I can’t keep quiet about it. All over this country we are talking about the outrageous cost of medical care, trying to tease out the reasons medical care seems to be more expensive in the U.S. than elsewhere in the world. I am sure there is not “one answer” or “one reason” for these escalating costs, but rather many reasons across all fields of medicine. So let me confine my comments to my field: eating disorders.
We had a patient fairly recently who was transferred to us from an academic center with an eating disorder program they (the center, not the family) think is quite good. I won’t argue with what they think, but I’ll make two observations: their eating disorder unit is on a locked psychiatric ward, and the patient was there for two months, leaving nearly as emaciated as when she was admitted.
After two months of failed treatment, the patient was labeled an “intractable case” and transferred to another psychiatric unit in the same city. Please understand: I am not saying there are no intractable cases, although they are very, very rare in my experience of seeing more than 1700 children and young adults. What I am saying is that to keep a patient for several months while making no headway at all is irresponsible and unreasonable. Not to mention incredibly expensive. This treatment (prior to the transfer to the second psych hospital) cost about $140,000. That is a lot to pay for failure.
I have little hope that I can personally affect the debate over health care cost in this country or even define what constitutes acceptable care in my own field, but I humbly offer up some guidelines for parents who are trying to define good care for their own child:
- Place a timeline on treatment. If your child has been in treatment for several weeks you should see some physical improvement even if psychological improvement takes more time.
- Ask your providers what they think constitutes a reasonable rate of weight gain and how they measure it, follow it and plan to achieve it.
- Make sure you are part of the discussion about care and how progress is to be assessed at regular intervals.
- If your child does not gain weight after, say, two weeks, strongly consider another program where weight restoration is considered non-negotiable.
- Anorexia nervosa is an illness. Do not let anyone call your child’s case “intractable” unless and until you are satisfied that their program, rather than your child’s lack of progress, is the real problem.
