03/05/2026
I will start off with saying 1) I have some outstanding P*P’s that I collaborate with 2) yes a patient has a responsively to communicate appropriately.
This happens weekly if not multiple times a week in my practice. Patient presents with weight loss or maintenance, is eating less than 50% of needs, exercising, and has a low heart rate in my office OR is getting low heart rate notices from their wearable.
I make multiple calls to the P*P to discuss ordering an EKG. They agree (thank you). The cardiologist does the EKG and says “you are young and have an athletic heart.”
There’s no question about intake OR what type of exercise and they are sent on their way. The P*P may not even get the report or talk to the cardiologist so they ask the patient who says I’m fine.
Meanwhile the patient can barely get through workouts, are dizzy, and can’t appropriately refuel because they are using energy that they need for rehabilitation for exercise instead.
I have this conversation of concern with the P*P ethnically does agree to pause exercise and thanks me for the collaboration but what if I didn’t make these calls?
Real life issues:
1) I have an angry parent who wants to school me on how pausing exercise will hurt their earning of their position (don’t get me started).
2) I have a cardiologist who says well their ejection fraction was normal and nobody told us.
3) I have a confused patient who is wondering why everyone else thinks they age just fine.
4) I have a thankful patient who says I know I don’t feel right.
This is why you need to work with an eating disorder specialist. Also doctors can bill insurance for collaborating discussions but all in all it’s not done enough.
Do better people. This lack of follow through contributes to diet culture and someone not feeling like they are “sick enough”.