I spent the last two weeks doing an elective rotation at an eating disorder treatment center, and I really enjoyed it. I worked with the medical director there, a family medicine physician, as opposed to the many psychiatrists that are also part of the treatment team. Everyone there was wonderful, compassionate, and so dedicated to the patients. Medical students don’t learn very much about eating disorders, so this post is going to share what it was like to work there. Perhaps it will inspire some to dedicate their career to this important work!
Working With Eating Disorders After Recovery
For those of you that don’t know, I have a history of Anorexia Nervosa, so this elective was of particular interest to me. Back when I was deciding on a career change, I was very cautious about choosing a career connected to eating disorders. For example, while I find nutrition fascinating, I was worried that becoming a dietician would make me think about food way more than was good for me. In the same vein, I didn’t know if working as a physician in eating disorder treatment would be smart.
That being said, my interest and passion for preventing and treating eating disorders has remained. I think that’s only natural. So I’ve done a little volunteering, lobbying, and writing about eating disorders, but was still on the fence about whether or not I’d find my career in the area. This elective was an opportunity to see how I felt now, nearly a decade after my initial recovery and with most of medical school under my belt.
Of note: The center has a policy on how many years out of recovery you have to be before you can work there. I think it’s something like five, which seemed short to me!
Day To Day Medical Work At An Eating Disorder Treatment Center
I wasn’t sure what an average day would look like before I started. Did she just rotate through seeing all of the patients in residential treatment? Would it function similar to a regular clinic?
Not at all, turns out! The doctor I worked with sees a variety of different types of patients and each day was very different. As medical director, she does an initial visit with every single patient that comes into treatment. She then only follows up with them should they have a specific medical need. The psychiatrist assigned to each patient takes care of their day to day recovery needs. Some of the patients in treatment do have frequent medical concerns, so we were bouncing around the different areas of the center checking in with them very regularly.
We also saw scheduled outpatient appointments. Lots of physicians in the area refer to her, and she also follows up with patients that have previously been in treatment. What she tries not to do is be the primary care physician for patients. The treatment center just doesn’t have all the resources needed to do complete primary care.
Of course there was also a lot of administrative work that comes with being the medical director. She had lots of meetings throughout the week that I didn’t always participate in.
What Medical Issues Did We Take Care Of?
Patients have to be medically stable in order to qualify for treatment there. An EKG, vitals and labs are required prior to admission. Patients are sent to the hospital if anything more serious – anything that can’t be managed at the treatment center – is going on.
For new patient visits, we did a complete history and physical, paying extra attention to the eating disorder. We always asked if they had any current concerns and addressed those. One of more intellectually interesting parts of the job was doing a proper workup to ensure that any symptoms that, while perhaps caused by the eating disorder, were not actually due to some other organic disease process.
Labs, vital signs and EKGs were always reviewed. This becomes particularly important when it comes to malnourishment, refeeding syndrome and psychiatric medications.
For patients currently in treatment, the vast majority of the concerns were related to GI distress. From reflux to abdominal pain to constipation, eating disorders and eating disorder treatment often brings about gastrointestinal issues that we would do our best to both normalize and alleviate. We saw a few patients with Type I Diabetes that needed to have their blood sugars carefully managed. Then there were patients with a number of other co-existing conditions, chronic diseases, or day to day symptom that arose.
Outpatient follow up was what you’d likely expect. We talked about how recovery was going, if any relapse was happening, what treatment team they had in place and if that was appropriate. Sometimes there was a discussion of escalating care vs. continuing as an outpatient.
The following two books were recommended to me to learn more about medical management of eating disorders:
- Eating Disorders: A Guide to Medical Care and Complications.
- Sick Enough: A Guide To The Medical Complications of Eating Disorders
What Stood Out To Me The Most
I shared a few of my takeaways on my instagram last week. I think the major one was just a reminder to me that eating disorders are relentless and treatment is really challenging. Lasting recovery can take a long time – I’m talking decades – and sometimes it doesn’t happen at all. But the treatment teams never give up hope. They are incredible people.
One positive was that insurance companies are covering more treatment than I thought would! Hooray for progress!
Other Takeaways from My Experience:
- There is a maddeningly low amount of eating disorder education in medical school. We had one lecture in our first year that just covered the DSM-5 criteria for diagnosis. Considering Anorexia is the third most common chronic disease among young people, and that eating disorders have the highest mortality rate of any psychiatric disease, this needs to change. (Check out NEDA for more data and research.)
- All healthcare providers need to do a better job of (and therefore need more training in) how to address health and weight in an eating disorder-sensitive way. Better screening, different language, less focus on weight, and more focus on health.
- You really CANNOT tell who has an eating disorder by looking at them. Not everyone with an eating disorder is thin. All shapes and sizes, ages and careers, genders, and backgrounds are affected.
If you’re struggling with an eating disorder, please reach out for help. NEDA is a great resource and has a helpline. Recovery is possible and you deserve it!
