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Tips for Doctors

This area is not meant as an insult to or an attack on the medical community... it is meant as a place for doctors and therapists to come and to see what scares sufferers most about reaching out for help. The tips that appear below are things to think about when facing the possibility of having one of your patients approach you and say "I think I have an Eating Disorder."

What Patients Fear Most

The list was compiled from thousands of e-mails we've received, where sufferers have shared their experiences and fears with me. If you suffer with an Eating Disorder and would like to share your own experience, feel free to send them to us.

When a person is ready to approach their doctor for the first time about their Eating Disorder, they have a lot of anxiety over what they will say, and over what their physician's reaction may be. Here are some of the concerns:

  • "I'm not thin enough. He/She won't believe me."
    Weight really has nothing to do with determining if someone has an Eating Disorder. It also does not indicate how much danger they may be in. Behaviors, self-esteem, psychological and physical health determine if someone suffers.

  • "I'm not sick enough. He/She won't think I need help."
    As a Doctor you are there to help your patients. You should validate your patient's feelings and symptoms and try to explain things in a compassionate way. If you are not knowledgeable in an area it is your responsibility to refer the patient to a physician who is.

  • "The doctor won't take this seriously, no one else does."
    Everyone should take Eating Disorders seriously. Of all psychological illnesses they pose the greatest risk of death. They are not "diets out of control" as previously thought in past generations, but complex emotional and psychological disorders where sufferers use the behaviors as a way to cope with emotional issues and low self-esteem.

  • "The doctor won't take my complaints seriously. He/She thinks I'm too young to be worried about such things."
    I mention this based on my own experience... Last year I requested my doctor do a bone density test (my charts clearly indicates my history of Anorexia and I also verbally reminded him). He told me I was too young and I had to argue with him for five minutes to get him to write the referral. The result came back the I indeed have low bone mass.

    I'm not sure if this becomes a power struggle, a lack of knowledge or a combination of both, but like mentioned in the previous quote, as doctors you need to take your patients seriously. Many of you are wonderful and do just that, and it may in some cases just be lack of knowledge about Eating Disorder... but please listen to your patients -- most of them are walking textbooks on the subject!

  • "He/She will tell my parents."
  • "People will find out."
    Patients have a right to confidentiality. Doctors and Therapists have corresponding obligations: to preserve that confidentiality and to protect the well-being of the patient. There may be cases where you need to protect a patient's well-being - for example, a minor (under 18 years of age) that is in immediate physical danger, or a sufferer that is suicidal. Doctors and therapists should discuss with patients (whether under the age of 18 or not) their respect for privacy and confidentiality, and should never make an attempt to violate it without talking with the patient first and giving clear reasons why (except in cases where patients have become unable to provide consent). All patients have that right and deserve that respect. Eating Disorders sufferers should be gently encouraged to seek support amongst their loved-ones, but as they reach to you for help, as doctors and therapists you need to respect their right to privacy and fear of someone finding out if they are not ready to reveal the information.

  • "He/She will just see me as fat, they won't believe it's an Eating Disorder." (Compulsive Overeating)
    There is clearly a difference between someone who is overweight and someone who suffers from Compulsive Overeating or Binge Eating Disorder. This reverts back to the first quote where weight has nothing to do with determining if a patient suffers from an Eating Disorder. It is behaviors, self-esteem, psychological and physical health that determines if someone suffers. More than ever, doctors need to determine the difference -- someone who is just overweight may respond well to purely nutritional counseling, whereas the Compulsive Overeater will need much more than that (therapy, support groups, nutritional counseling, and/or 12 step programs, etc.). In either case, diets don't work!

  • "The doctor is just going to make me gain/lose weight!"
    What more needs to be said to any patient suffering with an Eating Disorder than "our goal is to get you some help in coping with your issues and learning to love yourself, the rest will fall into place." Patients suffering will walk through your door already KNOWING they focus too much time and energy on food and weight. The need to be weighed for obvious reasons, but do so "blindly" (with patients standing backwards on the scale) and concentrate on monitoring their health as you guide them to seek treatment with a therapist, support group, 12-step program or treatment facility. For those with Anorexia or Bulimia, beyond all else, do not make the mistake of letting your patient think that you're attempting to make them fat.

  • "My doctor/therapist will tell me to 'just eat' but it's so much more than that!"
    As sufferers, we don't expect everyone to understand what we are going through, but we do expect the medical community to be sympathetic to what we suffer from. As doctors you wouldn't tell patients with cancer to 'just get better' - you would provide them with the necessary tools to works towards achieving recovery or remission. As therapists you wouldn't tell a patient suffering clinical depression to 'just cheer up' - you would provide them with skills for coping with it and a safe environment for them to talk about it so they could work towards being less depressed. From the perspective of an Eating Disorders sufferer, this is all we expect - to be given the tools that will help us move towards a means of coping with life and a healthier lifestyle. Doctors and therapists need to know what those tools are, and if they don't, have the responsibility of referring the patient to someone who does.

  • "My therapist refuses to treat me because I've lost/gained more weight"
    Treatment centers concentrate on the whole package, but should never work with "punishment" tactics. We are talking about sufferers of an illness who already have a low self-esteem. Therapists should not weigh their patients, but should encourage them to be monitored by their physician, nutritionist or dietician. If a patient suffering with Anorexia or Bulimia has lost weight, if a Compulsive Overeater has gained weight, and if any patient has continued to practice in their disordered behaviors it is because they are having a hard time! Encourage communication, offer support, suggest alternatives, but don't punish them. They are already punishing themselves for their behavior!

  • "I'm a man and I know they'll think I'm a freak, or they won't believe me."
    Increasingly men are coming forward and admitting to their affliction with and Eating Disorder. Where it was once thought to be a "woman's illness" we now know that just isn't true. Men face many of the same underlying issues in their struggles with Anorexia, Bulimia and Compulsive Overeating, even though, in addition and in some cases, they have their own set of specific issues. Never invalidate a male sufferer who says, "Hey doc, I think I have an Eating Disorder."

I think it is really important that doctors learn to recognize the physical signs and to validate the emotional turmoil. Therapists need to learn as much as they can about treating the sufferers, of all shapes, sizes, gender and color. With recent awareness, things have improved, but not as much as they need to. All of the old fashioned ideas and common misconceptions need to be tossed out the window to make room for the information now available.

It is also important for doctors and therapists to know that there can be many co-existing psychological illnesses and/or addictions to alcohol or drug abuse with the sufferers of Eating Disorders. While it is not a rule that applies to all who suffer, it does exist and can be very important to look into for successful treatment and long-term recovery.

A patient's weight really has so little to do with making a diagnosis of an Eating Disorder. I have met and have known men and women suffering with Anorexia and Bulimia who were not underweight, but were still in just as much danger, or who died. I try to emphasize this to the people who write to me everyday, trying to encourage them to see their doctors or turn to a therapist.

They look to you for help. Please don't disappoint them.

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