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.

I'm going to have to agree with others who say that your daughter's version of events is probably not accurate.

Anorexic people often hear what they want to hear in situations like this.

I'm sorry you're going through this, it just be really tough.

@oakleaffy what a stupid, insensitive comment, you sound as if you’re blaming the OP and her diagnosed. Anorexia is a disease.

*and her daughter, not diagnosed!

Hmm.vi think your daughter is not quite sure what's real. She wouldn't have lost 45 kg in a year if eating 1100 cals a day, surely.

Sadly from personal experience this doesn’t surprise me. Even at SLAM eating disorder clinic I was spoken to by some consultants that were really crap at knowing how to talk to someone with an eating disorder and I often left feeling much worse. Definitely reports this to PALS. I really wish you and your daughter all the best.

What blood tests "were off" from the ED clinic? You don't get results on the spot.

@Tigandgab

I work in complaints for a mental health Trust. Anyone can raise a concern through pals, or make a complaint, without the consent of the patient. It will still be passed onto the service, and we will still respond in writing if a complaint. What we can't do is share clinical information that the complainant is not aware of. In this case we could reference the appt, as you are aware of it. We could also tell you that yes, the doctor said this but he meant x y or z. We would not be able to tell you any info about what your daughter said or details of her care and treatment eg. Medication. So,, definitely worth raising this with pals and then you can escalate to a complaint if you're not happy with the response

I fucking hope you don't actually work in complaints in a medical setting.

Confirming a patient's appointment details? Breach of the DPA 2018/GDPR

Reporting what a clinician said to a patient? Breach of the DPA 2018/GDPR

If you are actually doing this, you are certainly breaching ethical standards and civil law and, in some cases, you may be breaching the criminal law. Seek urgent training before you land yourself and your Trust in massive trouble. Patients have the right to expect their data - including data about appointments and clinical advice - to be kept confidential.

@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

Worked in cardiology for years, literally never seen a doctor perform an ECG. That's a Nurse/HCA job. They just interpret afterward.

@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

As an A&E doctor - LOL 😀

But I suspect the OP may mean that the doctor 'got an ECG done', rather than he literally did it himself.

(Now, where does this lead go? .....)

@TheOrigRights

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.

Agreed- The weight loss surely must be a typo? 45 kilos is a huge amount to lose in a year.

Oh Christ , they just say mad shit the same as the rest of us. Academics are often socially weird and domt think ,before they say something
I was in hospital yesterday, and was asking about medication that was safe for my baby when breast feeding. As he left he said “ don’t worry about that! You’re baby had your 3 glasses of wine on Friday night!” with a shrug and a flourish whilst I stood slack jawed !

• I had told him I’d had 3 small wines for DH birthday meal once my baby was asleep and therefore plenty of time before feeding again at 6am !) I just put it down to all of the above and the fact that all the nhs staff must be bald mad with the past 2 years .. Hope your DD is ok -she doesn’t need her food issues justified by the Dr bloody hell I wonder what possesses him?

@MissLucyEyelesbarrow haha, love the honesty!
Based on what has been written by OP I feel your suspicions are unfounded (unless the story changes of course), there is nothing to suggest there was any member of staff in the room, other than the doctor.
For the record....limb leads...Ride Your Green Bike

One possibility to think about if what you want is to just communicate with the doctor is rather than making a complaint, see if there is some other way you can get in touch and say your piece. You could even write him a letter. I'd not be accusatory, just say that this was what your daughter reported, and that it's not been a good thing for her to have been told, etc.

That's not good. My friend is a psychiatrist in ED and he'd disagree hugely with those statements.

During the height of the pandemic people were considered for hospitalisation if their sats were lower than 92/93, obviously a different situation but 80 is still pretty low to say the least.

None of the story really makes sense - how would she have the blood test results right away? Why would a doctor do an ECG? I’m sorry but your daughter doesn’t sound very reliable.

Perhaps OP meant 43 pounds = 3 stone

@TheOrigRights

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.

Yes she has lost 45kg in just under a year. She’s 5´6 and about 6.5 stone. She was about 13.5 stone this time last year. We are frantic with worry. By the time we noticed what seemed like a quite normal pre-uni diet had spiralled to more than that last summer it was nigh on impossible to get a face to face GP appointment. NHS GP ordered bloods but said they were in normal parameters so no action. Back and forth to GP via phone a number of times as physical symptoms worsened but no one would take any action as she was and has always been eating.

She left home to start uni and moved GP to her uni town who also ordered bloods but no further action. It was only when she became really unwell in October that the GP made a referral to the ED clinic who a couple of weeks later did an assessment over the phone. The woman she spoke to said she would be put on the list for CBT in 6-8 weeks time but she ´wasn’t that bad´ as she was still eating. She repeated that message every time DD interacted with her. Nutrition guides etc were promised while she was waiting for an appt but none arrived. DD followed up after 10 weeks and got told they knew she was due an assessment, apologised for the delay and would get back to her in next couple of months. It’s only when she had another GP appointment and gave her current weight that GP followed up and ED called her in for an appointment. After DD fainted the doctor at the ED clinic turned to the woman who kept telling DD she wasn’t that bad and said we need to intensify her treatment regime, what’s her current plan? only for the woman to admit DD wasn’t on any plan yet.

DD has been crying out for help for months. She doesn’t look in the mirror and think she needs to lose weight. She doesn’t restrict herself to an apple a day. She is scared by how unwell she feels most of the time. This time last year she was clearly really restricting food and over exercising but the exercising stopped in the summer as she didn’t have the energy. She currently tries to make herself eat to a baseline of calories of about 1100 - 1200 but the amount of mental strength it takes and the anxiety she feels in doing that is enormous. She is desperate to be well enough to carry on at uni and knows if it gets any worse she’s going to have to drop out. We as her parents want her to defer her degree but she is an adult and we can’t force her to.

I’ve lost faith in the NHS system and got her an appt at a private clinic this week, who I’m hoping might be able to be more responsive. We are fortunate that we should be able to find the funds if she can get on with them. I’d happily sell an arm if it helped her get well.

For those thinking I was planning a medical negligence case, I’m not. I believe DD when she tells me what the doctor said as she is honest with me, but she might well have misinterpreted. I would like it if he was helped to realise that someone this vulnerable CAN misinterpret things and to choose his words more carefully.

Did he actually say that or did he say it's ok to eat 500 calories " sometimes" (which it is ). It's all about not making them feel 'wrong" and about taking control of eating in a different way.

It must be incredibly difficult looking after a child with an ED who is officially an adult because they have reached their 18th birthday. You are expected to provide exactly the same level of support as you did the day before they turned 18, but with no legal access to any helpful insight as to where your child is at medically.

A&E isn't where your daughter should have been seen. She has a chronic condition that seems to have been managed badly: if anything the clinic that threw its hands up, after months of delays in giving a first appointment, and sent her across the road is the problem. If it's an eating disorder clinic staffed by doctors and nurses why weren't they able to make a judgment and, potentially, admit her on the spot?

If you'd been in the room and heard these words verbatim you would be quite reasonable to drop a note expressing disappointment. But the NHS is massively overrun and I would rather that A&E doctors are working onsite for when a child chokes/ my husband has a car accident / I have a heart attack etc than doing extra training to teach them how to deal more thoughtfully with anorexics, who represent a tiny proportion of people showing up to A&E. I have enough experience with teenage eating disorders to know how devastating they can be and how difficult they are for caregivers to manage. But for a lot of people an anorexic in a wealthy western country is just as much to blame for their condition as an alcoholic, chain smoker, etc. I would hope that an alcoholic turning up at A&E after a drunken fall would also be treated kindly. But the most important thing is triaging and getting through the patients, many of whom are there as a consequence of someone else's behaviour, not their own. Being an A&E doctor has to be utterly shit. The last time I was there the doctor seeing my baby (with bronchiolitis) had just come from seeing a child brought in on a stretcher in very poor shape and was visibly shaken. So your daughter might consider practising some compassion too. But, if she wants to complain, she should. The complaint is for her to make, not you, given that she is a) an adult, b) you weren't in the room.

But I would definitely question the behaviour of the eating disorder clinic. Is this the only place she can be seen?

@hopsalong A&E is appropriate for someone severely anorexic, who has just collapsed. People with AN can have dangerously abnormal electrolyte levels (don’t worry, OP, this is what they will have been checking with the blood test and ECG, so your DD’s must have been ok).

A+E is a very appropriate place for an anorexic patient to be seen. Incredible high risk of electrolyte imbalance which can cause cardiac arrhythmias - hence the ECG - which BTW I would expect a medical student to know how to do, just because and A+E consultant delegates the job to a nurse or HCSW doesn't mean they don't know where the leads go ffs.

On another note as a senior nurse who has worked with many consultants over the years it is entirely plausible that this comment was made exactly as your daughter said it was. I've heard (some) consultants say much worse on ward rounds or to patients in A+E. Is it worth putting in a complaint? Probably not given that it will most likely never even be investigated, doesn't make it right in any way but given the absolute shocking state of NHS services at the minute I really think your energy is better focused fighting for the treatment your daughter needs now she has been cleared (I assume) from anything "acute"

He either didn't say it or perhaps she asked the question and he said yes they can - which is true. He may have also said but x y z which she isn't telling you. It's like an addiction and addicts lie or manipulate the truth. Unless you heard it first hand I am not sure that you can guarantee it happened

I’m not going to excuse what he said. It was at best, insensitive - but at worst, completely inappropriate given the history of anorexia… but you have to understand the context too. In A&E, he will probably have been working 12+hr shifts, dealing with COVID pressures and protocols, injuries, other potentially infectious illnesses, traumas from accidents, fights, burns, etc… He was probably very frustrated that another hospital department shunted your (very ill) daughter to his already smashed department to re-run tests that could have been handled where she was already. The fact that she had already fainted increased her risk of injury while being moved and having further tests, etc. I suspect he was venting his frustration at the inability of the other department to handle their own admissions. Not appropriate to take it out on you, but a weird way of saying that you shouldn’t have been sent from pillar to post in the first place.

@chichimcgee
From what I read, the doc did not tell her that 500 cals were ok, he said that one could exist on 500 cals per day, which is not the same thing.
In similar vein, one could drink 3 bottles of wine a day but no-one would think that's ok.