Anne,
Thank you for all you have shared about your experience. I have a few comments:
"As for 'different approaches work for different people'--Richelle, these were the EXACT WORDS a highly regarded ED nutritionist said to me when I first sought help and asked about evidenced based practice for adolescents. Perhaps in a highly theoretical way this is true, but I needed specific, concrete help in a big hurry--we were in a huge crisis. I needed RESEARCH driven information. I needed phone numbers. I needed a how-to manual. I needed support. And I needed to know specific options. I am certainly smart enough to figure out what is best for my family. When I asked questions (and they were good questions)the answers seemed so vague. And, it left me reeling...was ED treatment really this fuzzy? (FYI, this was back in 2003)"
I completely agree. I understand your comment is in reference to a nutritionist (for whom my comments are even more applicable), but I'd like to speak from my experience as a recent medical school graduate. Unfortunately in my medical training we received one 50 min lecture on eating disorders from a psychiatrist who does not specialize in EDs, were tested on the acid-base/electrolyte and other homeostatic imbalances that can result from vomiting, laxitive abuse and starvation, and perhaps some comments about EDs may have been made during a pediatric lecture. In clinical rotations, I found the same lack of up-to-date knowledge among many practicing doctors and often patient-doctor communication could have been improved. Obviously, we must be taught a vast amount of information and skills in a limited time, however I think this is grossly insufficient given that ~50% of my school's graduates go into primary care. Many people start with their family physician or pediatrician for referrals or if the ED is unknown, it is the doctor's responsibility to notice signs. We do get a lot of additional training in residency, but on the whole, knowledge about EDs and mental illness in general needs to be emphasized and valued more in the medical community. Recovery is "vague" because different things do work for different people, but we should be able to give you a list of options and the most current research just as we might give you statistics for any other illness.
"As a parent, when you first go for help, this dichotomy of approaches should be fully explained. Parents need to be made aware of the differing viewpoints and ALLOWED TO CHOOSE their path of treatment. This didn't happen for me and my family and I think that's a very common experience."
Again, I agree. Unfortunately, for a number of reasons I assume, patients are not informed of the "dichotomy of approaches" for many illnesses. Often, you are not told why we chose one antibiotic over another or are referring you to one specialist over another. Of course, it is impractical to explain the reasoning behind every decision and for decisions that can have a very significant impact, the patient must be informed. I think you bring up very good points, and in my opinion, we need better training on how to create a partnership with patients rather than the traditional doctor-knows-all model. Again, all of my comments come from a medical training perspective.
I also agree with you that professionals need to be aware of their own biases and if they favor one approach over another standard approach the patient should be informed. I think mental health professionals do receive a good deal of training in this area. It has also been discussed a number of times in my training. Disclosure of personal experience with an eating disorder cannot be enforced, just as you are not required to inform your employer, clients, customers, etc of your medical history. Obviously treating eating disorders while not in recovery is an ethical issue. From my limited knowledge, most ED treatment centers require a certain length of recovery for those working in contact with patients. I am sure the other professionals contributing to this thread have more knowledge and experience in this area than I do.
Comment Reply
Anne,
Thank you for all you have shared about your experience. I have a few comments:
"As for 'different approaches work for different people'--Richelle, these were the EXACT WORDS a highly regarded ED nutritionist said to me when I first sought help and asked about evidenced based practice for adolescents. Perhaps in a highly theoretical way this is true, but I needed specific, concrete help in a big hurry--we were in a huge crisis. I needed RESEARCH driven information. I needed phone numbers. I needed a how-to manual. I needed support. And I needed to know specific options. I am certainly smart enough to figure out what is best for my family. When I asked questions (and they were good questions)the answers seemed so vague. And, it left me reeling...was ED treatment really this fuzzy? (FYI, this was back in 2003)"
I completely agree. I understand your comment is in reference to a nutritionist (for whom my comments are even more applicable), but I'd like to speak from my experience as a recent medical school graduate. Unfortunately in my medical training we received one 50 min lecture on eating disorders from a psychiatrist who does not specialize in EDs, were tested on the acid-base/electrolyte and other homeostatic imbalances that can result from vomiting, laxitive abuse and starvation, and perhaps some comments about EDs may have been made during a pediatric lecture. In clinical rotations, I found the same lack of up-to-date knowledge among many practicing doctors and often patient-doctor communication could have been improved. Obviously, we must be taught a vast amount of information and skills in a limited time, however I think this is grossly insufficient given that ~50% of my school's graduates go into primary care. Many people start with their family physician or pediatrician for referrals or if the ED is unknown, it is the doctor's responsibility to notice signs. We do get a lot of additional training in residency, but on the whole, knowledge about EDs and mental illness in general needs to be emphasized and valued more in the medical community. Recovery is "vague" because different things do work for different people, but we should be able to give you a list of options and the most current research just as we might give you statistics for any other illness.
"As a parent, when you first go for help, this dichotomy of approaches should be fully explained. Parents need to be made aware of the differing viewpoints and ALLOWED TO CHOOSE their path of treatment. This didn't happen for me and my family and I think that's a very common experience."
Again, I agree. Unfortunately, for a number of reasons I assume, patients are not informed of the "dichotomy of approaches" for many illnesses. Often, you are not told why we chose one antibiotic over another or are referring you to one specialist over another. Of course, it is impractical to explain the reasoning behind every decision and for decisions that can have a very significant impact, the patient must be informed. I think you bring up very good points, and in my opinion, we need better training on how to create a partnership with patients rather than the traditional doctor-knows-all model. Again, all of my comments come from a medical training perspective.
I also agree with you that professionals need to be aware of their own biases and if they favor one approach over another standard approach the patient should be informed. I think mental health professionals do receive a good deal of training in this area. It has also been discussed a number of times in my training. Disclosure of personal experience with an eating disorder cannot be enforced, just as you are not required to inform your employer, clients, customers, etc of your medical history. Obviously treating eating disorders while not in recovery is an ethical issue. From my limited knowledge, most ED treatment centers require a certain length of recovery for those working in contact with patients. I am sure the other professionals contributing to this thread have more knowledge and experience in this area than I do.
Richelle
June 9, 2009 - 7:40pmThis Comment
Reply