‘There is a Degree of Reduced Volume of Brain Substance and That’s Significant’: Exploring Diagnostic Talk in Memory Clinic Interaction.

Diagnosing dementia is difficult for various reasons and on a number of levels (ethical, medical, interpersonal). Historically, negative impact on the patient (e.g., creating anxiety), caregiver (longer time in a stressful role), and services (overloading of specialist services) has been emphasized. More recently, however, the benefits of ‘timely’ diagnosis have been stressed, and, it has been argued, ‘catastrophic’ reactions are relatively uncommon. Existing research focused on the delivery of dementia diagnosis has observed a lack of usage of explicit dementia-related terminology, which is positioned as problematic. In this talk, I take a more neutral stance on interaction in this context through applying discursive and conversation analytic insight to a (small) corpus of naturally-occurring UK memory clinic interactions. These interactions are drawn from eighteen memory clinic appointments (including three home visits) that were video-recorded with fifteen patients (mean age 76.66 years, range 55-92 years) and fourteen accompanying persons (thirteen relatives and one neighbour) as part of the British Academy funded Dementia Talking project. I relate these data to the broader literature on breaking bad news in medical encounters. I suggest that, contrary to euphemistic language - or the patient themselves not always being the primary interlocutor - being viewed as inherently problematic, conformity to intersubjective norms of minimizing catastrophic reactions in medical communication demonstrates sensitivity to patients and families. Moreover, diagnostic communication with this group of vulnerable people is managing problems associated with ‘insight’ in terms of delivery and receipt, or indeed non-receipt, of diagnosis.