GP Stories - Calories in, calories out

Out of hours is a service that provides primary care when the normal GPs have closed, so is usually available after 18:30 on weekdays and all the weekends. It is also available on bank holidays if the GP surgeries are closed (which is most of the time but during Covid, GP surgeries have had to stay open for 2 of the bank holidays). Ideally issues that are dealt with are ones that are more urgent that can't wait until  you see your regular GP, not a long term issue that requires investigations or referrals. 

So I was working one late evening in OOH doing telephone triage. Last call of the evening was a 55 year old woman, clinical summary 'weight issues'. Now this is definitely not an urgent issue, and should be dealt with by her regular GP. Her history consisted of a years worth of vomiting and diarrhoea that happened constantly, so bad she cant keep anything inside her. She had been seen by her normal GP, has had the barrage of blood tests and stool tests which have all come back normal. When I asked her, you must have lost weight with all this, she said no, in fact she's gained weight. I asked how this could be, she replied this was what was worrying her, that she was gaining weight but not eating anything. 

Now this is clearly rubbish. Normally I would just try to ignore this statement but maybe because it was the end of the shift, or just tired to hearing this nonsense, I said that can't be the case, it would be impossible. She asked how can it be impossible. I said, it would be scientifically impossible for her to gain weight if she ate nothing, that weight change is determined by calories eaten and calories that are used. To gain weight, she must have eaten more than she used in the day and that excess calories would be stored as body weight. 

She then responded that it clearly wasn't impossible, as that's what's happening to her - she isn't eating yet she is finding she can't fit into her clothes. At that point, I knew there was no reasoning with this (crazy) patient, and that this wasn't a good use of either of our time. I said we have to agree to disagree, and I directed her to her own GP to continue being investigated. She seemed happy with this, clearly happy just to vent at someone. Strangely this isn't the first time someone has ever tried to say they've gained weight without eating anything, but usually on the mindless social media groups and not an actual professional conversation, what do they teach kids at school these days...