Letter to GP about mother?

[LozzaChops101]

Hello everyone - just after some advice about sending a letter to my mother's GP. This might be a bit garbled as my brain is completely fried at the moment, apologies.

My mother (74 now) tried to bring up cognitive impairment to her GP when I accompanied her to an appointment after she had a heart attack in early 2018. She thought she was becoming "forgetful" due to her heart attack, but I had been seeing signs for several years. Her GP was extremely dismissive, saying if she knew where she was and hadn't left the gas on then there was nothing to worry about. There was definitely something to worry about then, and it's obviously got worse since. I need to somehow get him to take it seriously as I'm now struggling to cope with her on my own. Another problem I have is that my mother is (has always been) quite difficult with me, and this is only getting worse as she gets older - she gets furious with me, then stops speaking to me for weeks if she feels slighted, which includes any suspicion that I might have noticed that she's done something a bit batty. I don't know how she remembers that she isn't speaking to me when she forgets everything else(!) but I really would like her not to know that I've been in touch with her GP about her.

We've got to the stage now where her friends are bringing it up to me, and each other. She can't remember any appointments, or that she's meeting friends, she struggles to follow conversations, and she completely messes up her (vast array of) medication; forgetting that she's already taken it, or forgetting to take it at all. We have the same conversation literally dozens of times a day, each time can be within a minute or two, and she won't remember. She can't remember very recent events, eg. last night I helped her fill in an online form for an imminent asthma assessment, the second she pressed "submit" she said "Oh, I think have to do a form about my asthma somewhere, but I don't know what that is." She is also now becoming very belligerent with her friends for little/no reason and then can't remember that she's done it. She's cut off completely two friends that she's known for over 60 years without explanation to them.

Her own mother developed vascular dementia in her late 50s, but this feels different, and if a stranger spent a few minutes talking to her they might not notice. She's also physcially quite active, she can garden all day, has pilates weekly (that she almost always forgets to attend now) and volunteers to go leafletting (then obviously can't remember where she's been) etc, so she doesn't fit the average image of an old lady with dementia to outsiders.

TLDR!

A) Can I write to mother's GP re. concerns about dementia/cognitive impairment?

B) If not GP, who, if anyone?

C) What should I include if I do?!

I think this is probably a garbled mess, apologies.

Thanks for reading! Yours in mild desperation, etc.

My patients would look at me as if I were mad if I asked them what they had for breakfast! I do love it when people who have never done my job tell me how to do it.....

I am not a doctor, but I think anyone doctor would get suspicious if their patient cannot remember a list of 3 items 10 seconds after having seen the cards. They might not be able to diagnose anything, but they should be able to suspect there's something wrong and send the patient for further investigation. Of course, it is cheaper to ignore the patients and do nothing

if their patient cannot remember a list of 3 items 10 seconds after having seen the cards

that's not part of any validated memory test, but shall we not let facts get in the way of the 'aren't GP's rubbish' narrative.......

So many GPs are amazing. I cant even count the amount of times that a good GP has had a huge impact on myself and my family. So many of us are aware of the huge stresses and pressure you are under- we are aware but we can never truly understand. And all this work exists in the context of criticism and the narrative that @letsgoskiing has highlighted.

But the fundamental problem remains: @letsgoskiing says the only way GPs can put patients on a dementia pathway is if the patient comes to them with concerns. And as people have said time and again, there are huge obstacles to this. A lack of awareness, stigma, fear, the capacity to make and then attend an appointment.

I am 100% a huge advocate of patient capacity and choice. I’ve navigated the dementia journey for both of my parents. I have a skill set that has helped me, but it’s still taken time and patience. I’ve given up work because there was no other option.

So while I see @letsgoskiing ’s perspective, it is still hugely disheartening to read the posts. It’s just a huge brick wall, leaving friends and relatives facing seemingly insurmountable challenges to get support for very vulnerable people.

@JeepSleeHack flip that round.

Would you want to be referred somewhere against your will, at a point when you had the capacity to make your own decisions?

The system isn't perfect, but the principle of 'if you've got capacity to make your own decisions you can do so' is a pretty important one.

@letsgoskiing seems to take the same view as our surgery and I do see the logic of it, but it does not help us as a family in our particular case, where it would be so easy to call the relative in for the shingles vaccination that is now over a year overdue, or for his medication review, which is similarly overdue, or for a review of his two chronic conditions.

A friend of mine in her early 70s also gets a memory test every year or so without asking as part of her general maintenance, so obviously things differ from surgery to surgery.

So I call them in, do the vaccination, enquire after their memory and they say 'thanks for asking dr, all is fine, I'll be off now.'

If you haven't given me permission to tell your relative that you have written in, what am I meant to say at this point?

A friend of mine in her early 70s also gets a memory test every year or so without asking as part of her general maintenance, so obviously things differ from surgery to surgery.

how bizarre. no evidence for that being a useful thing to do. Private GP/different country?

Rather than asking her directly if she has problems with her memory, given that you think it is possible that she has, and given that you know denial is part of the symptoms, why can you not ask a few less direct questions that might elicit more information? Such as date, time etc.

It just seems too simplistic to ask a patient without insight if anything is wrong. It is putting the responsibility onto a patient who isn’t capable of telling you, either because they don’t know, or because they are too frightened to tell you.

I have supported a teenager through anorexia, and lacking insight was a huge part of that condition. The psychiatrists at the clinic did not assume that if a patient said they were eating normally and all was well, then nothing could be done. A direct approach worked with some, but was disastrous with others who just shut down when faced with direct questioning.

The reason that some people ask for the doctor’s help is because they have the complexities of their own relationship with the parent to deal with, and an appeal to an authority figure can work with some older people who won’t listen to their own children.

NHS practice in the West Midlands

I agree with @nutmeg7. Of course, a GP isn't always going to be able to force an intervention, but sometimes it works. I'd tried to persuade DM to talk to the GP about her memory concerns, but she kept evading it (and there's no way she'd have let me come to an appointment with her). I wrote to the GP in confidence, and at her next appointment the GP (according to my dad) said something along the lines of 'and how's everything with your memory, as lots of people start to struggle with that around your age?'. DM said 'well it's not as good as it was, actually'. GP said 'well why don't we just do a quick memory test', and on the back of that that referred her to the memory clinic for fuller tests. If mum had said everything was fine then I can see that the GP's hands would have been tied - but in mum's case, a direct question from a reassuring and familiar professional made her open up.

I'm assuming that none of you are actually GPs. This all sounds great in theory. It doesn't work in practice.

No, we're not GPs. But some of us are people who have found that writing to the GP has worked very well in our own situations. I totally accept that this wouldn't always be the case.

Not a GP but as I said earlier, it is something I've done, more than once and it's worked.

Writing to the GP is very reasonable

Writing to the GP and forbidding the GP to tell your relative that you ahve written is the problem

Hi, op, please make appointment to see a GP at your mums practice, they will see you, you can explain concerns and your worries, GP may plan an home visit, mum needs a , memory test, GP will arrange normally there quick,
I worry about letters or results at GP, as these get uploaded onto patients notes and GP alerted to new notes ?? But from experience my GP did not see my hospital letter until I asked if he had received anything, so yep if you can pop in, also GP will have other agencies you can link in with to support mum at home, good luck x