A day in the life of a GP with an interest in dementia

Caring for, supporting, and facilitating best practice for people living with dementia has been one of the most rewarding parts of my general practice career.
 
Back in 2015, I was a GP with no particular area of specialist interest. Thinking about my then practice population, it struck me that we worked in an area populated by older people, many of whom lived in nursing homes with dementia and cognitive impairment.
 
It sparked something within me and I volunteered to be the lead GP for dementia.
 
‘Why would you do that?’ asked my colleagues. ‘What’s the point? There is no cure, and the people aren’t aware of what is happening, it’s all too challenging and hard.’
 
How wrong that statement turned out to be.
 
I was fortunate enough to be funded onto a PGCert at Bradford University to become a specialist practitioner in dementia. A year-long distance learning course followed, with a short period of clinical observation at the end, and I found my passion.
 
Understanding dementia – mainly attributed to Alzheimer’s or vascular disease – although caused by more than one hundred diseases, gave me a key into a world where people are often not treated with respect, and can be devalued and stigmatised.
 
As a young medical student, I had pictured myself working in a developing country where people needed medical services, not realising that there is a whole group of people in my own country in need of support, medical services and respect.
 
I learnt about person-centred care, the importance of personhood (understanding where someone has come from and how that impacts them today), and that people living with dementia can have treatments, many of which would be beneficial if they were only available.
 
I discovered that the brain is fascinating and because we all have different brains, dementia affects us all in different ways. This means as a practitioner you need to constantly be alert to the varying ways in which it might present, which can be extremely challenging in general practice.
 
On arriving in Australia in 2018, I was up for a challenge. Having travelled halfway around the world, I was keen to keep up my momentum for supporting people living with dementia. However, my memory clinic in the community did not exist here so I began to make my own path.
 
The same stigma and stereotypes exist in Australia as in the UK and people living with dementia are the unseen, forgotten members of society. The same stories of people being told at diagnosis to go on their last holiday and write their will were, and sadly are, commonplace.
 
However, in the past two years, I have felt change is coming.
 
Together with a fantastic team of GPs at Dementia Training Australia, we have been leading the way to challenge this stigma. We believe GPs can make a diagnosis of dementia in primary care and support their patients by implementing post-diagnostic care strategies.
 
The big fight is in trying to reach as many GPs as possible to change their hearts and minds.
 
Building momentum
Looking into my own practice community, I set about changing the view of the practice.
 
We undertook a process of becoming a dementia-friendly general practice, supported by Dementia Australia. All staff were encouraged to do the Dementia Friends program to raise awareness about dementia and we also participated in Dementia Action Week to signpost to staff and patient populations that we cared.
 
Still, I felt more change was needed.
 
The most recent geriatrician who had visited our clinic for sessions left, so I decided to set up some cognitive assessment appointments. These are longer appointments, dedicated to assessing cognition, and open for anyone outside of the practice population or from internal referral to attend.
 
Slowly but surely those appointments became popular. I believe they raised the awareness of other GPs in the practice, to think about cognition, talk about it with their patient and offer them a safe, familiar environment to have an assessment.
 
Seeing a gap, and a need, I offered the same but under the banner of a one-stop cognitive assessment clinic, in another area of Adelaide. This clinic is only for people to have assessments, without or with a GP referral.
 
I discovered that people appreciate the opportunity to come for these appointments without raising it with their GP first – particularly if they had encountered GPs normalising symptoms that they remained concerned about, or if they were young but with strong family history and concern about their cognitive health.
 
The longer appointments in both these clinics provide a calm environment to understand the person in front of me, listen to their concerns and offer some post-diagnostic support that tailors to their needs. This is the cornerstone of person-centred care – placing the person central to the care, valuing them as an individual – and something that people living with dementia have lost for so long.
 
Dementia, of any type, is a chronic disease, and needs to be reframed as such.
 
And like many other chronic diseases, such as stroke or multiple sclerosis, it should involve rehabilitation, because even though it is a palliative diagnosis in the end, it does not start that way.
 
Many people live with dementia in the community for a long time, and it is our role as their GP to make sure this time is as fulfilling and enjoyable as possible.
 
My goal now is to convince as many other GPs as possible that we need to wake up to dementia.
 
It is the leading cause of death for women in Australia (second overall for the population), as well as the leading cause of disability.
 
But we also know there are 12 modifiable risk factors that might delay the onset of the disease process, which means that we should be talking about brain health like we talk about heart health and eradicate the stigma of this disease.
 
Our patients deserve it.
 
Dementia Action Week runs from 18–24 September and aims to address a lack of understanding of dementia which may lead to stigma and discrimination in the community, and raise awareness to prevent this.
 
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