By Maggie McNair
Imagine yourself browsing the
aisles of Barnes and Noble. You notice a book titled Do It Yourself: Medical Diagnosing. Interested, you pick it up and
realize it was written by a registered dietitian. Do you trust it? Of course
not! The 6 to 20 hours of physiology and anatomy instruction a dietitian
receives does not qualify them as experts of medical diagnosing or validate
them as a credible source for medical information. Right? Then why does
research suggest that 40% of the public trust nutrition advice from a doctor
more than a registered dietitian?1
Medical students receive an average
of 24 hours of nutrition education.2 Registered
dietitians are required to complete an undergraduate degree in dietetics, 1,200
hours of supervised practice, and by 2024 a master’s degree before qualifying
to sit for the exam to earn the credentials “RD”. In my opinion, this level of education should
warrant RD’s the title “Nutrition Expert”. The profession that studies
nutrition the most should be the profession you trust to receive your nutrition
information from. If this is true, then why are doctors writing diet books? And
why are people buying them? Why do clinical dietitians need permission from physicians
to start supplements or recommend feeding advancements? What makes the 24 hours
of nutrition education a doctor receives more viable than an entire degree? Nutrition science appears to be in crisis
and is currently confronted with a public reluctance to trust nutritional
insights.3
I am currently completing my
master’s degree and dietetic internship while simultaneously my twin brother
Sam is a medical student. I frequently ask Sam what he is learning about
nutrition, if his professors are encouraging interdisciplinary collaboration,
and when dietitians are indicated for the plan of care. Unfortunately, all of
the nutrition education he has received in his first year of medical school can
fit onto two Powerpoint slides; nowhere
does it mention registered dietitians.
Sam knows the value of medical
nutrition therapy and when to refer to a dietitian, but he disclosed to me that
when he mentioned RD intervention during a case study, one of his peers was not
sure what an RD was. This is where I believe the problem is. Medical students
are not receiving adequate nutrition education and exposure to registered dietitians,
yet they are still providing nutrition recommendations in clinical settings
without collaboration with dietitians. Or in extreme cases, publishing quick
fix diet books.
The Dilemma: Do we provide physicians with more nutrition education
so that they are aware of how important it is in patient care to encourage
referrals to dietitians? Or by providing that education do we run the risk of physicians
referring less to dietitians because they feel they have sufficient education
to make nutrition recommendations.
To investigate the perspective of a medical
student, I asked my brother what he thinks the solution could be. This was his
response.
“My main priority will always be the
patient’s needs. I believe that providing doctors with more nutrition education
may make them more confident in providing nutrition recommendations and more
likely to bypass the process of referring to an RD.”
It turns out that Sam’s assumptions
were correct. In 2018, The journal of Nutrition
and Dietetics published research on frequency of referrals to dietitians. Out
of 227,190 diagnoses, only 587 (0.26%) referrals were made to dietitians. The
most common conditions prompting a referral were obesity and diabetes.4 This statistic highlights the gap between
nutrition knowledge and attitudes of physicians. I have been studying nutrition for five
years and I still have moments where I do not feel 100% confident in my
recommendations. This is because I understand the complexities of medical
nutrition therapy. My argument to the dilemma would be this. If nutrition
education in medical students is significantly increased, could this reveal the
complexities of medical nutrition therapy (which includes so much more than
diabetes and weight management)? So, does the solution require more nutrition
education or less?
I decided to investigate further by asking the same question to a clinical dietitian. She provided a very insightful solution; collaboration. She believes that all residents would benefit from shadowing a dietitian for a week to observe the depth of nutrition knowledge and the services dietitians have to offer. Residents would ideally use this information to refer to dietitians more frequently. Another suggestion she made was that dietitians need to make themselves available on rounds so that they are the primary source of nutrition recommendations. This also allows opportunities for interdisciplinary collaboration which always optimizes the prognosis of the patient.
So, what can a dietitian do to
combat this dilemma? Advocate and
collaborate. Be the voice of our profession. Do not be afraid to correct
recommendations. Be present in rounds and share evidence-based nutrition
interventions. Most importantly, never stop learning. The nutrition realm is
saturated with misinformation and too many opinions. Nutrition is not an
opinion, nutrition is a science. It is time for dietitians to reclaim the title
of Nutrition Expert.
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