F.E.A.S.T's Around The Dinner Table forum

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Hi all, 
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.

I would hope the GP sees this as feedback in the spirit is intended. I have had a quick look for some resources you could add. This is a GP guide from England which looks quite well written and confirms many of your points and adds others. https://www.gponline.com/clinical-review-eating-disorders/mental-health/article/1111690
It is probably an easier read than the NICE guidelines and gives the important information. 
D diagnosed restrictive AN June 2010 age 13. Initially weight restored 2012. Relapse and continuously edging towards recovery. Treatment: multiple hospitalisations and individual and family therapy.
@Ruby3 good thing is that your kid eats now. About the letter to the doctor, I am afraid we all have one similar experience at least.
It is a good letter and I hope that the doctor takes it constructively. The guidance given by Bronwen above is also good. The only thing I would say is that the GP may not know how stretched the school nursing services are. In the past he may have had good experiences of referring patients like your daughter to the school nurses and of their being the ideal first port of call. 
Fiona Marcella UK
Good letter!  I'm so pleased that you are taking the time to do this in the hope of helping those who follow you.  Yay, you!

My suggestion (pretty much always, when providing input about a letter) is to read through each sentence, each word and see if there is anything you can remove.  People are so busy!  The shorter you can make it, the better the chance that he will actually read it.  xx

"We are angels of hope, of healing, and of light. Darkness flees from us." -YP 
I think that is a good letter. I don’t know what School Nurse knowledge is like now, but 3 and a half years ago when my daughter was first heading down the path to diagnosis the school nurse gave her a leaflet about healthy eating. Well meaning but lots of not too much fat or sugar messages.
GPs now have a great deal more responsibility than they used to when it comes to all sorts of illnesses, including eating disorders. This survey being sent out to GPs in Scotland is a useful guide to what practices should be offering. https://mwcscot.citizenspace.com/mwc/mwc-ed-gp/ I would be fascinated to know what kind of response they get. It would seem that Scotland is working towards a system where GPs are knowledgeable and have the support to support their patients. 
Fiona Marcella UK
Excellent letter. I hope it’s cathartic for you when you post it. I would hand deliver it to the GP practice 😊 but then that’s me....I like them to see that I mean business!!
I suspect school nursing services need training to deal with eating disorders. I am aware that BEAT are offering a training package for them now in some areas but I suspect this is a big area for development and I am not confident that they would respond appropriately. Maybe those of us in the UK should ask our eating disorder services this week if they do any training for GPs, schools or school nurses. That would be good for eating disorder awareness week!
I think your letter is excellent Ruby. And I am really impressed at your constructive feedback and advocating for better services. Well done. Xxx

Great letter! Good for you and I hope it makes a difference to future patients that present with their worried parents 
I would add that they need to refer onto specialised mental health services 

Even though I was trying to refeed her myself as found as much info/read books etc, I just needed the professional support that I did not get 

our GP failed to refer my d and wasted precious time as my d was becoming a YA (18) which now makes it very difficult for us as parents to be involved as she has her “rights”
a problem we also have here (so I can’t offer feedback to the many GP’s we have seen) is that they seem to move around 
at one time we had an AMAZING GP, he sympathised with me and the toll it was taking on me and our ENTIRE family 
I found seeing him and crying and talking and helped immensely, then next minute he is gone from that clinic 🙁
makes it very difficult as he also had a kind and lovely nature with my d also 
she trusted him felt safe etc 
then........... no where to be found 
I do believe training for GP, school nurses/school physc/councillors etc should be happening
 (Especially in high school!! They should have a clue!!)our high school staff didn’t seem to
and I have since contacted them to express our situation (my d was seeing the school physc and her ED wasn’t picked up)

in my profession I’m continually upskilling (at my own expense too, and I’m darn sure I earn a lot less than these professionals 


Ruby3 that is a great letter. I agree with Torie that making your communications as brief as possible is important.

In case anyone else is looking for a resource this one here is from a Feed Your Instinct and takes you through questions that give you a checklist of sorts that you can give to a GP. It's probably really good from a carer who is at the beginning of their journey and isn't sure if there is even a problem. 

D fell down the rabbit hole of AN at age 11 after difficulty swallowing followed by rapid weight loss. Progressing well through recovery, but still climbing our way out of the hole.

Thoughtful polite and guiding letter, it is so important to think of anyone coming behind you and how you can make it better for them. Who knows what added difficulties another parent or child may have that needs that attention that was missing at your GP appointment. My daughters first appointment was focused on stomach pains but I raised suspicion / concern that the GP didn’t pick up on - what parent wants to be affirmative about this diagnosis? When I did finally get it through it was in a letter to GP requesting referral for ED. BMI confirmed that so that alone should have raised her concern to us - both parents attended with Daughter which also should have shown our concern. Last appointment she repeatedly told me how common it was - not particularly reassuring - GP was absent the previous week due to a family bereavement how many times have mourners consoled family by telling them how common it is?!