| What Should Your Doctor Do For You?
If you have or suspect you have an eating disorder (or if this is for someone whom you suspect has an eating disorder), you should see a doctor. Therapists are vital and dietitians as well. But you need medical assessment and, likely, ongoing medical care and monitoring.
This comprehensive care is expensive. It probably should be, given the many aspects of one’s health that eating disorders can affect, and therefore, how much has to be evaluated. Although health insurance should cover much of what happens, there can often be a fight to get adequate reimbursement. In spite of the hassles and financial hardship, medical (and psychological and nutritional) care is necessary. If you look at some of the other articles in the archives, you should see why medical monitoring is mandatory to avoid many of the negative, dangerous consequences of an eating disorder. And, of course, treatment can help you feel and function much better.
But I have heard many patients, family members, and others from around the country complain about the assessment and care they or their loved ones have received from doctors. Usually the complaints center around the lack of understanding of the basics of eating disorders. Not uncommonly, it seems physicians say some of the stupidest things. Some of the comments by doctors I have heard of include, "You don’t look like you have an eating disorder to me" or "I thought you were going to be skinny" or "Just eat some yogurt or have dessert and you’ll be fine" or "We’ll have you fattened up in no time" or "So, do you have anorexia or bulimia?" A psychiatrist for one of my patients had to look up the diagnosis of eating disorders while the patient was sitting there to see what she had. How could some doctors be so disconnected from or unaware of such serious illnesses as eating disorders? For whatever reasons, the reality is that many (most?) are.
So what do you do if you have to see a doctor to find out if you are ok? Is it enough just to see a doctor and walk away with an inadequate assessment or understanding? I do not think so, even if you really would rather not know the depths of the problems you may be causing to yourself.
What you can do is go in with the intent of assisting the doctor should the doctor be somewhat out-of-touch with the world of eating disorders. Here are things I think you can do to be prepared and to help yourself (and the doctor):
1. When you call for an appointment, insist that you will need an extended visit with the doctor.
This is very important because the office staff try to schedule things as efficiently as possible for the doctor to make it where he or she does not get too far behind. If you do not let them know your appointment will take time, then they will put you in a small time slot (10 to 15 minutes would not be unusual). You will need at least 30 minutes. Again, insist on this.
2. When they ask you what is the reason for the appointment, tell them you think you may have something wrong with your heart and may need an EKG.
Tell them it is beating irregularly and rapidly at times and you get dizzy when you stand up. Tell them that you may also be dehydrated. That all may or may not be true, but will get their attention and you will be speaking in terms they understand, plus it will give them an idea of how much time you will need with the doctor. If you just tell them that you may have an eating disorder, you may just get a pregnant pause from the other end of the line, and put in a short time slot. Believe it or not, the doctor may not get the idea that you may have something medical going on if you make the appointment for "just" an eating disorder.
3. Be honest with the physician about all the things you have done.
This includes how much exercise you do a day, how often you throw up, exactly how much you eat, and so on. Without that information, the doctor cannot possibly know best how to help. At least give the doctor a chance to disprove he or she is not worth your loyalty.
4. Be prepared to discover that the doctor knows little about eating disorders.
The doc may not know the difference between anorexia and bulimia. He or she may think or act like they’ve never seen a case before. They may think that just looking at you is good enough ("You don’t look like you have an eating disorder. You are fine. Just eat some yogurt").
5. Take a list of the physical concerns you may have and be sure you discuss each one.
This website has several places where physical complications and symptoms are discussed that may help guide you on what you may need to consider.
6. Tell the nurse to check your pulse and blood pressure in both lying and standing positions.
Also be sure they check your temperature.
7. Be prepared to tell the doctor what he or she needs to check for.
If your doctor does not address these, you may have to suggest doing an EKG, or blood tests, or even to check your body temperature or "tilt" of blood pressure and pulse (I explain these things in other parts of my archives). This means you may have to be educated about what goes on in the body of one with an eating disorder. Some of the usual studies needed include:
- CBC (complete blood count)
- CMP (multiple chemistries measuring electrolytes, protein, liver and kidney function)
- Magnesium and Phosphorus—needed in those who are significantly underweight or with rapid weight loss
- Thyroid Function tests
- EKG—recommended in all with purging or those with anorexia to see if the electrical activity and certain other aspects of the heart are ok.
- Other tests as indicated include CXR (chest x-ray), cortisol, pregnancy test, bone density, and urinalysis.
8. Know why those things may need to be done.
9. Be aware (and, maybe, let the doctor know as well) that most lab work is normal, except in those with significant and prolonged anorexia. In those who are purging, some lab may more likely be somewhat abnormal, but not necessarily so.
10. Listen to why the doctor picks what tests to do or not do. There may be very good and valid reasons to do or not do some tests at that time and there should be an easy to understand reason.
11. If you feel "short-changed" on your visit, ask your doctor if the insurance is a reason for less thorough or intensive care. Unfortunately, if you have certain insurance coverage or if the doctor is used to working in that environment (that the insurance company strongly influences what tests are done or not done), then this may be a factor to contend with. The doctor may have a real disincentive to order more tests or to spend more time with you. That may extend to how often you are seen. At least discuss this possibility with the doctor if you are unsure.
12. Assert yourself, if necessary. This may be very unlike your usual way of doing things. Most of my patients are peacemakers and don’t like conflict or to make waves. But, it is for a good cause—your health and well-being—and is what you deserve. Make your physician answer ALL of your questions.
13. Use your support systems to help you at your doctor visit. Parents have had more experiences in dealing with authority figures like doctors and are less intimidated by them. They are much more willing usually to ask questions, insist on answers, and such. They can show you how to do the same. If not your parents, some other trusted adult, such as an older brother or sister.
14. Insist on appropriate and adequate follow-up. Eating disorders are complicated and can affect all areas of the body. Changes in one’s physical status can occur quickly. Stabilization occurs slowly. Going a month in between visits is too long unless one is truly stable and if she is confident a thorough assessment has been done. I tend to see patients who are new at about once a week until I am reasonably sure of their stability to go longer in between assessments.
15. Discuss the likelihood of future costs for evaluation and treatment so that you can make adequate financial planning. The sometimes daunting costs of treatment should not be a reason to not get care (easy for me to say). Be creative and negotiate a way to get the evaluation and treatment you need.
The main thing to remember is to get the quality and quantity of care you need. Insist on it!
*Please write to me if you have had an encounter where this information has been helpful in visits to your doctor.
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