Until recently, disordered eating behaviors and thinking were confronted directly. It was believed that disordered eating had to be brought under control as rapidly as possible, even if this meant using coercive methods. The belief was that the patients had lost their ability to make changes because of their illness and were in imminent danger medically. Indeed, a number of patients were helped with this approach. However, a significant number also found the experience traumatizing and unhelpful.
For the past 4 years, neither nasogastric tube refeeding and bed rest nor wheelchairs have been used in the Eating Disorders Program at BC’s Children’s Hospital. Starting within days of their hospitalization, all patients participate in an exercise program. Within a month, most patients serve their own meals and eat some of their other meals in the cafeteria. Patients gain weight at the same rate they did before with more coercive care. Both patient and family satisfaction with treatment have greatly increased, and no patient has been certified for treatment in the past 3 years.
I do not believe that it is the patients who have changed, but rather our approach.
The articles in this issue provide a theoretical framework for this new approach. The articles also provide information to help physicians manage medical complications, practical suggestions for establishing a therapeutic alliance with youth, advice for dealing with the strong feelings that can be aroused by intense treatment relationships, recommendations for working with family members, and specific strategies to use when intensive treatment, including hospitalization, is needed.
Working with youth and adults with eating disorders over the years has made me aware of the risk of letting the authority associated with scientific knowledge devalue the patient’s knowledge or silence the patient’s voice. A 1925 quote from a nurse, Adelaide Nutting, best summarizes these concerns for us: “We need to realize and affirm a view that ‘medicine’ is one of the most difficult of arts. Compassion may provide the motive but knowledge is our only working power. Perhaps, too, we need to remember that growth in our work must be preceded by ideas, and that conditions that suppress thought must therefore retard growth. Surely we will not be satisfied with merely perpetuating methods and traditions; surely we should be more and more involved in creating them.”
—Pierre Leichner, MD, FRCPC
Psychiatric Director, Eating Disorders Program, BC’s Children’s Hospital
Clinical Professor, Department of Psychiatry, UBC
Above is the information needed to cite this article in your paper or presentation. The International Committee
of Medical Journal Editors (ICMJE) recommends the following citation style, which is the now nearly universally
accepted citation style for scientific papers:
Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.
About the ICMJE and citation styles
The ICMJE is small group of editors of general medical journals who first met informally in Vancouver, British Columbia, in 1978 to establish guidelines for the format of manuscripts submitted to their journals. The group became known as the Vancouver Group. Its requirements for manuscripts, including formats for bibliographic references developed by the U.S. National Library of Medicine (NLM), were first published in 1979. The Vancouver Group expanded and evolved into the International Committee of Medical Journal Editors (ICMJE), which meets annually. The ICMJE created the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals to help authors and editors create and distribute accurate, clear, easily accessible reports of biomedical studies.
An alternate version of ICMJE style is to additionally list the month an issue number, but since most journals use continuous pagination, the shorter form provides sufficient information to locate the reference. The NLM now lists all authors.
BCMJ standard citation style is a slight modification of the ICMJE/NLM style, as follows:
- Only the first three authors are listed, followed by "et al."
- There is no period after the journal name.
- Page numbers are not abbreviated.
For more information on the ICMJE Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals, visit www.icmje.org