Is the introduction of a British financial incentive to doctors for diagnosing dementia a dangerous precedent?
Leading doctors and health campaigners are urging the government to withdraw its Dementia Identification Scheme, whereby English GPs are to be paid £55 for every dementia diagnosis they make from now until next April.
In an open letter to Simon Stevens, NHS Chief executive, and Alistair Burns, National Clinical Lead for Dementia – published by The BMJ – Dr Martin Brunet and over 50 others say the policy is unethical and should be withdrawn without delay.
Helping people affected by dementia to achieve a diagnosis is a worthwhile goal, but the means of achieving this must have a sound ethical basis, they write.
They believe the introduction of a financial incentive to the making of a diagnosis “has set a dangerous precedent which needs to be urgently reconsidered.”
The diagnostic process is unique in the doctor-patient relationship due to the fact that the patient has to trust the doctor’s judgment, they explain. There must, therefore, be absolute surety that the doctor has no other motivation than the patient’s best interests when they make a diagnosis.
A direct financial payment like this “undermines this confidence, and with it the basis of trust inherent in the doctor-patient relationship,” they argue.
They point out that patients who may have dementia are particularly vulnerable, and that the diagnosis is a subjective, clinical assessment, meaning that misdiagnosis is a very real possibility. “To be given a diagnosis of dementia is challenging when the diagnosis is correct, but to receive such a label incorrectly can have truly tragic consequences.”
This scheme may have good intentions, but it has crossed a line that should never be crossed, and contravenes good medical practice, they conclude. “The reaction of the general public to the story is a demonstration of the widespread concern that the policy is unethical, and we ask for it to be withdrawn without delay.”
An open letter to Simon Stevens, NHS chief executive, and Alistair Burns, national clinical lead for dementia, The BMJ, published 6 November 2014.
Did I miss it in the article? What is the reason for the payment being given??? What do the payors hope to gain from this practice??
My guess is that it is because dementia is currently under-diagnosed. It is a well-studied, well-known reality that doctors defer diagnosing dementia for a variety of reasons. These include that it is an incredibly depressing thing to do for the doctor, especially as some patients react by saying they would have felt better not knowing. Another is that since the diagnosis is usually clinical, sometimes the diagnosis is wrong. Therefore, since it is such an important diagnosis, some doctors are hesitant to say it is dementia even when they are pretty sure it is.