Top 5 Misconceptions Impacting Collaboration: Dietitian POV

Top 5 Misconceptions Impacting Collaboration: Dietitian POV

November 6, 2019 0 By William Morgan


So one very, very common
misconception that I see happen
all the time is that lab tests
are an accurate and reliable
way to assess somebody’s
nutritional status,
or significance to
nutrition whatsoever.
And the reason for this is
because albumin and prealbumin
in the literature
have been shown to not
be sensitive enough
indicators to somebody’s
nutritional status.
We had a patient who had
a chronic GI disorder
And she was denied surgery
because her prealbumin
was too low.
The physician really
wanted the prealbumin
above a certain level,
and in order to accomplish
that, the surgeon
tried to put the patient
on TPN and tube feeds,
tried to put the patient
on TPN and tube feeds,
both at full strength.
If a physician suspects that
somebody is malnourished,
he or she should consult
the registered dietitian.
The registered
dietitians are the ones
who have the training to
assess somebody’s diet
history, somebody’s
weight history,
accurately, do the
nutrition-focused physical
assessment, and really
determine if a patient falls
into the criteria of moderate
or severe, or even mild
malnutrition.
That’s probably one of my
favorite misconceptions, so
thinking that as a
dietitian I’m going
to force someone to change.
And I have encountered this
with some of the physicians
that I’ve worked with.
They’ll come to me,
and they’ll say, Leah,
I need this patient to lose
50 pounds in two months.
A1C 12 to under seven.
I need them to start
exercising, and I need
them to start packing lunch.
I need these four things.
Can you go do that?
And sometimes I’ll
joke with them
if I know the
physician well and say,
I can’t go and cook
all their meals
for them to help
them lose 50 pounds.
Really we use motivational
interviewing as dietitians
to help elicit what
they’re willing to do.
We don’t force
them into anything.
we have then tell us the things
that they’re willing to do.
And we help create
things like smart goals,
so very targeted goals
that are going to help them
meet the needs that they want.
So there may be a misconception
that nutrition is not
a priority for
patients, physicians
holding this misconception.
I don’t think it’s a
true misconception.
I think that physicians
are well aware of it.
I think that they
unfortunately though,
are juggling so many
aspects of the care
that this is an easy one
to fall by the wayside.
And that’s where having
a dietitian involved
with each team in the hospital,
each team in the clinics,
and us being the one to
consistently lobby and push
for maintaining adequate
nutritional care
is appropriate.
Yeah, so there have been
times too where maybe we’re
sitting in rounds together,
standing in rounds,
and there is a
patient who is obese.
And the physician may
say something like,
well, we aren’t sure about the
function of their GI tract,
and we’re going to just
keep them NPO for a while.
They don’t need any help
from you as the dietitian.
I may say to the physician,
when are they going
to be able to eat by mouth.
And if that’s going to go
any further than one week
Let’s make sure
that we’re getting
them some type of
nutrition support
to enable them to get the
calories and the protein
that they need to
heal these wounds.
One very common misconception
is that dietitians are dietary
and we hate that.
We’re not part of the Food
Services Department, which
is what dietary refers to,
we’re part of Clinical Nutrition
I remember a time at
multi-disciplinary rounds
where we were all gathering
around the patient board
getting ready to
do medicine rounds.
And the attending
showed up and happened
to have a first year resident
with him for the first time.
And so he went around the
circle introducing everybody.
“This is so-and-so from Nursing.
This is so-and-so from Pharmacy.
And then he gets to me and says,
“This is Janine from Dietary.”
And he got everybody else’s
role right, except for mine,
so I had to correct him and
say, “No, I’m the dietitian.
I’m from Clinical Nutrition.
Dietary is Food Services.”
I think it’s important
in any working situation
that you know the people
that you’re working with
and it just shows a level of
respect for how you contribute
to the team and what you do.
It would be great if physicians
knew that dietitians were not
part of Dietary, that we were
part of Clinical Nutrition
and referred to us as such.
And also, if they could learn
to spell dietitian correctly,
And also, if they could learn
to spell dietitian correctly,
two Ts, no C, that
would be great.
One of the misconceptions
that physicians have is
they’ll ask me to go
see a patient, maybe
just for a brief
moment, and they’ll say,
give them one of those
carb counting handouts
with the big picture
of the plate.
And actually the other
day, I saw a patient.
And the physician was
saying, I’m not really sure
why the patient always has
high numbers after lunch
and moving into dinner.
Just give them one
of those handouts
we have on carb
counting.
And so after going in and
meeting with that patient,
I realized she has
a side business.
And her side
business is a bakery.
And so before lunch, she
samples cupcakes and cookies.
During lunch, she
eats her salad exactly
as she told the physician.
After lunch, there are more
brownies and cookies to sample.
So I think giving that
personalized touch is
something the dietitian can do.
Anyone can give a
patient a handout.
But oftentimes if
you give someone
a pamphlet or a handout,
where you find it?
In the garbage right by
their desk or their bedside.
And so we really provide
something and make
it speak more to the patient.
And I would say that
I think patients
find a lot of value in that.