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

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.