia. And we don’t know if lifestyle change will have any effect. But it will help their heart/kidneys/etc, so what’s not to like?
Hmmm. OK, if scaring really is the way ahead I shall, in future, consult dressed as the grim reaper. Or, I shall hide in a cupboard and burst out as the patient walks into my room, screaming, ‘YOU’RE GOING TO DIE….unless you accept my referral to the anti-smoking clinic.’
But I definitely won’t be using the dementia risk tool. Because resorting to a smoke and mirrors gizmo as a scare tactic is the same as prescribing a nocebo. And those, by definition, are worse than placebos, which I won’t prescribe either. Using ploys like this reduce us to the level of Mystic Medic: they’re demeaning and unprofessional.
Doubtless it’ll be in the next iteration of QOF. And that really is scary.
Dr Tony Copperfield is a GP in Essex. You can follow him on Twitter @DocCopperfield.