DOCTOR MAX THE MIND DOCTOR: Sometimes, the simplest cures are the best

Patients with dementia are sedated when, in fact, their disturbing behavior is due to easily treatable problems, such as earache, toothache or joint pain.

Just imagine being in pain, feeling confused and scared, and unable to tell anyone or ask for help. All you can do is moan and cry, while people come and go around you.

When the pain becomes too intense and your cries are more frequent, or if you start to writhe in agony, you sedate yourself with antipsychotic drugs and you are silenced.

It sounds like a living hell, right? However, this is precisely what thousands of people with dementia must endure day after day.

As Mail reported last week, a study from University College London estimates that up to a third of patients with dementia in the hospital experience physical pain, sometimes so intense that they become delirious.

Patients with dementia are sedated when, in fact, their disturbing behavior is due to easily treatable problems, such as earache, toothache or joint pain.

Patients with dementia are sedated when, in fact, their disturbing behavior is due to easily treatable problems, such as earache, toothache or joint pain.

However, so often, his way of expressing discomfort is dismissed as a symptom of his insanity.

They can go days, weeks, months or even years with acute pain without anyone noticing.

I witnessed this many times when I provided medical coverage to nursing homes.

Patients with dementia were sedated when, in fact, their disruptive behavior was due to easily treatable problems, such as earache, toothache or joint pain.

While reading the new research, I remembered another study published several years ago.

He found, incredibly, that paracetamol was a very effective treatment to control the anguish in patients with dementia.

In fact, regular paracetamol was more effective in reducing agitation and distress than antipsychotics, suggesting that the cause of agitation and distress was due to pain experienced by the patient.

Give them an analgesic and the pain, stress and agitation disappear. I decided to put this into practice with the patients referred to me by the care homes, and I was amazed by the response of some of them.

After only a few days of regular paracetamol, I was able to stop all the antipsychotic drugs prescribed for a woman. Paracetamol became my first-line treatment for agitation in elderly patients.

But paracetamol is not the answer for everyone. Skilled nursing care is the missing factor in the tragic situation of so many patients with dementia.

The fact that someone can not articulate how they feel or what is wrong does not mean that they are not communicating.

Non-verbal communication and subtle changes in behavior can provide a great deal of information about the patient, but experience and time are needed to study it.

I was once called to see an old man with dementia in a nursing home. "I do not know what it is, but I'm sure there's a problem," said his nurse. He knelt and took the man's hand gently. & # 39; You can see it by his face. See . . ? & # 39;

The only thing I saw was an old man with an open mouth and blank eyes, completely disconnected from the world. Then his lip curled very slightly.

"There," said the triumphant nurse. "He does it from time to time when he's hungry or thirsty, but he's been doing it for many days."

I was not convinced, but I realized that the nurse knew her patient so well that she recognized tiny, idiosyncratic changes in facial expression that indicated a problem.

However, after examining the patient, I could not find anything wrong. The nurse continued to insist that the opposite was true, so I agreed that the man be admitted to the hospital for a full investigation.

Later, he was diagnosed with a urinary tract infection that had spread to his kidneys and that must have caused him an acute pain. But thanks to his relationship with an empathic nurse, he did not have to sit there and suffer for a long time.

Unfortunately, this type of patient / nurse relationship is too rare in the modern NHS and even in many care homes due to staff shortages, high turnover and a pressured environment.

As a result, the most vulnerable in society must suffer in silence.


The Academy of Royal Medical Schools has had a great idea! Patients would be more involved in their treatment if they were written in a language that avoided medical terminology, instead of copying it in a letter to their GP, after a consultation with a specialist.

I tried a few years ago, but it was not a success. It doubled my workload because I still had to formally record everything in the medical notes instead of relying on a letter to cover everything properly. Neither did my patients like it. Quite rightly, they seemed to prefer that medical professionals communicate with each other about their health, rather than through them in a silent letter that risked losing key details.

Medical terminology and jargon is a language that has evolved to communicate precise and complex things as clearly and unequivocally as possible to other people who speak that language.

Most patients know that receiving a copy of the letter is a courtesy, but it is not intended to explain things to them. The doctor should do it face-to-face during the appointment, and the patient is encouraged to ask questions or seek clarification.

For me, this interaction is the basis of a good doctor-patient relationship. Shooting condescending masses to our patients is not a substitute.


The crisis in social care will not disappear. The latest figures from the charity Age UK show that 1,000 elderly people enter the hospital every day simply because of the lack of adequate social care.

I know very well how patients can languish in medical wards, waiting for social services to be implemented so that they can return to their own homes or find a place of assistance.

It is extremely unfair to patients and puts them at risk of infections and a general deterioration of health: increasingly immobile and without the mental stimulation of a non-hospitable environment.

It is also a shameful loss of the much needed NHS beds. Calling old and frail "bed blockers" is unpleasant, but without your own fault that is what they are. The green paper on government social assistance this fall will establish plans to address this growing crisis. But the hard truth is that ministers have few options. The system desperately needs more cash and I fear that taxpayers must be held accountable.

The alternative is a social care system that is not fit for purpose, that compromises the efficient functioning of the NHS, denies the medical attention they need, and disappoints the elderly.

I do not like the idea of ​​additional taxes, but I still dislike the idea of ​​inadequate care when I'm old and I'm sick.

A tax on social assistance – fenced, so that it is not subsumed by other expenses – would allow us to begin to build the kind of care system of the 21st century that is expected of the sixth largest economy in the world.

If we do not, as former Labor leader Neil Kinnock once said (albeit in a very different context): "I warn you not to get old."


New cases of HIV are at their lowest level for almost 20 years. This is largely due to new therapies, including drugs that prevent someone who is HIV positive from transmitting the virus.

It is also thanks to PrEp (pre-exposure prophylaxis), a combination of two anti-HIV medications that are taken daily and that protect someone who may be at high risk of exposure to HIV.

It is a truly seismic change in the management of a disease that, when I began training to become a doctor in the late 1990s, was still considered a death sentence. Now, men and women infected with HIV and who have access to the best medication can expect to live as long as someone without the virus.

Unfortunately, there has not been a change in the public perception of the disease.

We still make moral judgments about those who are HIV positive. We still consider infection as a kind of retribution for a licentious or hedonistic life.

This contributes to the persistent stigma associated with HIV, and I believe it is a factor in the significantly higher rates of mental health problems in HIV-positive people.

For many of the newly diagnosed, the fear of being excluded torments them. Therefore, it is not surprising that the rates of depression among HIV positive people are almost ten times higher than among the general public.

How sad that, despite the incredible scientific advances that have allowed us to conquer HIV, we have reached a stage in which the attitude of society and not the virus itself is what guarantees that HIV remains a feared diagnosis .

One in four nursing students surrenders before the end of their course, according to new figures. However, we face a deficit of 40,000 nurses. It is an absolute crisis. Nurses are the first to offer care. Without enough, the NHS will collapse.

This can not continue. We can recruit more nurses from abroad, but we also need homegrown nurses, and there is a simple solution. Eliminate the enrollment fees for nursing degrees and restore the student nursing scholarship. It would send a clear message that we value our nurses and appreciate their vocation. If the retention rates do not improve, I'm afraid we'll live to repent.