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Eating disorders referrals

Caffeine and contemplation

Dominique Thompson

Tuesday, 27 February 2018

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AdobeStock_101125223_eating_disorder_cropped1.jpgI have heard comment, on more than one occasion when delivering training to healthcare colleagues, including GPs, that managing patients with eating disorders is ‘challenging’ or ‘frustrating’. There is a sense of not knowing what to offer, or what to say, to be helpful. This is understandable in the face of a complex mental health disorder (with a significant mortality rate), so I offer this response: ‘if the person is sitting in front of you, in your consulting room, then you are making progress. There are so many more people who continue to suffer without seeking help or support’.

I was really interested to read therefore, a new report from Beat, one of our national eating disorders’ organisations, that in effect supports these reassurances to frustrated colleagues. It transpires that, for a person with an eating disorder, it takes approximately a year and nine months on average to recognise that they have a disorder, followed by a further year of delay before speaking to a health care professional. In other words, an average of two years and nine months will have passed between when the person first developed symptoms and when they walk into your consulting room to discuss them.

The Beat report then showed that a further six months passed, on average, between first GP appointment and treatment starting. The delay was significantly greater for males. Adults were waiting twice as long as children and adolescents, before seeking and starting treatment.

The new NICE guidelines on eating disorders management were published last May. They now clearly state that GPs should refer without delay: “If an eating disorder is suspected after an initial assessment, refer immediately to a community-based, age-appropriate eating disorder service for further assessment or treatment.”

This emphasis on rapid referral is because evidence is clear that earlier treatment of eating disorders leads to better outcomes and prognosis. In anorexia it is particularly important to try to avoid the risks that are associated with malnutrition, and suicide, which accounts for a significant proportion of the mortality rate. With bulimia, self-harm and other mental health co-morbidities are also common. Earlier referral could reduce complications here too.

I completely accept that in many areas the specialist services may not be able to respond as swiftly as would be ideal, and may be in a hospital, not the community, but the delay should ideally not be in the GP consulting room.

When seeing a new presentation of an eating disorder, the key for us is to recognise the condition, take it seriously (it is never a ‘phase’), investigate to rule out other conditions, for example thyroid disorders, and then refer to the local specialist service for further assessment, triage and treatment. You can’t do more. You will already have been very helpful and supportive by believing your patient, understanding how distressing the condition is, empathising, and then referring for expert input. As GPs, we do not need to be experts in eating disorder management or treatment, but we are the gateway to that expertise, and we should not be a barrier.

So next time you suspect a patient has an eating disorder, please remember that they may have been suffering for almost three years before coming to see you, and help them to move forwards without delay towards the treatment they so need.

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Dominique Thompson

Dominique has been a student health GP since 2000, developing innovative new services to treat eating disorders and personality disorder in primary care. She was the GP member of the NICE Eating Disorders Committee 2017. She was a Pulse ‘GP hero’, in 2014, and a ‘Rising Star’ in 2016. Dominique writes about young adult wellbeing and mental health, in both the medical and non-medical press. Her latest adventure is as an independent consultant in student health and wellbeing She is fuelled by caffeinated drinks.
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