Jennifer Leah
@JenniferLeahMD
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daughter | sister | friend | dog-mom | doctor | child/adolescent psychiatrist | eating disorder specialist | runner | marathoner Boston ‘22,/‘23/‘24 @runformgh
Cambridge, MA
Joined July 2021
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If my team gave up on me while in the throws of anorexia, I’d be dead. I am alive bc of them. I am a doctor, a sister, a daughter, a dog-mom. I live a full/rich life free from anorexia. We all deserve that, no matter how long our struggle, recovery is possible.
#MedTwitter
#MedEd
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When in the depths of anorexia, I had no insight, no understanding I was unwell despite being at death’s door. I can’t pinpoint when recovery took hold but it required weight stabilization (against my will). Let’s stop giving up on patients who are unwell—life awaits.
#MedTwitter
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I am a huge de-prescriber/med optimizer; it’s at least 50% of what I do as a psychiatric hospitalist. However, why have we accepted poly-pharm in oncology, primary care, other medical specialities but have such vitriol for it in psychiatry? Stigma?
#medtwitter
#pscyhtwitter
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The thing about
#eatingdisorder
recovery is that as brain space that was taken up by food/body moves out, there is increasing space for love, interests & passions to develop and grow. Life happens when the ED moves out and it’s beautiful <3
#MedEd
#MedTwitter
#holdinghope
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It is unacceptable to fail to provide care for patients with eating disorders bc our current treatments/systems of care are ineffective. This wouldn’t fly in any other areas of medicine and it is absolutely unacceptable here. We MUST do better.
#MedTwitter
#MedEd
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The # of times I heard “don’t worry I won’t make you fat” in ED recovery is astonishing. By good ppl. Fat-phobia and weight stigma is alive and well in eating disorder field and we must reconcile.
#meded
#medtwitter
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#MedTwitter
#MedEd
So I treat EDs, but have a ? I have yet to see at pt w/ BED who isn’t restricting—it’s a restrictive ED as far as I’m concerned. So if these pts are compensating with restricting how is this different than the restricting compensatory bx of bulimia nervosa?
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Had a blast
@CincyChildrens
giving grand rounds on a topic near and dear to my heart!
#MedEd
#MedTwitter
#PsychPearls
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#UnpopularOpinion
The fundamental driver of Binge Eating Disorder is restriction. The same is true for Anorexia and Bulimia Nervosa. Prescribing restrictive diets for these patients is harmful. “Obesity Medicine” is harmful. Sorry.
#DoNoHarm
#EatingDisorders
#MedEd
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#MedEd
#MedTwitter
#PsychPearls
When asking about SI with pts, try to weave it into the thread of discussion rather than ask as a checklist item; ie. “It sounds like you have been really depressed and hopeless lately; does it ever get so bad you think about ending your life?”
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@ChrisPalmerMD
As an eating disorder physician, the treatment of eating disorders actually needs to focus on incorporation of ALL foods into one’s repertoire. Focusing on “clean eating”, reducing certain types of foods, being restrictive in any way can LEAD to eating disorders.
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Not sure if anyone will see this but here goes. Over the course of the next several days/weeks I will share some pearls for medical students on their psychiatry clerkship.
I’ll start with general principles and progress to more specifics.
Follow
#MedTwitter
#MedEd
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#MedEd
#MedTwitter
#PsychPearls
When interviewing patients in psychiatric crisis, remember they are a human being—treat them with respect, dignity and compassion. Offer them privacy, try to ensure a sense of safety. Look away from your computer, engage w them on human level.
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@jamesldowns
I hear all the time that ‘this pt is too chronic, too unwell’ and ‘we can’t do anything for them…giving up is NOT an option we should be entertaining.
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#MedEd
#MedTwitter
A really impt q to ask residents/fellows is whether they have mentors in their program. Finding mentors/cultivating those relationships is really impt in training and beyond. Find out if programs invest in their trainees.
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#MedEd
#MedTwitter
#PsychPearls
If a nurse or nurse assistant is worried about a patient, you should be too! They spend the most time with patients and often pick up changes before we do. Respect their assessments, collaborate to problem solve.
Teamwork makes the dream work.
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@SadiqNaveed
Curiosity—those that are curious make excellent psychiatrists. They ask questions, they don’t assume, they try to understand and they don’t assume they know.
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Hey
#MedTwitter
#MedEd
, it’s ok if you’re not racking up awards, honors, etc during training (or ever). If you solidly care for your patients you are making a difference and ARE an MVP.
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@bearman_sk
Wow I didn’t see this when it was up. I am a psychiatrist and my sister is a psychologist and we have overlapping but distinct professions. Besides being inaccurate, this slide doesn’t capture the depth and breadth of what either profession does.
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“A critical aspect of work… has been my experience of having another person truly believe that my future includes a fully realised recovered self.“
Holding hope for all patients is critical.
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@DrScottHadland
@dellchildrens
It is heartbreaking what’s happening in our country. Thank you for all you do to improve access to care.
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Had a wonderful time at my first
#ICED2023
! Loved meeting
@mallarytenore
@jennaline_msw
and
@HeatherHowerMSW
. Loved presenting w colleagues on ethical issues in EDs.
#MedEd
#medtwitter
@McLeanHospital
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For all those starting/about to start residency, it’s the long nights on call where lifelong bonds are made. Get to know your co-residents, chiefs, attendings, nurses, SWers, janitors, unit secretaries, security guards, etc. They will be your everything.
#MedEd
#MedTwitter
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@DrNicoleC
@ChrisPalmerMD
Not all diets turn into eating disorders but all eating disorders I’ve ever treated (AN, BN, BED, OSFED) start as a diet in some fashion. Literally the most stable risk factor we know about.
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@jacasiegel
I actually am not sure if there is a real clinical difference. All of the BED patients I’ve seen have similar compensatory motivations but (usually) because they are overweight/obese they get diagnosed with BED….the weight bias in the field is just really rampant.
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I second this. I wouldn’t be here without my team holding hope for me when I both didn’t think I was sick and had no hope. We don’t give up on patients, it’s not ok in other areas of medicine and it shouldn’t be ok here. Ever.
If my team gave up on me, I would not be here. I borrowed my team’s hope until I had my own…. I went from being told I wasn’t going to make it to living a very full life.
Healthcare is failing patients… because anorexia is “too complex” to learn about according to many.
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Recently had a patient’s family member tell me “I was a breath of fresh air”—she was referring to the hope I provided her in pursuing recovery for her child with serious mental illness. To my fellow docs, PLEASE never stop providing realistic hope. It matters.
#MedEd
#MedTwitter
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I have and continue to tx highly refractory pts. Our treatments may fail some patients; that does not mean we give up on them. Our shortcomings in medicine are not the fault of patients—they are opportunities to innovate, create and push the boundaries of our current approaches.
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This was me. Substitute “Psychiatrist” for “Surgeon”. We have to make it easier to seek help, speak out before sh*t hits the fan. We are losing the equivalent of a medical school of our colleagues every year. This is an occupational CRISIS in medicine.
#MedTwitter
#MedEd
TW: Suicide
This was me.
Achievement, concealment, alcohol, drugs, depression, self-harm, suicidal.
Oh, and surgeon.
It's why I wrote my book, hoping more of us would find power in vulnerability.
Thanks
@lubitz_carrie
for joining the chorus.
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#MedEd
#MedTwitter
#PsychPearls
#EatingDisorders
Just because our treatments for eating disorders are inadequate for some doesn’t mean we should give up on them, blame or shame them for their illness. We need to keep searching for answers, innovating care and providing hope.
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@MarkLRuffalo
This is a really dangerous statement—stimulants are destabilizing for those with bipolar illness and can be hugely impt in this population when mood is appropriately stabilized. ADHD has hugely devastating effects when untreated.
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@DrSarahWakeman
@BostonGlobe
@MethadoneLib
While we’re at it can we stop having sober communities/residential programs that refuse pts who are on suboxone or methadone….
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@DrAnnieHickox
I couldn’t agree with this more. As a psychiatrist with lived experience I am grateful for the interventions that saved my life and practice every day knowing what I do is a privilege and honor that I am enormously grateful for.
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@sanilrege
It’s also the case that psychiatrists specialize in different things (not unlike other fields of medicine)…and therefore we utilize different tools (including meds) depending on what we specialize in.
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@ChrisPalmerMD
We know that restrictive eating in any form can lead to eating disorders in 25-35% of individuals. So most who diet in any form won’t develop eating disorders but many will. We don’t have other good ways of predicting.
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I was honored to share my story with you all. Thank you for being such a wonderful audience. It was a privilege.
#meded
#MedTwitter
@McLeanHospital
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Losing your sense of safety is devastating. Sending love to anyone whose sense of safety has been compromised. May you find comfort and peace.
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@jamesldowns
I’m in the US but medical school barely (if at all) covers eating disorders and rarely the medical aspects. It’s a HUGE problem at ED’s present in all areas of medicine, all specialities and settings and are often missed/if not worsened altogether.
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@DrZoffness
@PeterGr26283123
I had a similar type of situation with different details and it was awful. I had to report. This job is indeed hard and I relied on my peers (at the time was CAP fellow) and supervisors to get me through.
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#MedEd
#MedTwitter
#PsychPearls
When interviewing pts, follow their lead. Don’t ask q’s in a checklist, it feels dehumanizing/that the pt is “a task” for you to check off. Weave in your q’s as they narrate their experience. Validate their experience and provide hope.
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@Kel_MHB
Right--but every single person I've ever seen with "BED" as we currently diagnose it has also been restricting when you take an actual history. I think it gets ignored bc of 1) weight and 2) focus on binging and lack of vomiting/diuretic/laxative use.
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@AnorexiaMyths
@AgnesAyton
@RebeckaPeebles
@sensinglorna
@WHO
I have found that when patients believe you believe in them, are kind, transparent and hold hope, they allow you to guide them through true recovery even though it’s scary as sh*t….
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“We must, at all times, be guided by the protection of life and the possibility of recovery.” Hope is a key ingredient in all forms of health care delivery, especially in mental health care, esp in eating disorders.
#MedEd
#MedTwitter
#PsychTwitter
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@krigg01
Many (if not all) psychiatric disorders and many of their treatments are highly stigmatized, if not outright denounced, by the public. If a society is judged by how it treats its marginalized individuals, we are doing very poorly.
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@theshirarose
I can’t and I can believe this group exists. How sad. I have had so many bariatric surgery pts who clearly had EDs when they had surgery which only worsened post. Also congrats on your talk-wish ours weren’t at the same time. Loved meeting you and Bamba!
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For ob*sity medicine not to be harmful, it must involve eating disorder experts. And must rethink “ob*esity” as a disease entity as bodies themselves aren’t diseases, they are vehicles with which to live life.
#MedTwitter
#MedEd
#EatingDisorders
#PsychTwitter
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@KaraPepperMD
Gave a talk to med students yesterday and I think really made them think when I shared exactly this.
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@jacasiegel
Couldn't agree more..... BED, "atypical" anorexia, etc. Reform is needed. Complications/danger across all EDs.
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@PaulNWilliamz
“You are supposed to weigh the # your body sets when you are eating a variety of foods, getting necessary nutrients (micro and macro), not restricting your intake, engaging in joyful movement.” This # is different for everyone, every body is different.
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@CaraLisette
Correct. And they haven’t seen the degree of suffering that can be alleviated (at least partially) with medication.
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@CaraLisette
I like to say that you can’t talk your way out of a condition that you behaved your way into. Tx requires behavioral change (ie new eating patterns) before anything else :-)
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While it looks like pts with AN have capacity, if you eval their value system, it changes with the disorder; therefore the decisions they’re making are driven by the illness and not their “well selves.” We can’t let those illness-driven decisions lead to death.
#MedTwitter
#MedEd
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#meded
#medtwitter
@MKIttlesonMD
this is a must listen for all of us as we approach July 1. Dr. Kittleson is amazing!!!!
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@DrMarinaHarris
Also those of us who are in mental health/peds may have clinical expertise and not have children but still have important information to share.
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@jack_turban
Psychiatry and Medicine/Pediatrics: Bupropion (Wellbutrin) is contraindicated in individuals with eating disorders, esp those who binge/purge (any type) as it can cause seizures. Most risk is with IR>SR>XL (risk still present with XL!).
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@MarkLRuffalo
I think bc CBT is “manualized” it lends itself to more rigorous study than other forms of therapy which I agree are equally efficacious, sometimes superior depending on pt needs. I hate when people knock more traditional therapies, they are incredibly beneficial for many!
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Testifying in court to involuntarily hospitalize patients is a lose-lose situation. When we “win” we take away pieces of pt autonomy; when we “lose” we place pts in vulnerable positions in the world. Autonomy vs beneficence in action. Never easy. # MedEd # MedTwitter
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@DoctorPICU
Psychiatrist here; right there with you and sending love and support. You ARE amazing!
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Does anyone else leave conferences feeling bad about themselves or is it just me?
#MedTwitter
#MedEd
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#MedEd
#MedTwitter
#PsychPearls
When trying to determine severity of bipolar d/o, I often ask: “During any of these periods you’ve described have you done things that are dangerous or unusual for you? Have people been worried about the decisions you’ve made during these times?”
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@sanilrege
It is my experience that if you take thorough hx of pts with ADHD sx in adulthood, they’re present since childhood but often compensated for in various ways. Pts present when compensation no longer works. The impairment untx ADHD can cause is huge; often occurs with mood d/o.
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@ChrisPalmerMD
You’ll notice all of the things on the list were touted in similarly miracle ways. Nothing is a magic bullet and I’m afraid we’re going to see the consequences over time.
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Shout out to all the docs out there seeing patients, fighting for care with insurance companies, educating families, not necessarily giving talks or writing. YOU are the heros of healthcare and psychiatry. YOU matter. YOUR work is saving lives.
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Happy “medical new year!” Best of luck to all the interns starting today (or in the last week). Patients are lucky to have such dedicated, interested, excited new doctors taking care of them!
#MedEd
#MedTwitter
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THIS.
Lack of education and understanding on eating disorders creates harm through limiting medical professionals' ability to properly screen, identify, and provide appropriate referrals for patients with eating disorders.
We need to debunk myths and improve training depth.
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@aliciaandrz
Your bravery and candor in sharing your journey is a gift. Don’t let anyone tell you to keep quiet if you’re driven to share. Some ppl might turn away but so many of us will lean in and are grateful.
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#MedTwitter
#MedEd
Need some help: writing a book chapter on eating disorders for neurologist—what do you think is most important for this group to know when it comes to EDs??
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@jillian_rigert
We also know from research on capacity that "death is felt to be preferable to treatment", so patients may not even want to die but feel that the path to recovery is too daunting. WHY IS THIS OK????
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I am so conflicted about the idea of palliative care/hospital/MAID in anorexia nervosa. Decision making doesn’t reflect underlying non-eating disorder values and can be considered compromised. Don’t let illness drive decisions.
#MedEd
#MedTwitter
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@sulmoney
@PaulMinotMD
Clinically bipolar disorder likely exists on a spectrum including depressive, hypomanic/manic episodes. Often pts have been misdiagnosed and once they are appropriately treated do so much better. And it is sometimes used as a catchall dx but that doesn’t negate its importance.
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Sending love and compassion to all. It’s all I have during this awful time.
#MedTwitter
#MedEd
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Oh my thank you for having me. This talk was a true highlight for me and you could not have been a more gracious, open and warm audience. An honor and a privilege. Thank you <3
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@jamesldowns
Dying from low potassium as a result of anorexia nervosa is NOT natural causes. Disgusting.
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@DrHowardLiu
Connection is the key to so much. So many suicides/suicide attempts are related to disconnection in some way. I know this is small but I smile at people when I walk down the street, I wave and say hello to strangers. We’re all in this world together.
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#MedEd
#MedTwitter
#PsychPearls
Whether in ED/CL/inpt psych, make sure pts are comfortable, have food/drink, blankets/jackets, shoes, fresh clothing. Meeting basic needs is necessary before we can talk about hard things.
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As I reflect on 2023, community & connection have been vital. This year, I’ll be running the 128th Boston Marathon…to raise critical funds for kids/families battling cancer
@mghfc
. Please consider year-end giving using this link:
#MedTwitter
#MedEd
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@AgnesAyton
@AnorexiaMyths
Here too. But I always hold onto hope that we can and will get patients better.
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#MedEd
#MedTwitter
#PsychTwitter
If you see a patient who is “treatment refractory” ask yourself: 1. Do I have the right diagnosis/formulation? 2. Do I understand the social factors playing a role? My experience with “treatment refractory” patients can ~ be solved by asking this.
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@CheriLev
Love this. This has to start early; kids are now being asked in school to label foods as “good” and “bad.” It’s disgusting at best and dangerous at worst.
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Thank you
@DartmouthHealth
Depts of Surgery and Psychiatry for the privilege of speaking at Grand Rounds representing
@McLeanHospital
Deconstructing Stigma Campaign.
#MedTwitter
#MedEd
@DartSurgery
@harvardmed
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@Pres_APA
@APApsychiatric
As a psychiatrist with lived experience I wish we all celebrated those in recovery from mental health and/or addiction the way we celebrated those in remission from cancer. Thank you for leading the way!
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@ChrisPalmerMD
So as an eating disorder clinician, there really are no “good” or “bad” foods. However, the restrictive mindset and/or restrictive eating behaviors often lead to these behaviors in which folks feel out of control, etc. Freeing folks from restrictive diets and mindsets is key.
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In academic medicine your life is celebrated if you die by suicide; if your attempt had been unsuccessful you would have been shunned. Our culture IS THE PROBLEM.
#MedTwitter
#MedEd
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@MarkLRuffalo
The idea that a medical school/medical training cannot do both is ridiculous. Introducing the concepts so future physicians are equipped to not only treat disease, but to recognize and address some of the social factors that impact those illnesses is incredibly important.
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#MedEd
#MedTwitter
#PsychPearls
Let’s get into some more psych specific pearls.
Talking with patients in acute settings can be really hard. I start by asking disarming q’s like: “Can you tell me what you prefer I call you? I use she/her pronouns, what about you?”
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@Ontheboldstep
In my illness if offered palliation I’d have taken it bc treatment felt worse than the illness but that IS THE ILLNESS. This is collusion with the eating disorder and failure on the part of medicine to recognize our shortcomings and do better.
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I'm so honored to be a part of this year's
#40GatorsUnder40
!
#MedTwitter
@MedEd
@mghfc
@salemhospitalMA
@McLeanHospital
Proud to be a double Florida Gator and so incredibly grateful for my friends, mentors and colleagues from
@UFMedicine
!
Join us in congratulating Jennifer Goetz for being named to the 2024
#40GatorsUnder40
list!
She works to identify areas of eating disorder service gaps to better serve the mental health needs of this patient population.
Learn more
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@RebeckaPeebles
@AnorexiaMyths
@AgnesAyton
@sensinglorna
Correct—many of us recover into larger bodies and that is part of what makes up the diversity and beauty of humans beings!
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Loved working with
@harvardmed
first year students learning how to do psychiatric interviews. The future of medicine is bright!
#MedEd
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Been feeling the “conveyor-belt” of medicine—existing to get pts in and out of the inpt unit to clear the EDs faster. But each pt I treat has been an honor and privilege to know. To see pts at their hardest time and to meet them there is always meaningful.
#MedTwitter
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#MedTwitter
#MedEd
#PsychPearls
As a medical student, you add more to the care of your patients than you will ever know. You can spend time that others don’t always have and impact care in ways big and small.
In that time, be kind, be curious, be compassionate.
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@Gabby_Brauner27
I work in inpt psych, which is ICU mental health care and it never gets easier but I try to remind myself that in working the holidays I can bring a little cheer and joy where otherwise it might not exist.
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