Treating individuals with eating disorders in family practice: a needs assessment

With their myriad of serious and occasionally life-threatening physical sequelae, in addition to their complex emotional issues, individuals with eating disorders can be among the most challenging a physician may see in primary practice. A two-page, 10-item survey based on a literature review of family physicians' experiences with individuals with eating disorders was distributed to a sample of 500 Manitoba family physicians. Two hundred and one surveys were returned for a province-wide return rate of 40%. Eighty percent of physicians who saw individuals with eating disorders felt there were some patients they were unable to treat for a variety of reasons including lack of physician skills, limited resources, problems with patient cooperation, the severity of the patient's illness, and a lack of time to deal with the demands of an eating disordered patient. The services most often provided by the physicians included medical management of symptoms, referral to specialized services, information on nutrition and exercise, and limited counseling. Referrals were most often made to psychiatrists, dieticians, Winnipeg's Eating Disorder Program, and community mental health workers. The strong response indicates that eating disorders are a serious concern in primary practice. The role of the family physician is very much dependent upon the individual physician's skills and degree of comfort in dealing with the disorders. Continuing education is seen as vital to improve diagnostic skills and enhance physicians' level of comfort. More support for physicians in the short term and enhanced interdisciplinary programming in the longer term are crucial in meeting patients' complex needs.