Treating someone with an eating disorder is not easy. The condition is both emotionally and physically complicated and every dietitian should take care when helping patients recover from what could be a deadly problem.
As eating disorders have become more popularized through the internet and other media, treating the disorder also becomes mired in community, family and cultural relations. Say you have failed to recognize the disorder or the person refuses to help themselves. Perhaps the disorder is in its early stages and you believe that it could be easily brought under control, failing to understand all of the underlying reasons for the disorder.
Or perhaps your patient does a good job of hiding the disorder, so that it is barely detectable. This means the dietitian and/or nutritionist has to perform a bit of detective work to get to the root of the situation and that sometimes means recognizing the early signs of the disorder before it becomes full blown.
The first rule of thumb is to get rid of the notion that someone with a disorder is underweight. We know through research and experience that this is not the case; the mere fact of eating is only a part of the problem. Treating the whole person is increasingly necessary for the problem to be brought under control.
Sometimes registered dietitians, no matter how careful they are, become targets for malpractice lawsuits when it comes to eating disorders. According to an article in Today’s Dietitian, “It’s a dietitian’s worst nightmare to become embroiled in one of today’s high-profile medical malpractice lawsuits. Once upon a time, dietitians counted themselves lucky, as they could smugly cite that not a single dietitian had been successfully sued in a malpractice case …”. But as the article stressed, times are changing.
Each malpractice case is decided individually on the basis of the evidence presented in court. There are general principles and guidelines that govern the courts’ decision-making process. A patient seeking legal redress must prove actual injury, a relationship of duty between the parties, breach of that duty, and a cause-and-effect relationship between the breach of duty and the injury suffered.
How many times did you go back to the plan of care with new interventions? Did you talk to the family? Did you get the doctor involved? If they lose weight, develop decubitus ulcers, and you do not have proper defensive documentation, the liability falls on the care plan team and the dietitian.
The bottom line is ensuring the correct amount of professional liability insurance coverage. Dietitians and nutritionists, the article states, should get at least $1 million for their own coverage. Moreover, dietitians can minimize their risk by making sure that you are confident in the advice that you are giving and the treatment that you are providing; making certain to update skills, and to document, document, document. No one will ever punish for over-documentation. You should also keep a good rapport with the family and provide the best and most respectful care possible.
