Eating disorders are complex, pernicious, and more prevalent than ever. But there are concerns that they aren’t covered enough in doctors’ education and training, at a time when mental health should be a priority.
Since the release of the PHSO’s Ignoring the Alarms report, the General Medical Council has been working with others to positively influence the way eating disorders are covered in curriculum.
We’ve written to all medical schools to better understand current teaching, and where improvements are needed. Although we do not possess powers to change curriculum, we will share our findings with those who do.
And, as part of our current round of approvals, we’re asking the royal colleges to identify gaps and overlaps in speciality curricula and share best practise.
In March we convened a Parliamentary roundtable, in support of Baroness Kate Parminter, bringing together healthcare leaders, medical educators and politicians to discuss the issue.
The gathering heard from medical student Ellen Macpherson and medical registrar Dr Joanna Moore who, having personally battled eating disorders, had unique and valuable insights to share.
Here they explain why it’s so important that eating disorders are part of every doctor’s education and training. They believe the impact could be life-saving.
I suffered for about a year before I realised I might have an eating disorder. When I eventually built up the courage to see my GP, I was sent away, told to eat some toast and come back in a couple of months. This is not because she was a bad GP – or because she didn’t want to help – she simply was uneducated about eating disorders.
Through my experience as a patient and medical student I’ve realised that too many clinicians are similarly uninformed. Too many still see eating disorders as the stereotypical malnourished teenage girl but the vast majority of sufferers do not fit this description. And too many think it’s about food and losing weight, when those things are only the manifestations, not the cause.
Eating disorders, like depression, are a mental illness, and we would never diagnose depression on a physical exam. It’s akin to saying, “We will not treat your cancer until it’s spread all over your body”. Like cancer, if not caught early, eating disorders are much harder to treat and people are less likely to recover.
With a lot of hard work and perseverance, I was able to recover, for which I will be forever grateful.
A widespread issue
When I started work in a busy A&E in Manchester, I noticed there were patients who displayed behaviours and thinking patterns I recognised from my own experience.
However, when I mentioned this to colleagues, they said ‘we don’t see eating disorders in the emergency department‘. I knew this to be wrong; they were seeing patients with eating disorders, they just weren’t recognising them.
I conducted a staff survey and found no one had ever screened for an eating disorder in the emergency department. More than a quarter said they would not know what do to if a patient screened positive for an eating disorder.
The lack of knowledge and awareness was extremely worrying and underlines why it is so important that doctors receive enough training and education.
Medical schools have a responsibility to teach their students about what’s common and what’s life-threatening – eating disorders are both these things. 1.25 million people in the UK have an eating disorder. However, in my 6 years of medical school, I have had less than an hour’s teaching on them. To put this in perspective, I’ve had around 10 hours of teaching on schizophrenia, which affects 1/5th of the number affected by an eating disorder, and has half the mortality rate.
I found that the teaching I received on eating disorders was out of date and misleading. My fellow medical students will have walked away thinking that anorexia nervosa is the only eating disorder, that all sufferers are very underweight young girls and that aside from the physical complications, they are well.
A desire to learn
I have now had the privilege to teach a cohort of medical students, a room of emergency medicine doctors and a lecture theatre full of healthcare professionals about eating disorders. I explained the screening process, who should be screened and how those patients should be managed. To my pleasant surprise, doctors were very keen to learn more. Both doctors and students said they were extremely grateful to have had more teaching on eating disorders, as they had had either none or minimal as part of their medical education so far.
I am an acute medical registrar based in the North West of England. I am also in treatment recovery for anorexia nervosa.
I am aware that some medical schools include eating disorders as part of a psychiatry module, which may include clinical placements. But during my undergraduate training I did not have any specific teaching on eating disorders or the opportunity to learn about them as part of my formal training. I failed to appreciate the significance of this at the time, believing that as I wanted to work in hospital medicine, a minimal understanding would be adequate. However, as my career has progressed and following the development of an eating disorder myself, I can now appreciate how this lack of training has the potential to be very damaging to patients.
I have witnessed the mismanagement of patients in the medical assessment unit, noting that such patients are not having routine investigations such as blood tests and ECGs – which can indicate potentially life-threatening complications of the illness.
Supervision with eating, bed-rest and visits to the bathroom may be required but it’s often not considered or deemed the responsibility of the mental health team. Without such monitoring it can be challenging to get an accurate picture of how well the patient is managing their eating disorder, as this cannot be obtained from an assessment of weight and BMI alone.
Whilst to my knowledge and deepest hope, I have not overlooked the potential diagnosis of an eating disorder in the patients I have seen, it is clear that such events can and do happen.
The need for change
Eating disorders should be part of every doctor’s education and training and we’d like to see medical schools adopt a more up-to-date, holistic approach.
For example, the topic could be better incorporated into psychiatry modules, with opportunities to learn through didactic teaching and clinical placements. And patient stories could be used more prominently to give clinicians an insight into the experience of sufferers.
Importantly, content should recognise the complexity of eating disorders and the full spectrum of conditions.
By ensuring all doctors have the skills and knowledge they need, we can improve the care that patients receive and potentially save lives around the UK.