Eating Disorders in Physicians

Previously, I blogged about an ignorant comment I once received from a psychiatrist: “I see medical school couldn’t immunize you against anorexia nervosa.”  In that post I remarked how many people I have been in treatment with are medical professionals themselves.  Given all this, I wasn’t too surprised to read an article recently about eating disorders in physicians.  The article was titled “Physician: Starve Thyself.  Are Eating Disorders the Last Taboo in the Medical World?”  As the title suggests, eating disorders are quite common in the medical field, but kept very hush hush.

The article discusses how it makes sense that medical professionals are especially prone to eating disorders. Many people with eating disorders are perfectionists, have high standards, and pride themselves on being productive – all qualities that serve one well in medical or nursing school.  In addition, medical professionals often work long hours and have erratic schedules, which almost normalizes sporadic eating.  I can’t even tell you how many times in medical school I heard people say around 4pm “wow, I have been so busy, I haven’t had time to eat all day.”  Makes it pretty easy to justify “well, I don’t need to have lunch today.”

To quote the article: “’Medical school and residency training are particularly challenging for those at risk, combining competition, stress, and wildly erratic schedules for eating, sleeping, and self care,’ agreed Dr. Jennifer L. Gaudiani, assistant medical director the ACUTE Center for Eating Disorders at Denver Health.

‘Temperamental traits such as perfectionism, rigidity, and anxiety can be very useful in the pursuit of a medical career,’ Dr. Gaudiani said in a telephone interview. ‘A lot of us share them and have done very well by them.’  But against the backdrop of a fat-phobic, diet-obsessed culture and those hard-driving personality traits, the uniquely stressful professional demands that are inherent in medical training and beyond may unmask disordered eating or sharply accelerate patterns left over from adolescence.”

In addition, denial, already a common feature of eating disorders, is also rampant amongst physicians.  This only adds fuel to the fire: “’Denial is part and parcel of the eating disorder mentality but, in doctors, it runs a little deeper.  Medical training reinforces that mind-set of, ‘I can handle it’ or ‘I have it under control to the ‘nth degree.’”

Furthermore, because of misconceptions about eating disorders and the fact that almost every doctor feels overworked and stressed at times, there is a little sympathy for those who struggle.  A lot of people incorrectly think of an eating disorder as a diet gone wrong, or something that  is due to an inability to manage stress.  As a result, “’Doctors can be an unusually unsympathetic group when it comes to colleagues’ illnesses of any kind,’ [Dr. Gaudiani] noted.  Underpaid, overworked residents are virtual poster children for compassion fatigue, notoriously tough on ’colleagues not able to pull their weight,’ said Dr. Gaudiani.”

Despite being aware of all the issues I pointed out above, I was nevertheless shocked to read in the article about a response that was posted on an online medical student forum regarding students being told by program coordinators to take time off for treatment.  The article states, ‘On the website, some medical students questioned the judgment of program coordinators who insisted the poster get help before continuing her studies.  Said one: Exactly what danger is this person in risk of? Passing out while rounding? Erosive esophagitis?  Neither of these truly present a risk to the patient. “Danger to others” implies explicit threats, or impaired behavior, e.g., substance abuse. Certainly she is placing her own body at risk, but what about those who overeat and place themselves at risk for other complications?”

Seriously?  First off, even if the person isn’t a danger to patients, I would like to think that “just” placing her own body at risk is enough of a reason to warrant being told to get help.  In addition, having an eating disorder is absolutely placing patients at risk!  I would argue that having a starved brain is pretty much the same as being impaired with a substance.  When acting on symptoms, you can’t think clearly or make decisions. Your coordination is off.  And how is passing out while rounding not presenting a risk to patients?  Again, seriously?

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