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Saturday 28 September 2013


I have always loved Stephen Fry and Hugh Laurie, as a partnership. 

Me, being me, I have always been more drawn to Stephen Fry, with his darker side and I do admit to the hugest brain crush on him.  But then came House.  Oh my!  

The underlying point of House is the whole "murder mystery/clever detective" - the murderer being the disease, the Holmes being House.  Marvellous stuff.  The whole point is to find out what is causing the lesions/boils/seizures etc and treat them with the right stuff and save the life of the patient.  It usually ends happily ever after (sometimes minus a limb or two) and we all breathe a sigh of relief.

This is TV, after all.  

But this is not what happens in real hospitals.  In real hospitals, people come in with various illnesses, get treated with various medicines, according to various protocols and recover (hopefully without losing limbs).  If you know what you are treating, you treat it right?  I mean, if someone came in with a very dehydrated child, who was obviously thin, lethargic and discombobulated, you would think "Ah!Dehydration. Underweight. Let's hook her up to a heart monitor, rehydrate her, get some nutrition and go from there."

Then you go to your computer, put her name in, see she has a diagnosis of Anorexia Nervosa and down come the shutters.

"Because this child of 11 is so obviously starving herself to death because she has "control issues".  Why has her father brought her in?  Is he safe to be left alone with her?  Where is her mother?  She must be either overcontrolling or distant?  There must be something wrong with that family if a child of 11 wants to be thin.  Too much exposure to her mother's Vogue magazines I expect.  I bet they watch America's Next Top Model.  Still, it's the child's choice to be like this and the parent's fault.  I haven't got time for this.  I have really sick people to see to.  All this attention seeking behaviour will just have to wait.  If her father wants her rehydrated and fed, I will give him a Fortisip to feed her and order a glucose blood test.  That should do it.  Now I am off to look at the poor boy in No 4 who has a fish hook through his finger."

So we come back to, if you know what you are treating, you treat it.

In general medicine, nobody cares about an eating disorder patient or their family because they come loaded with the prejudices and KNOW that this is a choice by the patient and is mostly about their childhood and bad parenting.  I mean everyone knows that, right?  Let's leave it to the professionals - like the Child and Adolescent Mental Health teams.  They will know what to do, right?  

Well, no.  It seems that with Eating Disorders, any treatment of physical symptoms is put on the back burner by most CAMHs teams, whilst they slice and dice a family to find out the "cause". Although treatment guidelines are clearly there and Dr Dasha Nicholls' wonderful team at Great Ormond Street will give you help over the phone, if necessary, it is so much more important to find the "psychological" cause of this, than to restore the patient to physical health. Urgent restoration of physical health is definitely a second priority, these days.  Who cares if this child gets osteoporosis or her heart never develops properly?

This seems to be an endemic prejudice throughout the system, now.  So children with eating disorders don't get the proper care they need, because they don't deserve it?  I would certainly agree that this seems to be the current attitude within the Health System at the moment.

You don't believe me?

Tell that to the Dad, sitting right now in a hospital room, trying to persuade his 11 year old to at least drink something more than the 50ml of Dr Pepper that the hospital gave her to get her blood glucose levels "back up".  That is all she has had to drink all day.  She is still in her school uniform.  It is 2.45 am.


It is a brain disorder/dysfunction.  It is the result of an energy imbalance.  It is a serious mental health condition.  It is also a serious physical health condition.  It needs urgent and immediate attention.  It needs both the physical and mental problems treating - not one to the exclusion of the other. 


  1. Absolutely. I will try once to explain to someone that "what was really wrong" with my daughter was anorexia. After that I'm done. I praise the universe daily that my husband and I picked up on it fairly quickly, the pediatrician was 100% on top of it and UCSD was in my backyard. It made all the difference.

  2. This is the same for adults too. You can develop new physical symptoms that may or may not be related to the eating disorder but many doctors aren't willing to see anything beyond the word 'anorexia' in your notes.
    For example, three weeks of acute debilitating headaches? GP says it's due to the anorexia.
    In A&E with breathing problems. Tachycardia on the monitor "but that's because you're anxious". Funnily enough, I tend to know when I'm feeling anxious and I was far too tired for my anxiety levels to be high. It's been an educational few months: the respiratory consultant has diagnosed atypical asthma but no A&E doctors will treat asthma symptoms because of the combination of atypical presentation and the distraction of the eating disorder, which allows them to tell me that I'm being overanxious, that my breathing is hyperventilating from anxiety, that the changes in my ECG are related to anxiety, etc. I'd been concerned about palpitations for the several weeks before I collapsed in June. But when I told 3 different A&E doctors about it, on 3 different occasions, all of whom had commented on changes in my ECG, they took my complaint as confirmation of my mental state rather than an indication that there may be something happening with my heart. Ironically, my cardiac condition predates my eating disorder (I was born with a problem in my aortic valve), but it seems that psychiatric conditions invalidate medical conditions for many doctors.
    Even when I had lost consciousness, the paramedics assumed that the problem would be low blood sugar and wanted to correct that even when their blood glucose meter told them otherwise.
    The thing is: cardiac problems can be caused by, or exacerbated by, anorexia. This does not mean that cardiac symptoms in people with anorexia should be ignored. In fact, surely the opposite should be the case and close attention should be paid.

    Sorry for the incoherent rant and I hope that the 11 year old and her family start to receive the help they need and deserve.

  3. This, from a medical report from a qualified doctor now specialising in psychiatry but with a background of medicine as good as the next doctor's about my daughter who has a 12 year history of AN binge-purge subtype and resultant osteopenia and gut issues as well as the terrible psychological scars (put it this way, Atos think she's too sick to work) Past Medical History
    "X is a relatively healthy young lady who experienced febrlle convulsion as a young child" - that's it! Even Bertie Wooster would go better than that, let alone the gorgeous House

    1. ATOS passed me as unfit for work (in support group for ESA) but I had to appeal a DLA renewal decision because the doctor who did that assessment wrote that I had "no significant mental illness". Apparently 25 years of AN (with 6 inpatient admissions to date and having been sectioned for AN in the year before this assessment) plus co-morbidity of recurrent major depression does not count as significant. My appeal was successful and the tribunal actually increased the award from the previous assessment.
      I'm not sure that the issue stems from doctors not receiving any training on EDs in medical school ... it seems as though sometimes attitudes develop within certain professionals that prejudice the way in which they treat a patient who presents with an ED, failing to take that person as a new case, an individual worthy of their time, respect and attention.

  4. The lack of a clue, or the desire to get one, in some medical services is appalling, the way some professionals and services think they know it all when they know nothing is probably worse.

  5. I am curious about something. Do you have the field of Adolescent Medicine in the UK? They are specialists who probably spend about a third of their fellowship on eating disorders, and are generally excellent and very family-based, at least in North America. Pediatric residents generally receive some training from them, and in children's hospitals can consult them if need be. So most pediatric residents here trained recently have at least a basic sense of what anorexia is and how to treat it (from a correct perspective). GPs and adult emerg physicians, less so. Is this not the case for pediatricians in the UK? (Also, just have to vouch for the odd person who really does have another emergency to attend to - hospitals tend to be understaffed at night and on weekends, and if you have an asthmatic about to go into respiratory failure and an anorexic child who very much needs acute care, but not necessarily instant care, you may have to delay a little after leaving basic orders for the nursing team.) But the UK seems strange to me - every medical student here usually at least have a lecture from a child psychiatrist or adolescent med physician involved in FBT, although they don't necessarily remember it.

    1. I have a friend who is currently a medical student and also has a history of AN, including hospital admissions. In the UK, medicine tends to be a course that starts with undergraduate and additional years of study in order to obtain the clinical qualification. She started her course 2 years ago and is now in her third year of study. Recently, she commented that their morning had been spent in eating disorders lectures, which had made her feel uncomfortable because of her own personal history (not because the lectures were bad).

      I have other friends who are doctors (2 of whom have anorexia too) so I can ask them more about their training if you are interested.

    2. I'm curious about this training. Our daughter was seen at an Adolescent Medicine Clinic by AM specialists who didn't seem all that up-to-date about eating disorders or how to treat them, although they had 20+ years' experience. This is an Adolescent Medicine Clinic affiliated with a Children's Hospital that is part of a prestigious university medical school. They didn't have a clue about FBT. You'd think that if ONE THIRD of their fellowship was on EDs that this would be something they would know about. Where is the program you are talking about? I'd love to recommend it to them.

  6. I'm in Ontario - most people here have trained at Sick Kids in Toronto. I thought this was true of other programs as well though - maybe not. EDs are such a huge part of adolescent medicine - but I suppose it's still a fairly unregulated field. Strange! And sad.