To be angry with comment from A&E doctor

[whethertheweather]

DD is 18 and anorexic with BMI of 14.5. After months and months of delays she is just starting to be dealt with by an NHS eating disorder clinic. They called her in for the first in person appointment to do a blood test and physical exam, where she fainted. Blood tests were apparently off, they said O2 levels were at 80% and blood pressure was really low. The doctor at the clinic was very concerned and walked her over to A&E across the road for more tests with a letter explaining her position and the results of their own tests.

Nurse at triage says she needs a blood test so to wait and that O2 levels are hard to check with a pulse oximeter as DD's circulation is so poor in her fingertips. 3 hours later a doctor calls DD in, says he doesn't need to check her O2 levels "as I can see you're breathing". He then went on to say to her that people can exist quite well on 500 calories a day and that it's the constant going up and down with calories from one day to the next that is doing her body harm. He did an ECG, said it was OK and sent her on her way.

AIBU to feel incredulous that anyone would tell an anorexic it was OK to eat 500 calories a day? DD is trying so hard to eat but she's lost 45kg in a year and the scales are still going down.

I tried to complain to PALS, but they've said as DD is over 18 she has to authorise the complaint and I feel she's got enough on her hands. I'm sure the doctor's doing his best in extreme circumstances, but I want him to understand the potential impact of his words on vulnerable patients.

That’s shockingly poor and please do complain.

I totally believe it as a doctor once said the same to me. Different circumstances but equally stupid. I am not anorexic.

Were you there?

I work quite closely with ED patients, and this is within the realms of something they might say, or manipulate what was actually said. I hope your daughter feels able to support the complaint being made so that it may be fully investigated.

Complain directly to the Trust than runs the hospital. They will have a complaints department, ring the main switch board and they will give you the email address. Do not be fobbed off. You are entitled to make a complaint as a concerned family member.

Were you at the appointment with her OP? If not I’d wonder if DD has either misunderstood what was said or whether she might have told you that’s what was said to allow her to limit her calorie intake ? I really feel for you as an ex anorexic . My Mum must have gone through hell - I’d do whatever it took to eat as little as I possibly could. I hope DD gets the help she needs to overcome this horrible disorder.

I think either she has said that so you don’t worry or the doctor said it in a way to be reassuring.

I can’t say I know a lot about anorexia and the treatment but if you say she’s trying really hard then it could have been a way to show he sees that.
I can imagine telling someone who’s anorexic to eat 2000 kcals would not work (I’m overweight and would feel overwhelmed eating that much) so it’s a way of saying she’s doing a great job and to carry on down the path she’s going.

Of course if it wasn’t said in that way then it’s obviously very bad.

I am curious how the 500 calories came into the conversation ? Were you there ?

A friend of a friend got referred for ED the therapist said your bmi isnt low enough to get help and sent her home

shes still losing weight

@Chichimcgee

I would complain directly to whoever is in charge, that’s really shocking. I would also consider medical negligence

You clearly know nothing about medical negligence.

Sorry have only skimmed the thread, (and have noted that it's possible your DD may have misinterpreted what was said to you) but I am not sure what PALS have said is true. I used to work, admittedly many years ago now, in a hospital complaints service and people would complain all the time on behalf of relatives.

It's the kind of thing an ED patient might tell their mum if you weren't there. On the other hand it's the kind of thing a junior doctor might say as they don't have much mental health training.

The DD of a friend of mine was told when she hit 18, that it was time for her to take control of her own treatment. So she stopped having any and her weight plummeted dangerously low. This was all on file a
complaint was made. It was actually a consultant psychiatrist who told her this, but young, and I don't think he really understood anorexia tbh.

So yeah - not impossible.

You are right to complain.

My daughter had severe life threatening anorexia between the ages of 15 - 18. I’m “glad” if I can call it that, that she was under 18 during the worst, as we had more involvement. I really feel for you. Any suggestion at all that 500 calories a day is remotely normal will be alighted upon by your daughter to validate her extreme restriction. To put it in context, when my daughter had been consuming 400 calories a day she was hospitalised and nearly lapsed into a coma.

You are not wrong to be incensed. The only reasons not to complain is if DD doesn’t want you to or if you need to conserve your energy for other things. It’s a long journey. My DD is 20 now. Healthy and doing a degree. So there is hope. Best wishes. PM me if you wish.

Were you in the room with her?

A doctor wouldn’t have been alone with her without a chaperone.

I honestly sympathise, but you need to be REALLY sure this happened.

@scaredsadandstuck

Sorry have only skimmed the thread, (and have noted that it's possible your DD may have misinterpreted what was said to you) but I am not sure what PALS have said is true. I used to work, admittedly many years ago now, in a hospital complaints service and people would complain all the time on behalf of relatives.

You can complain on behalf of another adult if you have their consent, or if they are unable to give consent - e.g. if they have severe learning difficulties or have died.

PALS are correct in this case.

That’s horrific. I’m so sorry 💐

Sadly there is so little knowledge about eating disorders from some doctors- just what you don’t want to hear. 500 is worrying calorie amount

@DoubleYouOhEmAyEn

Complain directly to the Trust than runs the hospital. They will have a complaints department, ring the main switch board and they will give you the email address. Do not be fobbed off. You are entitled to make a complaint as a concerned family member.

No you aren't.

There is an inverse confidence to knowledge ratio on this thread.

I really can't imagine any doctor saying that 500 calories a day is sufficient. It's basically a starvation diet.

Thanks for all your comments. I wasn’t in the room but sitting in chairs in the waiting room (thank you Covid) but DD came straight out and told me what was said. I don’t think she was trying to justify a low calorie intake; she hates how thin she currently looks and the physical symptoms that are manifesting and eats more calories than that even on a bad day. The letter given to her by the ED clinic mentioned that she was eating 1100 odd calories a day, which is what it’s fallen to again recently. She was really angry with what the doctor said but I just needed to get her away rather than query at the time.

I will approach the Trust. I don’t want the doctor crucified, just to have the potential consequences of his words brought to his attention.

Perhaps I should park it with the comment made by DD’s now ex therapist who told her the ED was a blessing as it’s got the family talking together more….

@Chichimcgee

Medical negligence is a stretch though.

Telling a seriously ill girl struggling with anorexia she only needs 500 calories a day is negligent. When she starves herself to death because ‘the doctor said it’s ok’ it’s definitely medical negligence.

Sure, if it happened.

@Chichimcgee

Medical negligence is a stretch though.

Telling a seriously ill girl struggling with anorexia she only needs 500 calories a day is negligent. When she starves herself to death because ‘the doctor said it’s ok’ it’s definitely medical negligence.

I don't',t believe this. Anorexics are notoriously untruthful when they want to protect the progress of their illness. They can be honest about every other aspect of their lives but when it comes to this horrible illness they will lie. She will be hoping that you just accept what she says because she has stuck the word 'doctor' on it to give it authority. Anorexics can be infantile in some ways.As you love her and want to save her from herself, do not believe stuff like this. You could speak to her nurse or the doctor about a diet sheet and find out what her targets are. Good luck.

@scaredsadandstuck

Sorry have only skimmed the thread, (and have noted that it's possible your DD may have misinterpreted what was said to you) but I am not sure what PALS have said is true. I used to work, admittedly many years ago now, in a hospital complaints service and people would complain all the time on behalf of relatives.

ONLY if the patient agreed their relative could complain on their behalf or if the patient lacks the capacity to give consent.

Is what he said factually incorrect?

@Chichimcgee

Medical negligence is a stretch though.

Telling a seriously ill girl struggling with anorexia she only needs 500 calories a day is negligent. When she starves herself to death because ‘the doctor said it’s ok’ it’s definitely medical negligence.

That's not what OP said he said. OP said he said it was possible for people to exist on that much, and the fluctuation is what causes more harm.

If they had said what you just said that WOULD be awful, but it isn't.

@PaperTulip My mum somehow survives on around 500cals a day. Has done for many many years now. She's extremely active and although skeletal and generally suffering odd symptoms, bizarrely still alive. I just don't understand how it's possible but it is.