GPs 'failing to help people with eating disorders'
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Independent Minds
GPs are failing to help people suffering from eating disorders such as anorexia and bulimia, a charity said today.
A new report from the charity Beat found that only 15 per cent of sufferers felt their GP understood their disorder or knew how to help them.
Many thought their GP was not up-to-date on eating disorders and some believed he or she did not take them seriously.
Some GPs told patients they were "going through a phase" or had embarked on a diet "gone wrong".
The report comes after figures released last week showed a rise in the number of young girls admitted to hospital with anorexia.
Over the last decade, the number of admissions among girls aged 16 and under in England jumped 80 per cent, from 256 in 1996/97 to 462 in 2006/07.
Beat chief executive Susan Ringwood said the rise could be down to a "wait and see" attitude in primary care, with young girls only being admitted when they were seriously ill.
Today's report, based on a survey of 1,500 people with eating disorders, found that many sufferers did not think their GP was knowledgeable about treatments or how to access them.
The report said a patient's recovery was not about choice - a current NHS buzz word - but was entirely down to chance, "with the odds stacked against them".
One patient told the charity: "I felt as if my weight had to drop before the GP would take my worries seriously" while another said: "When I first went to see my GP they didn't listen at all. They just told me it was a phase I was going through."
Another sufferer said: "I left the doctors feeling disheartened, patronised and as if I was making a big fuss about nothing."
Guidelines for the NHS from the National Institute for Health and Clinical Excellence (Nice) were an excellent tool for GPs but implementation varied across the country, the charity said.
The guidelines set out how recovery is possible, provided GPs listen to their patients, act quickly and, in the case of young people, involve their families as much as possible.
Eating disorders are estimated to affect more than 1.1 million people in the UK.
Launching the report, Ms Ringwood congratulated Prime Minister Gordon Brown, who acknowledged last week that late diagnosis of eating disorders was an issue.
"Gordon Brown has just become the first Prime Minister to acknowledge the problem of eating disorders," she said.
"The Prime Minister admitted that treatment for eating disorders is not always good enough.
"He indicated this is something that the Government would work to change.
"However - despite these positive signs - we are aware that people affected by eating disorders still aren't getting the treatment and support they need.
"Only 15 per cent of the people we surveyed felt their GP understood eating disorders and knew how to help.
"This is a shocking statistic: it means that the majority of people encounter uninformed GPs - a huge obstacle to their recovery."
Professor Steve Field, chairman of the Royal College of GPs, said doctors were aware of the signs of eating disorders.
He said: "One problem is that the group of patients we are dealing with - including bulimics who look as if they are eating normally - frequently present to GPs on a number of occasions before they open up about their problems.
"Eating disorders don't respect age or sex or social background; boys as well as girls are affected, old people as well as young people.
"Often they are associated with psychological traumas such as a death in the family or bullying at school.
"It often takes a while for there to be understanding of the problem, it's not very often that the patient comes to the GP and says 'I've got an eating disorder'.
"But doctors do know what they are doing and the signs to look out for and patients should be reassured of this."
Prof Field said specialist services, where patients can be referred, do need to improve, adding that the quality was "patchy" across the country.
He said the Nice guidance recommended patients were managed outside of hospital settings.
The rise in the number of admissions to hospital could represent a success for the NHS, perhaps because more services were available or more people are being referred, he added.
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Comments
How many teenagers 'think' authority figures don't understand them?
What were, exactly, the questions the subjects were asked over the phone?
How were the subjects for the survey chosen, are they a representitave group?
Can one generalize from a phone survey like this?
Admissions to hospital are UP - then surely it;s being diagnosed more often..?
Eating disorders are psychiatric disorders - bulimics and anorexics are a notoriously unreliable bunch.. do we trust their responses?
If GP's diagnosed every thin person who came through their doors as anorexic they'd be stigmatized for overreacting... is this merely an attempt to smear GPs?
The survey goes from the fact that 15% of people with eating disorders THINK their GPs don't understand them to the wild ("shocking") colclusion conclusion that the majority of GPS ARE uninformed. Surely the way to find out if GPs are uninformed is to test the GPs not the disturbed patients feelings?
Most people with anorexia THINK they're too fat, but they aren't. How reliable can they be about how they FEEL their GPs think. How reliable are their perceptions about other people?
Where were the controls - did the survey ask any NORMAL people if they were wrongly diagnosed with eating disorders?
All in all, bad science, bad journalism.
1. Not every person with an eating disorder is a teenager- I have been in contact with many people over the age of 25 with eating disorders
2. Anorexia is partially psychiatric, but once it has taken hold there is a physical simention to it.As for being an unreliable bunch? well upon what do you base this? I have come into contact with university professors, nurses, mothers, speech and language therapists, police officers, teachers ALL with anorexia.NONE of these people were in the remotest way unreliable.
3. SOME G.P's are uninformed, others are not, the aim is to spread awareness and not to smear GP's- I have met some doctors who have helped enormously in the eating disordered patient's recovery process.
4. Nope, not all anorexic's think that they are fat. Often when confronted with statistics such as their Body Mass Index, the patient recognises that they are underweight but then has an intense fear of gaining weight. A lot of people have intense fear about an issue- for example lifts or spiders- I bet you are afraid of something...
5. I just can't believe you could be so ignorant to refer to 'normal people'. 1 in 4 people will suffer with a mental illness at some point in their lives, and it can happen to anyone.Anyone at all and can be triggered by stressfull events such as a death in the family.
all in all, bad predjudice, bad understanding.
Anorexia is a psychiatric disorder, the physical component is the same as someone suffering from starvation due to any cause. Like Bulimia the physical manifestations are secondary.
And to reiterate - this is a survey about how anorexics etc FEEL about their GPS It says nothing that can be relied upon about GPs themselves.
To state with any degree of certainty that GPs are ignorant (as the article implies) you'd have to test the GPS. I actually surveyed GPs in the 80s about their knowledge of sickle cell anaemia (in an area with a significant afro-carribbean population) and found they knew next to nothing. But at least I'd tested the GPs. Surveying patients perceptions of their doctors' knowledge simply tells you about the patients' viewpoint. It may or may not be true, but you can't say one way or the other.
To quote a widely publicised description of anorexia:
"Individuals with anorexia often attempt to hide the disorder. Denial and secrecy frequently accompany other symptoms. It is unusual for an individual with anorexia to seek professional help because the individual typically does not accept that she or he has a problem" ie: unreliable - especially at point of first contact with GPs. Contrary to popular belief GPs don't mind read.
"anorexia nervosa typically begins in late childhood, adolescence, or early adulthood" - there are 12 year olds with university degrees (and I've met one) but most people with university degrees are over 20 and most people with anorexia are under 20 at diagnosis. Notice I say most, that is the norm.
'Normal" means conforming to the norm, ie if 3/4 people are not suffering from a condition and only 1/4 are then a condition is not normal. Try a dictionary.
The most important thing about a psychiatric condition is to understand it, not fantasise about it. That requires straight, not wishful thinking. Until we find the anorexia virus it remains a psychiatric disorder.
Being afraid of spiders, lifts or aeroplanes doesn't kill you. Not eating will certainly do that. Both Anorexia and Bulimia will significantly shorten your life.
And I'm sorry you're upset but - grow up. I have been out with an anorexic (a ballet dancer) and seen it at first hand. Avoiding the facts is the worst of all possible scenarios.
Attitude adjustment by the person with the eating disorder is the aim. Back to the 'norm'. We've banned websites that encourage people to starve themselves. Good thing too. It is not a 'normal' way to behave, it is not a lifestyle choice. The first step to recovery is to admit that. Otherwise the next generation of little girls will be going for a size 00. Starving yourself is not chic, not sexy (of course for some anorexics that's the point) and certainly not normal. It is a condition to be avoided.
- So I am the one who should get a dictionary? I have several ,and a linguistics degree.I still do not understand this sentence although I'm pretty sure it's supposed to be an insult.
Also, what's class got to do with anything? Incidentally I'm not middle class and I do not hate myself, I am not part of the political correctness brigade but i do think that it's unfair to call and eating disordered person abnormal. Their way of thinking may become abnormal and disordered as the eating disorder takes hold, but this can be reversed, to an extent. So yes, maybe the eating disordered person is abnormal in some respects, but completely normal in others; it is a bit essentialist to just lump all eating diordered people together as abnormal and everyone else as normal.
I am well aware there is no such thing as an anorexia virus, but some pathological aspects of the disorder are apparent- as a basic starting point maybe read http://www.newscientist.com/article/dn6
However, I do agree that the illness has a vast psychological component to it aswell.
Point taken- perhaps there are some issues in the way the data was collected? But surely anything that raises awareness of eating disorders, make information more widely available and therefore may make it possible for individuals to be diagnosed as soon as possible a good thing?
Why do I need to grow up? I'm not avoiding the facts? I am aware anorexia kills and that it is not glamourous and that it can be very secretive.
In explaing that everyone has a fear of something i was perhaps trying to show you a way of emphathising with the eating disordered person. Yep fear of aeroplanes or spiders wont kill you, but dont you see the point i'm making?
And thankyou for your kind explaination of the word normal. But can't you see how it is a term loaded with some quite predjudiced connotations? Maybe you could've just said something like "ask healthy people".
Im sorry you're angry- but grow up.
I agree that eating disorders are conditions to be avoided and it's a shame your ex had to suffer an eating disorder- i just don't understand why you seem to be so angry and predjudiced towards those with eating disorders.
As the parent of someone with an eating disorder and a member of "B-EAT" I took part in the survey and in some discussion with B-EAT about the publication of the results. I was concerned that the report would be used to pin the blame for everything that ever goes wrong in the treatment of these tragic diseases fairly on the shoulders of the country's GPs and it seems to me that my fears were somewhat justified.
While I am sure that there are individual GPs who are as prejudiced and uncaring as the author of the Bad Science post, the majority are probably bumbling along trying to do their best with a fair amount of information but an appalling lack of options when it comes to referral to secondary care. Secondary care services are, as Prof Field has stated, "patchy" and in many areas have been under severe pressure themselves during constant rounds of "reconfiguration" (which usually means cuts).
Understanding about the aetiology of and best treatments for these illnesses is still sketchy and a matter of furious debate among the "experts" so the fact that the "average GP" has not kept up with the latest thinking should not be much of a surprise. It is, of course, a matter of concern, because, with the ever stretching of resources and threats of privatisation in secondary care, the "average GP" is the person who, along with his or her relatives, ends up picking up the pieces if specialist care isn't available (as it usually isn't to most people with bulimia and a frighteningly high proportion of those with anorexia) or when it proves ineffective.
I am delighted that Gordon Brown has acknowledged that late diagnosis of eating disorders is an issue, and indeed that he is interested in the illnesses at all, but if all he does about it is criticise the one group of people who are providing the majority of care then that will be a very great shame.