Earlier this Spring an 18-year-old graduating senior came to my office for a checkup and told me about the stomach pains she was experiencing. She had already seen a gastroenterologist who had instructed her to eat more fiber and check back in six weeks. Upon further questioning, it became clear that other symptoms included a strong urge to vomit after meals and the need to exercise up to three hours a day especially after dinner.
It also became clear that we needed to nail this incipient eating disorder. How would she manage in college if the problem was not addressed now? I could imagine her returning the following Spring, unable to complete her courses, metabolically unstable or worse. Within a week—and in no small part because she was able to talk openly with her parents and because they were understanding about the addictive nature of disordered eating behavior—we were able to assemble a team of people to help her.
How did this come about? It was made possible by the extraordinary resources available to all of us who care for patients in Westchester. As an adolescent medicine specialist, this sort of situation comes up very frequently and I rely on a network of professionals in the mental health field to collaborate with me. Adolescent medicine is a sub-specialty composed largely of pediatrics and internal medicine practitioners who care about and for adolescents and young adults.
In my particular practice I see patients from age 12 to 25. It’s not uncommon for parents or patients to come or be referred to me first for evaluation of a problem that is ultimately diagnosed as a mental health concern. What makes our specialty different is the comprehensive medical and developmental approach to this age group. Many choose to visit a medical doctor who uses a comprehensive approach because they are not sure if the underlying issues are physical, emotional or psychological.
The team for a patient with a confirmed eating disorder may consist of a psychologist, a dietician, a psychiatrist, and a medical doctor. In addition, other participants in care may include the school social worker, psychologist, or coach. Sometimes clergy are brought into the mix if their approach and insight can be helpful. As a physician, the role I play in this group is to lend support to a diagnosis, consider all medical possibilities, and act as the “orchestra conductor,” as one of my early mentors taught me. Often my role includes:
- translating a clinician’s thoughts and concerns to the patient or the family,
- supporting fellow clinicians to avoid splitting the treatment team,
- interpreting medical test results to the family, patient and team,
- collaborating on decisions about higher levels of care, eg hospitalization,
- coordinating responsibilities among the team leaders, and
- evaluating other treatment options when current strategies are not working.
In addition, I often will have the siblings in my care and have learned to pay special attention to them. In a recent article in the Journal of Adolescent Health by Areemit, Katzman and colleagues, 80% of twenty siblings of ED patients reported that their quality of life was negatively affected by the onset of their siblings’ ED.
Much of this kind of intensive work is made possible by our ability to use email and electronic communication. Although there are pitfalls and concerns with this new way of connecting a team, we all know that reimbursement for time on the phone or even team meetings is minimal or non-existent. Truly, the ability to compare notes, share information and give each other a heads-up on progress and problems makes it possible to treat complex disorders and share the stress and responsibility we all experience.
For more information visit Dr. Engelland at www.AnnEngellandMD.com.
