Information for those suffering from it, loved ones affected by it, and those treating it.
I understand that eating disorders are complex and I thank you for trusting me to care for you, your loved one, or your client/patient.
Why do you address eating disorders?
Eating disorders are a physical and psychological disease. They are not a diet. Eating disorders become your life. Eating disorders destroy your life. Eating disorders kill.
What is the role of an internist in the care of a patient with anorexia nervosa or bulimia nervosa?
An internist is needed to medically evaluate, monitor, and treat patients with eating disorders. Internists who specialize in treating patients with eating disorders are an important part of the treatment team. We understand best what medications simply do and do not work in the starving body as well as which ones are needed, and which can be deadly in this patient population. If you do not have years of eating disorder focused knowledge, something can be missed. Abnormalities in eating disordered individuals are often subtle (a slightly low potassium level, an elevated bicarbonate, a minimally abnormal electrocardiogram) and can lead to ill patients being misinformed that their lab results are normal. At a minimum this can be detrimentally validating to the individual suffering from the eating disorder; they may consider their condition “not that bad”. In the worst-case scenario the overlooked values could be fatal.
How does the internist coordinate with the other medical providers caring for the patient?
As with any illness, an internist must coordinate a multidisciplinary approach with constant communication between team members (dieticians, therapists, etc.) so that the patient, also a member of the team, has the best, longest lasting positive outcome. As a physician, I give everyone the support they need to treat a complex patient in the outpatient setting while having the insight to advocate for more aggressive inpatient/residential treatment when appropriate.
What special accommodations are made in your office for those with eating disorders?
Even for otherwise healthy individuals, it is difficult to come to the doctor’s office for the first time or for the one hundredth time. My entire office is sensitive to the needs of patients with eating disorders.
A patient’s weight is a vital sign. Except for extreme situations, it MUST be taken. It should be done in the most neutral way possible. We call it a “Blind Weight”, taken in a gown, the individual is not informed of the number. The scale is carried into and out of the examination room for each patient. This avoids individuals being tempted to independently check their weight while in the office. The individual is not told their weight by any of us or via portal unless we feel it is a part of your treatment.
How is the first appointment for a patient with an eating disorder performed?
Honesty is paramount, and I have had the greatest success with individuals who make a first call in which they state, “I would like to make an appointment because I have an eating disorder.”
In most cases, we have a virtual appointment first. This takes at least one hour. I want to know the person and the disease: past and present. Family or another person as support is welcome and encouraged to attend. We have the capability to arrange for others to join virtually from a separate location. I will generally order laboratory and other relevant tests. The second appointment is within two weeks of the first and will be in person. An examination and electrocardiogram (ECG/EKG) are performed at that time and a plan is created. If you cannot be in the state of Virginia for a virtual appointment, then both evaluations will be in person.
How long does it take to treat an eating disorder?
Treating a patient with an eating disorder takes time, persistence, patience, and honesty mixed in with some sternness. Everyone must empower the patient to become a member of their own team. I know that all of this cannot be done in just a visit, a set of labs and a follow-up appointment three months later. Success is found with consistent progress towards healing.
What is your final goal when treating patients with eating disorders?
I do not want to be someone’s “eating disorder’s doctor” forever.
I am an internist first and foremost. When this is all over, I want to be the person’s internist