Expert: Ryan Hale - 3/15/2010

Question
QUESTION: I have had problems with food and body image since 7th grade. In the past few months I have been restricting more than ever, and when I do eat I purge or use laxies to make myself feel better. I don't want to do this anymore and I know I need help. I really want to talk to my doctor but I'm scared of how she will react. I see her in a few weeks for a physical and I want to tell her then. How should I tell her about this? Should I tell her at the begining or the end of the appointment? Lastly if Im 18 and this is still my pediatrician is she allowed to tell m parents? Thanks so much I'm just so nervous :/

ANSWER: Macy-  That's very bold of you to want to know how to start the conversation and take the first step.  Your family physician is a great place to start.  The best thing to do is to tell her right up front.  The counseling, we talk about how clients always seem to "drop bombs" 10 minutes before the end of a session.  Those are big issues that need to be discussed at length but they haven't allowed enough time in the session to talk much about it.  So, I would recommend telling her that there is something you are concerned about and want to make some changes and would like her to help you figure out how to go about it.  Let her know EXACTLY what is going on and what you are concerned about.  It would do much good if you sugar coat it or make it sound less severe than it is.  Be up front and honest.  It's hard because nobody wants to just dive into everything or to admit that they may need help to overcome something big in their life.  You might even want to make a list of questions you have so you don't forget anything.  Make sure she knows just how bad things are.

As for her telling your parents, if you are 18 you can ask for confidentiality even if you are still living at home, however, often times there are family issues or relationship issues that can contribute to the problem so she may ask some questions about your family life or relationships.  Also, eventually, you'll need to iron those things out in your life in order to get better completely.  if you have had a history of abuse (from anyone) it will be important for it to be discussed in counseling and your Dr may ask.  As a counselor in Colorado, we are able to see clients 14 and older for a total of 5 visits without having to notify parents.  However, the sooner you can include them in your situation and your healing the better.

Don't be nervous, as corny as it sounds, we (doctors, counselors, etc) spend our lives doing this because we want to help and we love seeing people get better.  If you want, you can even script what you are going to say and practice having the words come out of your mouth.  Something like: Doctor (fill in the name), they measured my height and weight when I came in the door, what do you think about it?  Does it concern you?  The reason I ask is because I feel like I've been...  

The government has a pretty good web site that can explain BMI and height weight charts.  They also have some pretty good pages on setting up healthy eating and diets.  Usually the government is pretty awkward in the information that they provide about most things, but this is a pretty good site I have to admit.  Try www.mypyramid.gov  If it doesn't work just google food pyramid and US government.

Good luck.  If I can do anything more to help please ask.  

---------- FOLLOW-UP ----------

QUESTION: Thanks so much Ryan I really appreciate it. So just to clarify she cannot tell my parents at all? And would it be aukward if my friend went with me or will the doctor want to talk to just me?

Answer
Macy-  your doctor may have her own personal policy about what information she chooses to share.  technically, if you are 18 you are not a minor and can request that she just discuss it with you.  if you still live at home, are considered a dependent or your bill is being paid by your parents, her policy may be to treat you like a dependent.  It just all depends.  You can ask her though what her policy is before you tell her.  i would not bring my friend along into the actual exam room (it may not be allowed anyway under the clinic's policy to have non-family members).  I know you'd like the moral support but it is something that would be better discussed between you and her.  it's sort of like bringing friends along to apply for a job.  You want to give the impression that you are responsible and grown up enough to have an open and honest dialog about a serious issue with your doctor.