Tell me what to say to a consultant who has wrongly diagnosed my dad

This is why I was asking about the dementia diagnosis. I couldn't tell from the wording of the OP whether the 'working diagnosis of psychosis caused by his dementia' meant that the dementia was clinically confirmed, but it was the working assumption that it was now causing psychosis. Or is it that a working assumption has been made on both counts based on behaviour.

I probably sound pedantic but it makes a difference because once you have an official clinical dementia diagnosis, that can be the basis for arguing that your dad needs certain support, including potentially in patient treatment. It also looks bad if this consultant is denying that he has dementia (or psychosis) and claiming it is 'just' depression instead. Medics listen to other medics and what they say. Rather than emphasising your own disagreement with them, I'd be asking why they don't agree with the existing diagnosis of dementia (if there is one) and / or why they disagree with their colleague who diagnosed him as psychotic. References back to what's in his medical history and records will help you.

@Skybluepinky OP is not suggesting they keep him in, just that they discharge him with the correct diagnosis (Alzheimer's with Psychosis) as this unlocks support for her Mum.

I don't think OP is suggesting they keep him in, just that they discharge him with the correct diagnosis (Alzheimer's with Psychosis) as this unlocks support for her Mum.

This. Let him be one of their bed blockers if they're going to play this game. If they say he's "just depressed" then he can bloody well be 'just depressed AND their sodding problem!!!"

Arrogant doctors (who decide for themselves what type of person you are before you've even sat down), wind me right up. Been there.

They won’t section for longer than needed, so when they r in crisis, its down to the family to sort out suitable care for him, especially as yr mum can’t cope.

So he's calm due to taking medication and Dr says it's anxiety. Maybe a week off meds for her to monitor his "anxiety" would show her what he will be like once home and non compliant with meds. I've looked after people like your father in a Dementia nursing home. They can wash and dress and then they can slam you up against the wall refuse medications, throw furniture and put other residents in danger.
We used to have a lovely Older persons mental health team (headed by an psychiatrist who only looked after older people) who would come and visit and also do meetings by phone with us to try and get the resident into a place where they could live calmly without being sedated too much, it was an on going balance.

From the sound of it, regardless of your dad’s diagnosis he will go home and not comply with his medication. Your mum should simply tell them all in the meeting that she cannot have him back home as it isn’t safe for either of them.

Can you say that the family do not feel they can manage him and you feel unsafe.

The issue is he's been sectioned but no longer meets the criteria for the section as he is stable. Keeping him in would breech his human rights. You need an urgent referral to cmht or the crisis team. You need the gp on board as well. Anxiety and depression won't prevent him getting support from cmht.

This is correct. A diagnosis of dementia is made through completion of an ACE III assessment and the type is determined by symptoms and scans. Quite often a person with dementia doesn't know they have dementia, so input from family members often helps.

Refuse to allow him back. If, as the Consultant says, there's nothing wrong with him cognitively, he's an abusive man your mother is under no obligation to let back in (unless the hospital want to get involved in getting a court order, which they won't, they won't be able to force the matter even if it gets to the point that she's changed the locks and isn't answering the door when they try and drop him off).

And if his abuse isn't his fault, that means he isn't able to control his behaviour and is therefore clinically unfit for discharge.

Whatever way they argue it, you're telling them that he is not getting let back into the house and they'll have to find an alternative.

I've pm you x@Borntorunfast

Why do they discount everyone else like this? It's breathtaking in its arrogance.

Endemic in doctors, I am afraid, especially if you dare to suggest what the problem may be - never met a lot with such fragile egos.

OP@Borntorunfast I’m a little bit confused by your posts ….is this a psychiatric hospital he has been admitted to? Have you had community mental health team involvement in the past and has he been on antipsychotics for a while ,who originally prescribed them? It wouldn’t actually be good practise to make a diagnosis of Alzheimer’s for a patient presenting acutely/ in a crisis and if it’s a psychiatric consultant I don’t think it’s fair to say she’s “ only used to severe cases” ,that belies her experience, plus generally hospital teams are multi disciplinary so it’s also about what all the staff treating him are feeding back to the medical team. If you are presenting a case as such ,then utterly do stress your mums needs and ability to have him home in view of his past behaviour / non compliance with meds if that’s been the case previously. I had my parent discharged with a diagnosis of depression with psychotic features and it doesn’t necessarily mean extra support as psychotic features can and do resolve but I presume you want acknowledgement from the medics that he is experiencing a chronic illness that is going to continue to worsen and increase his needs and strain on your mum? Ps has he had a brain scan as sadly some people presenting with cognitive decline and psychosis actually end up with a brain tumour diagnosis.

Would they let you use iPhone's voicenotes to record the conversation for your reference later if you asked? That plus asking about safeguarding concerns might help.

Make sure you express your belief that he continues to be a danger to himself and others, particularly your mother, who I assume is a vulnerable elderly adult. They may well have completed their assessment and decided not to carry it forward to a section 3. That doesn't mean it's safe to discharge him home.

I'm so sorry OP. I don't have strong advice but do use the word "safeguarding" as that can carry weight

Good luck and don't let them knock you down ❤️

Could you refuse to take him home? Tell them that based on your previous experience you have fears for your mothers safety and for his, and cannot support him in his home.

I've been in hospital many times. I have experienced and witnessed incompetence on a scale that is so scary you couldn't comprehend.

So it's clear this is not simple anxiety but more. But anxiety empties the bed, there's no follow up needed with social care support at home ( blocking the bed longer).

You need another adult present at this meeting. It's pretty important. You need evidence or documentation or anything that points to the Alzheimer's diagnosis. Do you have that?
If there is no formal diagnosis or anything to support it, you can, with your witness friend present ask them to tell you what they will do regards the Alzheimer's. Which you have significant reason to believe is happening. Don't back down using the word Alzheimer's once. You can say yes he is anxious and add ' because of the Alzheimer's '. We want him assessed by Adult Social Care as he is behaving abusively because of Alzheimer's ( or suspected Alzheimer's). He can't come home. We refute your claim this is Anxiety and feel strongly this is a manifestation of his Alzheimer's.

Had he been diagnosed with Alzheimer’s prior to this latest episode? Or was that the working diagnosis based on how he presented at admission?

Would a diagnosis of depression/anxiety with resolving psychosis feel more accurate?

I can see a psychiatrist digging their heels in about the Alzheimer’s more than the psychosis.

Please don’t be intimidated. A trained medical professional prescribed your father anti psychotics based on him meeting what I would assume is a rigorous diagnostic criteria. This should be documented in detail in the paperwork. The consultant needs to make a case against the documented medical evidence, not try to bully you into accepting an alternative diagnosis.

Say that you are deeply concerned her discharge diagnosis and after care plan is inadequate since it is based on how he presents when on anti-psychotics without acknowledging the relevance of the antipsychotics in his care going forward.

Say that in your informed opinion, based on observing him over a number of months and not a 'what's in front of your eyes' snapshot, you strongly request that the medics need to assume that his current presentation is due to the efficacy of his existing medication and therefore the diagnosis that led to him needing this medication should be respected.

Say you therefore request that they continue to approve and prescribe his antipsychotic medication and acknowledge his schizophrenic tendencies as an essential aspect of his after care package.

Check whether Martha's Rule has been rolled out at that hospital. Among its directives is that family can request a second opinion if they feel that a diagnosis is inadequate and not in the best interests of the patient. But I don't think all hospitals have adopted it yet.

Is 'what's in front of my eyes' the new medical word salad for 'can't be arsed to look at the whole patient, so making my decision based on the snapshot of what's in front of me right now and washing my hands of responsibility for his welfare in two minutes' time when he is no longer in front of me and may present differently'? Because it is a dismally fragmented and unreliable approach.

A medic used that exact phrase on my son last week and I thought it was lazy bollocks then. DS collapsed and was rushed to hospital. He had an infection showing up in the blood tests but the doctor wouldn't prescribe antibiotics because he couldn't see an obvious infection of the ear or lungs. Four days later, at a different hospital, a sensible doctor prescribed antibiotics. And DS is now feeling better.