Hi Shredech,So many members write of how hard it is to persuade the person to go to their GP to even begin the process of diagnosis ...
then having the GP fall under the spell of 'host mode' and not see any problem ...
also that a GP may not really take on the info given by family ...
and the person goes on to tell consultants/memory clinic that nothing's wrong and/or cancel the appointment ...
Or medics say they can do nothing without the permission/cooperation of the person ...
ways around all this?
does GP training cover these key issues that create problems for family wanting to support the person they are concerned about?
Struggling to persuade someone to go to their GP or memory service is a really common problem. Most often it's caused by either not recognising their symptoms as potentially being an illness ('it's just old age'), denial (not wanting to face the possibility) or lack of insight (where the disease prevents the person from understanding that they're having problems). The first is relatively east to solve with constructive discussion and good quality information, or talking to a GP or community nurse. Denial is harder and may take some time - or they may need to get a bit worse before they're able to make the decision to see the GP. Lack of insight though is probably the hardest and leads to a lot of people not getting the diagnosis they need. When this happens it can sometimes help to suggest going to the GP for a general check-up, during which the GP could assess their memory and thinking, or you could try to arrange a home visit if the person is unable to attend the GP surgery (either due to physical disability or because of potential dementia). The latter would still need their cooperation though, unless their diagnosis was really very clear.
The ‘host effect’ you describe is a common feature of many dementia assessments – particularly when a person lacks insight into their condition and the assessment is being done in the person’s home where they’re generally able to function better than in a strange clinic environment. One way to allow for this is to do a ‘collateral interview’ with a family member to get a sense of whether the answers to questions are likely to be correct. If there’s a big difference between the responses of the person and the ‘informant’ (family member) then this might indicate a lack of insight. On the other hand, it could indicate that the family member is wrongly attributing certain symptoms as dementia when they’re not (this can happen), so the clinician needs to use their experience and judgement to work out what’s the most likely.
I hope this helps.
Best wishes,
Simon