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.

If you know the name of the doctor, you can write to them at the hospital saying exactly what you’ve said here: explaining the impact of his words on your daughter but without making a formal complaint. I did that once to a GP who made unhelpful remarks about my medication - I didn’t want to get them into trouble but I did want them to understand the effect of their words, otherwise they’d never change.

This is awful. Unfortunately I have had similar experiences with doctors. When I was in eating disorder treatment, that my doctor was fully aware of and had been told the details, she told me I could lose more weight if I cut out carbs. As an adult woman I felt capable of making a complaint to PALS and it was completely dismissed.

You can complain, I’m not sure who told you that you couldn’t.

How has your dd been since the appointment?
Did you tell her team about the alleged incident?

This will have been a really tricky time for your DD, first face to face appointment with the ED team, her anxiety would probably have been off the scale. Was she able to complete the appointment or has it been re-scheduled or was it just a quick physical examination initial booking in sort of appointment ?

OP, I am a former anorexic who still has tendencies in that direction. My first thought was that 1,100 calories is a lot of calories. Is that what your DD says she is consuming? I would have thought that was a lot. Is it possible she said it was 500 (which might be closer to the truth), and this apparently elicited the doctor's response that this is enough to survive on (because it is, just)?

The fact that you didn't hear the whole conversation is a big problem, as you can't possibly know the truth (and anorexics don't tell the truth). You could very well ask to have this investigated, but you definitely shouldn't jump into wanting to have the doctor disciplined/advised as to how to handle this kind of conversation in future.

Some facts need to be established, first.

That aside, I am sorry your DD is having to deal with this (and that you are, too - but anorexia is a selfish illness. I remember overhearing my mum crying at the height of my anorexia. I thought she was being selfish because I was the one who couldn't eat, not her. This is anorexic thinking).

I don’t believe he said this She can pursue it-if he really did but she won’t because he probably didn't You could cause a lot of trouble for heresay

I don’t want to scare you in anyway, and I’m glad she has the support of a specialist ED service.

But ED is so dangerous - I’m not saying this to upset you (and now she finally has an ED service she’ll be supported properly by people who understand her needs) but more because you have to complain about that Dr.

That’s a terrible thing to say to anyone!! It’s not just about how many calories someone can live off. ED is much more complicated than that!
500 calories and then some excessive exercise etc, would be no where near enough and the attitude of the Dr is dangerous.

Reinforcing those thought patterns is a dangerous thing to do!!

Imagine if someone without an ED service is taken to A&E by a friend or relative, just to be told - the same thing. Only, without the specialist support, which may not be sought because some idiot dr at A&E told them it’s ok!

We could also tell you that yes, the doctor said this but he meant x y or z.

But couldn't that give away medical information about the patient? Say a patient lied to a relative to put them off the track off what really had been said, wouldn't the trust telling a third party what had actually been said, risk compromising a patients confidentiality and even safety? This makes me quite concerned. Don't discuss me, my treatment or any conversation I have with an unknown person.

I think that's abysmal

I think telling a relative what a doctor may have said and meant is extremely unlikely and a massive confidentality breach

The sats could appear low due to anaemia or other reasons, the doctor is correct that it clearly wasn't accurate given that she was not out of breath and functioning normally.

As for the comments, if they are indeed true then of course it needs addressed. You know your dd best, if you believe her then so do I. I would just go ahead and write out a letter and ask your dd to sign it if she is happy to. Good luck op

In all honestly, I would let it go partly because it's incredibly hard to make a complaint that is 'he said, she said' and also because you and your dd need to focus on her contact with the ED clinic and her recovery.

I would let the ED clinic know what happened in A&E ie results of ECG but bloods not done, and let them know that you're very concerned.

What the doctor said or didn't say is a massive distraction from your dd's ED and recovery.

@feelthefearanddoitanyway

In all honestly, I would let it go partly because it's incredibly hard to make a complaint that is 'he said, she said' and also because you and your dd need to focus on her contact with the ED clinic and her recovery.

I would let the ED clinic know what happened in A&E ie results of ECG but bloods not done, and let them know that you're very concerned.

What the doctor said or didn't say is a massive distraction from your dd's ED and recovery.

Good comment.

I would also be very suprised if there was no chaperone present, especially when performing an ECG on an 18yr old female.

I would consider that your dd might be lying. I know it's shit OP. A member of my family died from alcoholism very young, and even 3 days before she died she was saying 'oh the doctor said it could be a bacteria I picked up from swimming in the sea, I'll get some antibiotics and be out by the weekend' clearly that conversation never happened, but if I'd have challenged her on it she would have crucified me.
I hope she gets well very very soon

I’ve seen mil at 81% sats and not aware of it. It affects patients differently.

Did I read that right?
Your daughter has lost over 40 kilos in the last year?!
How is that even possible?
That’s a massive weight loss that clearly isn’t healthy
Maybe the A&E person was just exasperated
I found a collapsed person with remains of drip in their arm
The A&E staff ( reception) were of the attitude
“ They are a a drunk- they left by choice”
I was shocked.

YANBU do whatever you can to ensure that the complaint is noted.
It's disgusting. I have an eating disorder on the opposite end of the spectrum (I can't stop bingeing- I eat to the point that I'm sick several times a day)

And I would use inappropriate things people said to me as an excuse to continue, or proof that I was normal, and my behaviour wasn't that damaging to my health.

Infact, I was told my a GP one day when I was in tears that I couldn't lose weight, because I was obsessed with food, that I was a normal, curvy, attractive young woman who didn't need to lose weight.
I'd gone into detail about how badly my life was affected by my weight and I was over 20 stone at the time. I held onto that and used it in my denial, having heard from a Dr that I was OK!

This will have been very damaging to your DD, I hope she gets the help she needs

@whethertheweather I'm so sorry you and your DD have had such a bad experience.

I know this is not relevant to your AIBU, but wanted to mention that there may be quite a link between anorexia and undiagnosed autism in girls. I've read this whilst researching autism in girls (both my children are diagnosed autistic) and wanted to mention it just in case it's helpful. Obviously it might have no relevance for your DD, and I'm certainly not saying most or all anorexia is actually undiagnosed autism. Just worth knowing.

to you both. It's great she's engaging with treatment.

@whethertheweather
Perhaps your Daughter did lie about it
Eg
“500 calories okay- the medic says so”
Anorexics can bend the truth to carry on starving themselves.

If she interpreted the comments directly, that is an extremely ignorant response from a health care professional.

In many places a BMI of 14.5 would get you an immediate admission for medical stabilization, especially with the rapid weight loss, low BP, fainting etc.

Can you follow up with the clinic that she was first visiting when the fainting happened?

Doctors can say breathtakingly stupid things to patients with eating disorders.

And anorectics can and do lie for England.

There's no way of knowing which is true in this case unfortunately, although I imagine you can get a much better idea of the real situation in person than we can by reading it over the internet.

At about the same age my daughter told me that her (specialist ED) doctor had told her that she had made a really good start to this round of recovery by eating a muller light for every meal and that if this was her safe food that she felt comfortable with then she should have a muller light for breakfast, lunch and dinner for a while then, after a few weeks when she felt more stable, she could try adding some fruit or plain chicken. It was an oscar worthy performance. Just a shame for her it was so clearly bullshit!

But then on the other hand, I did witness a doctor questioning her choice of frosties for breakfast each day at one point. He said it was 'empty carbohydrates' and 'too much sugar' and suggested she have eggs instead. I nearly hit the roof. My then 15 year old had been out of hospital for all of 2 weeks and we were trying to keep her on some kind of stable plan with enough calories to keep her weight going up. If she wanted cornflakes for breakfast she was bloody well going to get them!

Has your DD not had bloods and an ECG via her GP surgery?
This is standard for people if there is a long wait to be seen at the ED clinic.

With a BMI of 14.5 I am shocked she had to wait months to be seen. Did she straddle child/adolescent and adult services due to be 17 when you first saw your GP for a referral?

Is "she's lost 45kg in a year" a typo?

If she's 5'4" a BMI of 14.5 is about 6 stone.
43kg would mean she was 13 stone a year ago.

So, she has a dangerously low body weight and a terrifying speed of weight loss.

Telling anyone 500 cals a day is weird - telling someone like your DD is frankly quite bizarre.

In 20 years of A&E nursing I have never encountered a Dr that has carried out an ECG, this was the point at which I started to question the accuracy of what was reported to you.
It would be difficult to raise a complaint based on hearsay, unfortunately

@Fuckaduck21

In 20 years of A&E nursing I have never encountered a Dr that has carried out an ECG, this was the point at which I started to question the accuracy of what was reported to you. It would be difficult to raise a complaint based on hearsay, unfortunately

I came here to comment this. I don’t think many doctors would even know how to do an ECG, and a male doctor definitely wouldn’t have done it unchaperoned.

I don’t think you’re getting the full story from your DD here OP, sorry.