I mainly just follow rather than post, but I wanted to ask for responses/suggestions about a letter I'm writing to my GP who I felt responded very badly when I first raised concerns about my daughter's eating more than a year ago. I want it to be constructive rather than blaming and to help him respond better to another parent in a similar situation and I also feel that sending the letter will help me put away some of my anger (although perhaps that word is a bit strong) about his response. I saw him once with my daughter after the diagnosis, but have since taken her to other GPs in the practice. The draft of the letter is below. Does anyone have any suggestions for additions? Could anyone direct me to a good reference for GPs - I couldn't find one on the BEAT website, and the NICE guidelines are a bit concise - although they do say that family reports on changing eating behaviours should be taken into account as well as stressing the importance of early diagnosis...
thanks in advance!
Dear Dr X,
I’m prompted by eating disorder awareness week (this week) to write to you about my experience with my daughter. I don’t expect you necessarily to remember it, but a bit over a year ago I had an appointment with you which was followed by one with my daughter (ostensibly to address a relatively minor health issue of hers). Before bringing her in, I raised with you some concerns I had about her weight and eating. I was vague, I wasn’t sure there was a problem and I was perhaps trying not to think the unthinkable. I wasn’t clear what I was expecting from you and, to be honest, you seemed alarmed at the idea of having to talk to a teenage girl about her weight. So you ended up suggesting perhaps contacting the school nurse. I’m sure you’re aware how under resourced the school nursing system is and I didn’t have a clear way of either speaking to the nurse or getting my daughter to them. Having felt a bit of a brush-off, it took me a further month or two to directly address the situation and get my daughter referred to the eating disorder service where she was immediately diagnosed with anorexia. Although a year later she’s done well and is on the road to recovery, I can’t help thinking about those extra two months of weight loss and delay in treatment and wish that I had been more assertive in pursuing my concerns.
I appreciate that eating disorders, whilst not rare, are also not that common. You may also in the intervening time have re-considered your approach. But can I suggest some alternative responses that you could have made.
I think what I would now wish you had said was something along the lines of: ‘look, you’re concerned enough about her eating and weight to raise it with me, so I think we should weigh her and perhaps raise the issue of eating.’
I know that eating disorders are not always accompanied by low weight, but this was something I’d raised with you. Whilst presenting it as routine, you could have weighed her, measured her sitting and standing BP and asked her to come back in a week or so to me weighed again by a nurse or doctor. This would have established whether she was losing weight . You could also (although I accept this is perhaps more difficult in a 10 minute consultation) have questioned her about whether she was restricting her diet and at least delivered the message that children should expect to gain weight throughout their teens/early twenties and that weight loss was not advisable. In common with many people with eating disorders, she is very responsive to the voice of expertise and authority and this message would have been helpful.
I hope you take this in the constructive spirit intended. I appreciate that you are very busy (particularly right now) and don’t need a response but I hope it might help you in responding to a parent in a similar situation.