'Timely' diagnosis of dementia: what does it mean? A narrative analysis of GPs' accounts

作者：Dhedhi Saadia Aziz^*; Swinglehurst Deborah; Russell Jill

来源：BMJ Open, 2014, 4(3): e004439.

DOI：10.1136/bmjopen-2013-004439

• Primary Care
• Qualitative Research

Objective
To explore general practitioners' (GP) perspectives on the meaning of 'timeliness' in dementia diagnosis.
Design
Narrative interview study.
Setting
UK academic department of primary care.
Participants
Seven practising GPs with experience of conveying a diagnosis of dementia.
Methods
GPs' narrative commentaries of encounters with patients with suspected dementia were audio-recorded and transcribed resulting in 51 pages of text (26 757words). A detailed narrative analysis of doctors' accounts was conducted.
Results
Diagnosis of dementia is a complex medical and social practice. Clinicians attend to multiple competing priorities while providing individually tailored patient care, against a background of shifting political and institutional concerns. Interviewees drew on a range of explanations about the nature of generalism to legitimise their claims about whether and how they made a diagnosis, constructing their accounts of what constituted 'timeliness'. Three interlinked analytical themes were identified: (1) diagnosis as a collective, cumulative, contingent process; (2) taking care to ensure that diagnosis-if reached at all-is opportune; (3) diagnosis of dementia as constitutive or consequential, but also a diagnosis whose consequences are unpredictable.
Conclusions
Timeliness in the diagnosis of dementia involves balancing a range of judgements and is not experienced in terms of simple chronological notions of time. Reluctance or failure to make a diagnosis on a particular occasion does not necessarily point to GPs' lack of awareness of current policies, or to a set of training needs, but commonly reflects this range of nuanced balancing judgements, often negotiated with patients and their families with detailed attention to a particular context. In the case of dementia, the taken-for-granted benefits of early diagnosis cannot be assumed, but need to be 'worked through' on an individual case-by-case basis. GPs tend to value 'rightness' of time over concerns about 'early' diagnosis.

• 出版日期2014