I’m done hearing stories of eating disorders being overlooked because of how a client looks. I’m DONE. This is my first real experience with it happening to one of my current clients in such an impactful way. This doctor jumped on the higher level of care train way too late in the process, once she found out we were pushing forward with it. She asked me what she could do to help the client get IOP. Too bad NONE of her notes support anything we are trying to do. This letter is only the beginning.
Practitioners: I’ll be putting together a crash course type letter that will be going to all doctors. Please provide input. With the letter, I will explain that I will be reporting them if they don’t give the client proper care and if they violate the Hippocratic oath.
Clients: This letter was not just for my specific client. It was for all of you who have been overlooked and mistreated by the medical system. I’m fighting for you and really, I’m just getting started. I wish I didn’t have to feel such rage over poor care some of you have been given but I’m happy to channel it into making things better for you. You are loved. You are worth this.
Everyone else: if you want to know how you can help, hit me up. I’ve got some ideas brewing.
Hello Dr. ——-
We got your notes on —– and I have to say, they are extremely disappointing and appalling. You noted that the client looks well nourished. There is nothing about her intake. Did you ever ask? It is standard with clients who have eating disorders to ask about their intake. Did you ever ask how her eating disorder is impacting her life? What her activity level is? This client is begging for a tube feeding. She’s reporting being so depleted that she can barely shower, can’t prepare food, doesn’t have the energy to eat, much less get to her appointments. I can get her to drink one boost in session but not more because it makes her feel so full. I went to the grocery store with her once and she barely made it through, she was so exhausted. She’s terrified of most foods, and hasn’t been able to increase her intake, despite all my efforts. I sent her in worried that she was dehydrated she reported to me that you told her that she didn’t look dehydrated and you did nothing to test for that. I do not fault you for not being familiar with eating disorders if you haven’t dealt with them much but I do expect a practitioner to educate themselves so that they can offer the best care to their patients. I believe your negligence with this client has needlessly caused her harm. Your notes carry the most weight with insurance companies and assessment teams at treatment centers and from your notes, it shows the client is not in need of a higher level of care. Both her therapist and I specialize in eating disorders. We have both worked at treatment centers. I exclusively see clients with eating disorders and we both know when this level of care is not appropriate. I wouldn’t necessarily expect for you to know that but again, educate yourself. We are not getting her assessed for IOP. That is a half day, half week program. It is not the slightest bit appropriate. We believe she needs residential. This client reports eating under 400 kcals a day for months. MONTHS. Usually, it is in the form of gummy candy because that’s all she feels she can do. It is not uncommon for clients with anorexia to have normal weights, labs and vitals. It is not uncommon for all of these things to be fine and then for the client to drop dead. You asked what you can do to help get this client a higher level of care. You can send an email or call her caseworker telling her that while your notes don’t reflect it, you believe this client needs a residential level of care. If you need to see the client for an appointment, I’m happy to take her in to see you so that you can hear from her mouth how she is doing. I HAVE to believe that these things weren’t in your note because you didn’t ask, not because you neglected to leave them out. This client is not well nourished. She needs residential as soon as possible. As a doctor, you can recommend a higher level of care even when a client “looks nourished.” I have clients in larger bodies who are starving themselves and hope that you don’t have any doing the same. Please look past what you see with this client. If she was your family member, you would ask more questions. You would want increased care for them based on their reports. Please do better by this client. She deserves it.
Please advocate on this client’s behalf to her case manager and make this right. Her email is below. I also cut and pasted the last email we received from her.