Top 5 Pointers for New Physicians: Dietitian POV

Top 5 Pointers for New Physicians: Dietitian POV

November 4, 2019 0 By William Morgan


One thing to remember is that
nutrition impacts outcomes.
Poor nutrition will delay wound
healing, will delay healing
from any kind of illness or injury
and it will decrease somebody’s
functional status as well.
So I once had a patient
who came into the hospital.
Her primary issue was
chronic migraines.
But her migraines
were so bad that she
had nausea and vomiting to the
point where she hadn’t eaten
or kept any food
down for 30 days.
And as a result, she
had malnutrition,
she was refeeding,
and she wasn’t
able to tolerate tube feed
so we had to put her on TPN,
but as soon as we
got her on TPN,
her hair stopped falling out,
the color returned her face,
she was able to get out of
bed without being orthostatic,
and she was able to go home
and live independently.
Communication is key.
Working on a team that
communicates– the physicians
communicate with the
nurses, with the NPs,
with the dietitians– that’s
how we best serve our patients.
Because we’re all the eyes
and the ears for the patients,
and we’re all able to create
a full picture of what
that patient’s life looks like.
For example, are the patients
taking their medications?
The nurse can report back
to the doctor about that.
Are the patients following the
carbohydrate recommendations?
The dietitian can report back.
So really, that’s how we best
serve our patients as a team.
The place
that I work at,
we have a wonderful
communicative team.
Sometimes they’ll have
me actually go in,
and they’ll go back in
and tell the patient what
they want to do with
medications based
on their motivation and my
assessment of their nutrition.
And that just
empowers me to want
to be an even more
active part of the team.
I think that’s so important.
So we’re all here trying to
do the best for our patients,
and utilizing the dietitian in
that journey is definitely key.
So communicate with each other.
Understand your limitations
as a new physician
working with patients.
There’s a reason why it’s an
entire team full of people
including physicians,
nurses, physical therapists,
occupational therapists,
dietitians, social workers.
When it comes to
nutrition, you don’t
get a lot of hours in
Med school on nutrition.
I as the dietitian and
my colleagues, that’s
all we learn in school,
and that’s all we
do in our practice.
Our nutritional expertise
exists in a hospital setting
around tube feeding and
total parenteral nutrition,
around strategies with
oral feeding by mouth
to help maximize the patient’s
intake, also around counseling
and education rather than just
to tell a patient, you must eat
and you need this much,
to be able to spend
the time with them, break
down the reasons behind it,
and also figure out
motivational strategies to help
them meet these goals.
Important opportunities
for physicians
to consult the dietitian include
any time patients come in
with unplanned
weight loss, reports
of eating less than
normal, any patients
on artificial nutrition
support like tube
feeding and total
parenteral nutrition,
and even can be
any time a patient
may just have questions
or concerns or things
relating to their diet
or their food intake.
Another important
thing to remember
is to always include nutrition
in your plan of care.
is to always include nutrition
in your plan of care.
When you’re going over
a patient and you’re
reviewing all
their systems, when
you get to the GI system
that should be your trigger
to think of what is
this patient’s nutrition
plan for today?
And the dietitians are
there as resources for you
to help you come up with the
best plan of care in regards
to the patient’s nutrition.
The benefit to
consulting the dietitian
is that we have the
expertise, the experience,
and the knowledge, to come
up with the best nutrition
plan for your patients.
And this is what
we get paid for.
This is why we’re
here in the hospital.
So use us as a resource.
So when the physician puts
in a nutrition consult,
we’re going to go
and actually do
a lot of the work– so
lifestyle management,
exploring patient’s
motivation, using
motivational interviewing,
all the tools that we have.
And then either
the dietitian can
follow back or the physician.
follow back or the physician.
If you want to check
in with us, we’re
going to have a
wealth of information
that we’ll be able to share
about the environment,
the lifestyle that the
patient is living in,
where they’re at with
motivational change–
if they’re motivated to
change weight, motivated
to change diet and lifestyle–
what we’re really working on.
And we’re going to
be able to spend
a lot of that one-on-one
time with your patients.
So reaching back out
to us, maybe we’ll
be able to give you a couple of
those little pearls of wisdom
that we’ve learned about
your specific patient
and their lifestyle that
will help you better treat
them and their medical issues.