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 throughout your recovery.

This comprehensive care can be expensive. Eating disorders can affect many aspects of one's health. Therefore, much has to be evaluated. Although health insurance should cover much of your care, 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 who have been frustrated with the assessment and care they or their loved ones have received. Usually the complaints center around the lack of understanding of the complexity of eating disorders. Too commonly as a result of a lack of full understanding, comments made by practitioners that were meant to be encouraging or helpful may actually be hurtful.

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. Here are things I think you can do to be prepared and to help yourself:

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. 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, try to insist on this.

2. Be honest with the physician about all the things you have done.
This may include how much exercise you do a day, how often you throw up, exactly how much you eat and drink, and so on. Without that information, the doctor cannot possibly know best how to help.

3. Be prepared to help educate the doctor about eating disorders.
The doctor may not know the difference between Anorexia and bulimia or he or she may think or act like they have never seen a case before. They may not do a thorough assessment. Tell them why you want one--that from what you have read EDs are complicated and deserve a complete evaluation.

4. 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. My office can give you more places to get more of this information.

5. Tell the nurse to check your pulse and blood pressure in both lying and standing positions.
Also be sure they check your temperature.

6. If knowing your weight causes great anxiety, insist that they not let you hear or see your weight.
Ask for a "blind weight" where you stand with your back to the scale. Your BMI should be measured and compared with past measurements and preferably graphed out.

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 blood pressure and pulse in lying and standing position. This means you may have to be educated about what goes on in the body of one with an eating disorder. Some of the usually recommended lab needed include:
a. CBC (complete blood count)
b. CMP (multiple chemistries measuring electrolytes, protein status, liver and kidney function):
c. Urinalysis:
d. Magnesium and Phosphorus-needed in those who are significantly underweight or with rapid weight loss:
e. Thyroid Function tests:
f. Estradiol in females and testosterone in males:
g. EKG-recommended in all with purging or those with anorexia to see if the electrical activity and certain other aspects of the heart are safe:
h. Other tests as indicated include pregnancy test, bone density, LH & FSH, and others as needed:

8. Be aware that most lab work is normal, except in those with significant and prolonged illness.In those who are purging, some lab may more likely be somewhat abnormal, but not necessarily so. Ask your physician to discuss your specific results and how they correlate to your health.

9. 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 easy to explain.

10. If you feel you did not get what you need on your visit, let your doctor know.Perhaps insurance coverage or the lack of it may be a factor. The doctor may have a real disincentive to order more tests or to spend more time with you. That may also extend to how often you are seen. At least discuss this with the doctor and negotiate a compromise.

11. Assert yourself, if necessary.This may be very unlike your usual way of doing things. Most of my patients are peacemakers and do not like conflict or to make waves. But, it is for a good cause-your health and well-being-and is what you deserve. Ask your physician to answer ALL of your questions.

12. 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, then find some other trusted adult, such as an older brother or sister--but get an advocate to support you.

13. 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 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.

14. 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. Be creative and negotiate a way to get the evaluation and the treatment you need.

The main thing to remember is to get the quality and quantity of care you need.

*Please write to me if you have other helpful advice that can be passed on to others.


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