Are GPs Failing to Diagnose and Treat Eating Disorders?

On page 13 of The Times dated the 12^th 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 12^th 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.

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.

A Recipe for Disaster

Sitting at my father’s feet, he reading and I gazing into the fire, a thought occurred to me, and I asked him:

            ‘Father, how do you make gunpowder?’

            Now, you might think that most fathers would change the subject with alacrity, or deny any knowledge of the recipe and tell the errant child to go and help with the washing up. But my father had more than a little of the eccentric about him, and though a learned man he sometimes deviated just a bit from the path of conventional wisdom that says at all costs to keep your child safe. And so he replied:

            ‘Fetch a pencil and some paper and I’ll tell you.’

            I did. And he told me.

            ‘Sulphur I can get from the greenhouse,’ I noted. ‘Charcoal from where we have the bonfires at the bottom of the garden. But where can I get saltpetre?’

            ‘Well, you can ask the chemist in town to sell you a couple of ounces. Only thing is, he’ll probably ask you what you want it for.’

            I nodded and saw at once that this might present a problem. ‘I wonder what I should say?’ I murmured, half to myself.

            Some might think it shocking that a parent should not only encourage such hazardous experimentation as I proposed, but fibbing as well, as he did indeed encourage:

            ‘Tell him you want to use it to clean the front doorstep.’

            But he was anything but a bad man. He was in fact ever generous and kind, and as a doctor admired and loved by his patients, and respected by those he taught and unfailing in his support of them. But that aside, I hadn’t the least idea that front doorsteps could be cleaned by such a means. In any event, I did not doubt him and duly made my way to the chemist the next day.

            As anticipated, he leaned over the counter in a way most certainly calculated to intimidate a small boy, and asked me not a little severely:

            ‘And what would you be wanting saltpetre for, young man?’

            I am sure that I looked as if butter wouldn’t melt in my mouth as, picture of innocence as I must have been, I repeated what my papa had told me. He hesitated and regarded me unsmilingly. But I was duly handed the chemical, weighed out into a small brown paper bag. I concluded that the correct way to clean front doorsteps was a piece of knowledge to which adults in general were privy.

            And that afternoon my best friend and I had our eureka moment behind the garden shed. And we suffered no worse effects than mildly singed eyebrows.

            Determined to repeat the experiment – this time perhaps to manufacture a rocket that would actually take off – I returned to the chemist’s. Only this time I made the mistake of taking my elder brother with me.

            The chemist asked the same question again. Again, I replied that I wanted to clean the front doorstep.

            ‘Oh no he doesn’t!’ interrupted my brother, ‘he wants it to make gunpowder!’

            The chemist’s reaction was predictable and I will not detail it. At least he did not summons the local policeman. We were, indeed, sent empty away.

            The time came, of course, when I sourced my supplies elsewhere. And this time I did not go with my brother. My father was delighted when my first rocket rose about six feet from the ground before detonating violently. Sadly, my next pyrotechnical escapade resulted in the blowing of a two foot crater in my father’s asparagus bed. This was not at all well received and in fact signalled the end of my firework manufacturing. And while I have no recollection of the penalty exacted upon me, it was not a severe or in any sense cruel one, he being, as I said, a kind man. It was the sight of my father’s anguish at witnessing the destruction of his pride and joy that did for me, and caused me more pain than any chastisement could have done.

Reading to Children - a grandfather's perspective

Reading to Children – a grandfather’s perspective

I am sure that I’m not alone in having cherished early memories of being read to while sitting  on someone’s lap, or at their feet in front of the fire. I don’t recall being read to by my mother as she died when I was quite little – although I am sure that she did read to me: I have a dog-eared edition of “Orlando the Marmalade Cat Becomes a Doctor” (dog-eared perhaps not being quite the right way to describe a book about a cat. Sorry Orlando). It is 62 years old and signed inside “To Henry, with love from Mama”. Yes,I am sure she read it to me, and I am sad that she never saw me read it in turn to the grandchildren she never had the joy of knowing or indeed her great-grandchildren, who have all delighted in it in turn.
            I certainly have memories of being read to by my father. He was a kindly if rather austere man – probably something to do with his never ceasing to grieve for my mother until his own death, 18 years after hers. His choice of books perhaps reflected this – Conan Doyle’s “Sherlock Holmes Short Stories”, Kipling’s “Puck of Pooks Hill” and Kenneth Grahame’s “The Wind in the Willows”. His live-in housekeeper who – although my father was never comfortable with it – did the essential mothering after my own mother died, liked a different genre: Alison Uttley’s “Little Grey Rabbit” series, and the “Rupert Bear” annuals. Oh – and Blyton’s “Noddy”. Those got passed on to my own children, then on to theirs. And how deliciously un-politically correct those original editions are too. But I don’t think my little grandchildren even notice what so many of their elders would consider gross beyond words.

            My grandchildren are as involved with the television and their computer games as any others of their age. But it is not difficult to coax them away with the promise of a story and loving physical proximity. Last weekend we spent the day with my younger daughter and her husband and their three little ones. The youngest, Jimi, will be 4 in September. We’d bought a book back from Italy for him, of all things about a grand-dad and his truffle hound (we’d had a holiday in Piemonte, famous for its truffles). It was perhaps a little old for him, and with a good smattering of Italian words. But he wasn’t deterred. He snuggled up dreamily to me while I sat cross legged (yes, some of us 65 year olds can still sit cross legged. I am rather proud of that) on the grass, like an old Buddha. Jimi’s  rabbit nibbled the grass at my feet. His attention held for a good ten minutes, and he was as mesmerised as any child would be in such a situation. Magic.

            And it reminds me of two of my nieces in the west of Ireland. They are in their mid-twenties now, and both qualified teachers. But on the (sadly) rare occasions that they see me they never fail to run up excitedly and hug me. ‘Do you remember, Uncle Henry, how you used to read “Peter Rabbit” to us. And we loved your English accent!’

            But how could I forget?

Tinnitus

I suffer from tinnitus because (a) I am old and (b) when I was young - 17 in fact - I had 20 rounds of .303 (this was a WW1 rifle) fired off in quick succession at the school rifle range, about 18 inches from my left ear. Ear defenders were not issued in those days, and I have wondered since if I might get anywhere by suing them. I doubt it, but perhaps the threat might staunch the steady flow of begging letters coming in my direction from that institution

The tinnitus is a nuisance because if I am wakeful at night it sounds like running water. It doesn't make me want to go to the loo, but it does make me want to get up and check that the roof isn't leaking.

No cures for tinnitus sufferers about, I'm afraid, but the condition is certainly a gold mine for the less ethical alternative medicine practitioners ( the more ethical ones being plain deluded).

Care of The Elderly – again

So the Commission reported today. Yet another damning assessment of the treatment of elderly people in hospital, this time focusing on “dignity”. Or the denial of it.
It is all very sad. But it just tells us what we already surely know.
But will it make one jot of difference? You know, I really doubt it. They talk about the lead nurse in a ward having complete control on what goes on in her/his patch. And that nurses falling below the acceptable level on the compassion scale with be dismissed.
But how on earth do you get to dismiss staff on such grounds with present employment law as it is?
I can predict pretty confidently what will happen: the alleged miscreant will go weeping straight to their GP claiming stress due to victimisation and discrimination, demanding to be signed off sick. And believe me, GPs do not refuse them lightly. It is simply too much trouble, especially when the waiting room is packed.
And armed with the requisite piece of paper, the next stop off points will be the union representative and the lawyer.

Sadly, the patient, as happens so often, will come second. Unlike the employee whose livelihood is threatened, if you are old, frail or dementing you are hardly in a situation to stand up for yourself.

On Idiotic Driving

This morning I left Wiltshire at about 8.00 a.m. to drive with my wife to London on the M4.

The light was actually quite good, and the roads dry. But there was a slight mist. As always, when there are the least visibility problems I switched on dipped headlights.

For a few miles between junctions 15 (Swindon West) and 14 (Hungerford) the mist became rather more dense, as the downs are fairly high up there.

I noticed that at least a third of the drivers coming up behind me had no lights on at all. I was driving at just under 70, and plenty of these lightless drivers overtook me.

I just wonder what is with these people. Do they think their batteries will go flat or something? It worries me, though, how such thoughtless driving habits might equate with others – if they are not worried about being seen in poor visibility, do they also not worry about bald or under-inflated tyres, defective brakes or non-functioning windscreen wipers?

Then I remember the wise words spoken to me many years ago “never fall into the trap of thinking you’re a better driver than the one in front of you. And always assume that the one behind you is a dangerous fool”.