{"id":953,"date":"2010-01-15T15:00:05","date_gmt":"2010-01-15T14:00:05","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=953"},"modified":"2010-01-15T15:00:05","modified_gmt":"2010-01-15T14:00:05","slug":"richard-smith-what-use-are-memory-clinics","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2010\/01\/15\/richard-smith-what-use-are-memory-clinics\/","title":{"rendered":"Richard Smith: what use are memory clinics?"},"content":{"rendered":"

\"RichardThe government\u2019s dementia strategy, which promises a memory clinic on every corner rather than a chicken in every pot, is not working. That\u2019s not surprising as it\u2019s the easiest thing in the world to come up with grand sounding strategies but one of the hardest to get them implemented. As the economist Alan Maynard says, the NHS does 8\/10 for bright ideas but 4\/10 for implementation\u2014and without the implementation you have nothing but empty promises, which are worse than no promises.<\/p>\n

But is a memory clinic on every corner a good idea? I\u2019m doubtful.<\/p>\n

My lovely and amusing mother has had no short term memory for about three years now, and sceptical as I am of many medical benefits I thought that we ought to \u201cget into the system.\u201d So we started with the GP. Despite the fact that the man in the corner shop could tell you in about two minutes that she has no short term memory, the GP had to administer a standard questionnaire. Unfortunately, he didn\u2019t have time for the full questionnaire\u2014so asked us to come back after some blood tests.<\/p>\n

Every time my mother and I engage with the NHS I have to drive from London to her town\u2014let\u2019s call it Elysium–some 40 miles away. Usually when I visit I go by train, but I need the car to transport her to the various clinics, some of which are 10 miles from Elysium. So the climate suffers.<\/p>\n

We have to go the branch clinic of the surgery if we want a blood test in under three weeks. So I drive down, drive her to an obscure corner of Elysium, and she has the blood test.\u00a0<\/p>\n

Two weeks later I drive back to Elysium and we go to the GP. Surprise, surprise nothing is abnormal in the blood tests. Unfortunately he doesn\u2019t have time to do the full questionnaire, but it\u2019s obvious she\u2019ll need to go to the memory clinic\u2014so he refers her.<\/p>\n

But first she needs a CT scan. \u201cIs all this worth it,\u201d asks my mother who\u2019d prefer never to see another doctor or nurse as long as she lives. \u201cWell it might help keep you living on your own for as long as possible,\u201d I answer without much conviction.<\/p>\n

More than half a century ago she lugged me screaming to the fracture clinic at King\u2019s College Hospital. Now I\u2019m lugging her. Neither of us liked either visits, but we enjoy the symmetry of the relationship and \u201cwe \u2018ave a laugh.\u201d There\u2019s lots to laugh at.<\/p>\n

So a month later it\u2019s back for the CT scan, which is in another hospital 10 miles from Elysium.
\nSix months later we have our first visit to the memory clinic in yet another town. We see a charming occupational therapist who takes a very full history and declares this to be a prelude to seeing the psychogeriatrician.<\/p>\n

Another six months pass, and we see the psychogeriatrician, who is kind and helpful. He tells us that the CT scan is mostly normal with \u201ca little scarring.\u201d He\u2019d now like some psychological tests. My mother hates the whole experience.<\/p>\n

We the have an interlude while my mother has her hip replaced. A striking feature of these encounters is the staff giving my mother elaborate instructions without grasping that she has no short term memory\u2014despite me saying \u201cMy mother doesn\u2019t have very good memory.\u201d Maybe I should have been blunter.<\/p>\n

After another year we are back on the memory clinic treadmill, and we go back for my mother to have a whole swathe of psychological tests. They take about two hours, and she hates them.<\/p>\n

We wait a month or so (to be honest I\u2019m forgetting the sequence, but it\u2019s about three years overall), and then we go back to see the psychogeriatrician. The psychological tests show my mother has very poor short term memory and is not well oriented, but her language skills are good. I knew that. Crucially, she\u2019s just under the NICE cut off for drug treatment, but the psychogeriatrician is willing to prescribe the drugs anyway. My mother and I have had many conversations about whether she should take drugs.<\/p>\n

\u201cWhat\u2019s the point of all these visits? What can they do?\u201d she asks.
\n\u201cThey could prescribe you some drugs that might help.\u201d
\n\u201cBut they won\u2019t improve my memory.\u201d
\n\u201cNo, but they might stop it getting worse.\u201d<\/p>\n

She\u2019s not keen on the drugs, and I\u2019m very doubtful that they\u2019ll make much difference, but I\u2019m falling victim to the disease of \u201cneeding to do something.\u201d<\/p>\n

So we take the drugs\u2014which in itself involves another trip because Elysium Boots doesn\u2019t have enough in stock. We stick notices up on the wall about when to take the drugs. It\u2019s obviously a philosophical problem getting somebody to remember to take drugs for poor memory.<\/p>\n

Predictably after about a month it becomes apparent that she\u2019s not taking them\u2014and I see that she never wanted to take them. I\u2019d pushed her into umpteen tests and visits to clinics at considerable cost to the NHS for no benefit at all.<\/p>\n

I ring the memory clinic to say thank you but we\u2019re signing off. They are happy to have us a back if and when we need more help\u2014but what will they do?<\/p>\n

I can\u2019t help thinking that maybe the government would do better to spend the money it appears not to have for memory clinics on opera or something with tangible benefit. The one overall benefit of all these visits is that my brother is developing a stand up routine around memory clinics, which are intrinsically comic. \u201cYou get there, and it\u2019s empty. Everybody has forgotten to come.\u201d<\/p>\n

\u00a0<\/p>\n","protected":false},"excerpt":{"rendered":"

The government\u2019s dementia strategy, which promises a memory clinic on every corner rather than a chicken in every pot, is not working. That\u2019s not surprising as it\u2019s the easiest thing […]<\/p>\n

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