This week our Friday Surgery is written by Dr Veronika Wagner, expert in mental health.
Dementia Tests Strike Back!
Early reports are coming in from across the country that even cognitive screening tests are ganging up on David Cameron.
Several doctors report that patients respond with expletive-laden outbursts when asked the name of the Prime Minister (a standard question in several cognitive screening tests). Gems have so far include "that rat b**rd" or "I can't remember his name, but it's the one with the funny taxes". Even patients who are so confused and delirious that they don't know they're in hospital seem to get that question right.
Junior doctors (for it is they who administer the questionnaires) are so moved by this show of solidarity by their most vulnerable patients that they might even allocate a bonus point for particularly creative answers.
This, of course, raises questions: just why are the cognitive tests so utterly fed up, and what moves patients to answer this one question correctly when they can't remember what they had for breakfast, lastly, why are junior doctors so elated when they hear these responses by their patients?
Let's answer these questions in order.
Cognitive screening tests have been around for a long time. They have largely been used to assess memory and other aspects of cognitive function (like the ability to generate words, or copy a drawing, or do basic mental arithmetic) in people where some difficulties in these areas are clinically suspected. So far so good. The tests were happy with that, they were being used appropriately and helped doctors make diagnoses and supported psychologists in doing detailed assessments of specific domains of function.
Enter David Cameron and his government of people who see ££££ signs on NHS hospitals, NHS land, public libraries, swimming pools and sports fields, you get the idea. The government was thinking up ideas to make even more money, particularly for the health insurance industry. But how could it go about it without anyone noticing?
They had an idea: they could get healthy people to get themselves tested for all sorts of things and pretend that this would lead to better health for the nation! What a brilliant idea they thought, and decided that people should get tested for dementia.
This really incensed the cognitive tests, for they were not in the habit of being used to make money, they wanted to be used to help people, including those known to be at high risk of dementia. They knew though that there were lots of people the government wanted to test who were basically healthy, or had other conditions that caused memory problems that had nothing to do with dementia (such as head injuries). They protested but were over-ruled. Their expertise counted for little in the face of a health insurance onslaught out to gather huge amounts of data from the population and to make money.
Now to the second question.
People tend to remember that which matters to them. Poverty, erosion of living standards, so-called austerity, tax avoidance by the 0.1% on an industrial scale matter hugely to most people. Therefore anyone not in the 0.1% who is faced with a cognitive assessment questionnaire containing the question, 'Who is the Prime Minister?'.... well you can look up some choice answers above.
Question Number Three.
Contrary to public opinion in some quarters, junior doctors are not part of the 0.1% (maybe with the very rare exceptions of those whose parents are part of the 0.1%). Austerity and the neoliberal driving down of working conditions and terms and conditions for public sector staff are hitting junior doctors just like other workers. The government's mantra that people are motivated by money does not particularly apply to public sector staff, once the basic necessities of Maslows pyramid of needs are met.
Junior doctors are scientifically curious beings which this brings us back to the beginning. The reports received from junior doctors suggest that Cameron is so s**t he biases the AMTS (Abbreviated Mental Test Score) and present this in a totally scientific and only politically biased way.
After the infamous #Hunteffect, so named by junior doctors after a certain Secretary of State for Health (who is not responsible for the health of the nation anymore, courtesy of the Health and Social Care Act 2012), one might very well end up calling this latest example of government interference with science and statistics the #Cameroneffect