Introduction
The article "Expectant futures and an early diagnosis of Alzheimer's disease: Knowing and its consequences" by Julia Swallow reviews the ways through which the early diagnosis' hopeful promissory claims of Alzheimer's disease (AD) as it keeps the primary biomedical model for AD management, are discussed by healthcare specialists. The researcher draws on qualitative data collected from the out-patient clinic and in-patient hospital in the United Kingdom. Also, the author develops the analytical stance of the sociology of anticipations to show that early diagnosis can potentially close off hope the future promissory visions in twofold ways. First, it reproduces the dreadful AD expectations built around anticipations regarding the aging future, and second, it generates uncertainty regarding care accessibility as a material source. Although practitioners recognize anxieties and uncertainties it creates for patients as well as their families; they as well express a sense of uncertainty regarding early diagnosis. The author explores the internal contradictions and conflicts characteristic to the viewpoints of practitioners concerning the consequences of early diagnosis.
Methods
The researcher draws from data gathered in two memory health centers as well as a clinic in a big training hospital trust in Yorkshire, United Kingdom. The researcher collected the data for one year. The researcher conducted an ethnographic study that explored the function of the tools for cognitive screening in the AD diagnosis procedure in the clinic. The tools used were the Montreal Cognitive Assessment and the Addenbrooke's Cognitive Examination III. The researcher performed observations in the multi-disciplinary team (MDT) consultations with medical experts from the out-patient memory clinics, who work across the psychology and psychiatry fields. Also, the researcher conducted in-depth interviews with 23 medical experts who worked in both hospital and memory clinic settings, including geriatricians, psychologists, consultant psychiatrists, occupational therapists, and memory nurses.
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Further, a gate-keeper approach was used to acquire practitioners in the out-patient environment, while snowball sampling was employed to collect different perspectives along with expertise levels. The researcher also obtained informed consent to conduct consultation observations from the family members, patients, and healthcare practitioners. Interviews were transcribed verbatim and audio recorded. The researcher recorded observations in handwritten notes, and the field notes and interview transcripts were analyzed thematically. Also, the data was analyzed manually.
Results
The findings of the study indicated that for AD, earlier stages detection as a way of managing the risks related to an elderly population does not necessarily mean that it alters the ultimate prognosis of patients. Consequently, early diagnosis can potentially create anxieties and uncertainties surrounding patient futures, especially since the biomedical model underestimates the function of care as predicaments of both emotional labor and material resource in managing AD. Moving the diagnostic activity toward earlier stages introduced specific contradictory future expectations and representations, which had crucial inferences for the means through which various memory service players performed early diagnosis. The importance of the analysis is that it shows the articulations of uncertainty by practitioners. Thus, discussing early diagnosis is a complicated activity since diverse players acknowledge the low anticipations created by the existing biomedical model, although it is still the main AD management framework.
Discussion and Conclusion
The article concludes by asserting that the early diagnosis's hopeful promissory claims eradicate the anxieties, anticipations, and expectations which such work may create and carry out in the clinic. Thus, the article expects to provide a brief understanding of early diagnosis as it moves the ignored patient expectations and practitioners' concerns – creating uncertainties and concerns which it is expected to solve. As a way of privileging the biomedical model to frame and make sense of AD, policymakers must focus on the affective labor at work, and a healthcare structure's complexities in which diagnosis is advantaged and care underfinanced. Overall, early diagnosis eradicates anxieties and uncertainties which it creates in practice, since it limits the co-existence of accounts to make sense of loss of memory beyond self-loss, and does not acknowledge care as a practical option for AD management.
Reference
Swallow, J. (2017). Expectant futures and an early diagnosis of Alzheimer's disease: Knowing and its consequences. Social Science & Medicine , 184 , 57-64.
