Saturday, 13 October 2012

Are GPs Failing to Diagnose and Treat Eating Disorders?

On page 13 of The Times dated the 12th October 2012 a report by Martin Barrow, Health Editor, claimed that GPs are ‘failing to spot early signs of eating disorders’ as number of sufferers soars. The article followed a typical format: identifying family doctors as being at the root of the problem through an inability to understand, assess and manage appropriately its various manifestations. I was not surprised to see that the views of the chief executive of ‘Beat’ – the eating disorders charity – featured prominently. She presented opinions as facts and portrayed the GP in a negative light.
No doubt the intention behind the publication of such material is – so far as the charity is concerned – to draw attention to their cause. I have no issue with this so long as demonstrable facts rather than hypotheses are presented. So far as the newspaper is concerned the intention is to sell copy – and any article that portrays doctors as lazy, ignorant, greedy or whatever is certainly going to do that.
No – the problem for sufferers from eating disorders is one of very limited resources for a condition that requires intensive, time consuming and costly intervention. And possibly – I cannot say certainly – a public that is much less sympathetic towards eating disorders than it would be, say, towards heart disease or breast cancer.
In my 40 years as a GP and a teacher of young doctors in training to become GPs I gained a considerable experience of people with eating disorders. I would emphatically counter any suggestion that GPs ignore the possibility of an eating disorder presenting even in its earliest stages. The problem for family doctors is not that they are ignorant or disinterested, but the perception that when they refer patients any number of barriers is put up. Not least one of long waiting lists. The other problems are those of denial and concealment on the part of sufferers and their families. On those occasions when I tactfully raised the possibility with patient and parents by far the commonest reaction was that of a refusal to accept it. But in the end the GP is trained and equipped to gain the confidence of patient and family so that the true nature of the problem is acknowledged and treatment plans initiated. I acknowledge that GPs may have failed in the past, but the present day vocationally trained doctor is far less likely to fail the patient.
Eating disorders present to GPs one of the greatest challenges in their day to day work. And, contrary to such misreporting as appeared in The Times on the 12th October, they will rise to it and do the best they possibly can. Knocking the GP will really not help the cause at all. It is the politicians who should be pressured to ensure that effective, adequate and local resources for treatment are put in place.
And perhaps a little more attention, too, should be paid to identifying the possible causes of eating disorders. Not just by the health professionals, but by the families as well.

Friday, 12 October 2012

Burn, Booze and Snooze

Just back from a week's respite from the dreadful English weather. Lanzarote can be depended upon for this, and it must be about our 6th visit. This time we tried a not-so-upmarket self catering complex. Here's what I said on Tripadvisor: Room service was sufficient and efficient, the rooms being cleaned and the beds made up 5 days out of 7. The beds we found comfortable. There is a generous sized safe which could accommodate my laptop (Wi-fi is available, at a cost), in the reception area. For an additional payment we could have had air conditioning and the use of a television in the room. We didn’t bother with the TV as we don’t go on holiday just to sit in front of the box. Neither with the air conditioning although it was very hot in the day. We just didn’t want to come all the way from the UK to confine ourselves to our room just to keep cool.

On the not-so-good side: in the context of Spain suffering as deep a recession as has – I am sure – ever been experienced, everything looks just a tad dowdy. Outside of the complex there are great swathes of abandoned development projects and large numbers of businesses that have shut down. The holiday complex immediately adjacent to Sun Royal, advertising itself as being for the ‘over 50s on extended holidays’ seemed to have been abandoned entirely. Sun Royal itself had something of an air of neglect – small things that really could have been attended to and while these didn’t impact much upon our stay, they were irritating enough: damaged light fittings, non-functioning extractor fan in the bathroom, shower head loose, equipment listed on the inventory that just wasn’t there, plant troughs throughout the complex that would once have been full of geraniums etc. left dry and dead. Many of the sun loungers were damaged and just left. Cigarette ends thoughtlessly dropped by people who may have known no better just left where they fell.

We’ve had holidays in the past seriously spoiled by the inconsiderate behaviour of our fellow guests (see my previous reviews). But as I’ve said, at Sun Royal this was much less of a problem – the leavings of dirty cigarette smokers notwithstanding. It was generally quiet, and we were never disturbed at night. This is important to us and made up considerably for any other minor failings. But out around the pool I had to keep my nose buried in my Kindle. Talk about ‘vile bodies’! I can never quite grasp the need to abuse oneself through sloth, gluttony and addiction (far too many smokers still – but I am naturally troubled by that as I am a retired physician). And the irresistible urge for many of the men – and (shockingly) women too, to model themselves on celebrities in the context of having themselves tattooed, mostly with gross designs all too reminiscent of fascist regalia. In spite of all the health warnings too, why is it that people insist on wrecking their skins and risking some of the most aggressive forms of cancer by lying out nearly naked for hour after hour in the intense sunshine? My suspicion is that most of the offenders were British where our Welfare State is seen by some as a buffer against the consequences of what they are doing to themselves. The pity is – it isn’t. As I said, I kept my gaze firmly on my reading material - the sight of a middle aged woman, morbidly obese and without any top is, quite frankly, as good an emetic as I know. But to be fair, I never saw or heard any the worse for drink. But it’s their concern if they are content, wilfully, to wreck their health and precipitate themselves towards an early death. Thank goodness I no longer have to sit in my consulting room trying to sort out the frightful mess they get themselves in to. Overindulging in sun, cigarettes and junk food may seem fun to them. Sadly they discover, in the end and when it is far too late, that cancer, diabetes, stroke and heart attacks certainly aren’t.