Surprising Discoveries in 5 years as a Clinical Dietitian

This August, I celebrated 5 years employed as a clinical dietitian. Like the introspective, analytical person that I am, this anniversary has had me reflecting on why I became an RD, how it is different than I expected, and what I have learned in just 5 years.

My decision to pursue a career in nutrition started as similarly as other aspiring RD’s as well as vastly different from others. At the time, it seemed like the ‘right’ fit for me; a physically active & health minded, dietary intake focused individual who believed in regimented diets and exercise, as well as helping people. With this sentence, you may also read, “eating disorder” between the lines, as that is where I was at the time in my life when I began pursuing a career in nutrition. Thinking back to my initial 19 year old perceptions of what my career would look like, I could have pursued online personal training and nutritionist certifications to fulfill those perceptions. The time, money, and insurmountable hours of studying I would have saved would of been phenomenal…but not nearly as phenomenal as the skills I have gained, the healing and recovery I have experienced, and the passion I have found for what I now do.

The field of dietetics and the scope of practice for a dietitian is undeniably immense. It is also a wildly misunderstood, underutilized, and often ignored profession. Yet, the longer I work in the field, the more I fall in love with my job and it’s opportunities. In 5 years as a clinical dietitian, I have learned the following non-traditional, career & life-changing things:

1. It is not JUST about food – ever.

In the midst of reviewing clinical conditions, labs, physical parameters, intakes, & nutrition focused interviews, there are PEOPLE. People who are undergoing a wide array of mental, physical, and emotional stress. People who are desperate for a friendly ear or are angry and in need of an outlet. Between the facilities I service, there is dementia and amputation, inability to self-feed or verbalize. There are people confined to chairs or beds and people who desperately want to leave; to return to loved ones, homes, animals. There are people with incredibly intricate relationships with food; encompassing poverty, eating disorders, bullies, alcoholism, frequent diet cycling, food and nutrition knowledge deficits, various cultures and beliefs. Within my first year as an RD, the stories, conversations, & depth of despair I met in people and their families was heart wrenching. I began to realize the work I was doing was often less about nutrition science, diet orders, nutrition related labs, or measuring intakes. It is often about unpacking someones relationship/viewpoint/response to food, finding relation in current clinical conditions/status, and providing nutrition counseling, care, intervention that meets the all-encompassing health needs of the person/patient/client. It takes time and more time and follow up…which are often scarce in the world of clinical nutrition. So, we do our best to be listener, counselor, educator, and nutrition expert – often in 30 min or less per patient, per encounter.

In the midst of the busiest days, with a seemingly mountainous caseload, I have found myself sitting at bedsides hearing stories of death, inability to access grocery stores or inability to purchase food. Stories of choosing to feed animals over themselves as animals served as primary companions. I have held hands with family members & mirrored their tears as they make hard decisions between artificial nutrition and allowing loved ones to pass. I have sat and fed people who can no longer feed themselves. At times, I have realized the most important/meaningful thing I can do for someone in my role as “dietitian” is to listen, feed someone’s father ice cream before bed, or provide comfort to family members who need to be told that it is “ok” if they bring their mom’s favorite McDonald’s meal for dinner as her body submits to cancer. These are not experiences we learn or prepare for in biochemistry or medical nutrition therapy. These are experiences that cause us to recognize that while my end assessment and intervention remains focused on clinical nutrition and an individuals nutritional status and care at a set point in time – there are an incredible amount of emotional, economical, physical, mental, and psycho-social factors at play. Nutrition is always about so much more than JUST the food.

2. You will have to fight for your place.

Any dietitian working in any clinical care setting will tell you that their job description includes “member of the interdisciplinary care team” (IDT), which means, working closely with physicians, nurse practitioners, therapists, nurses, and social workers in providing care for each individual patient. The degree to which each of these disciplines value and respect your role on the IDT is largely dependent on the individual practitioner/care provider. It will NOT be uniform across facilities, or even patients in the same care facility. As misunderstood as dietitians can be to the general population, their role may be equally misunderstood or misrepresented in clinical settings. Physicians will not always see the value in a nutrition consult. Physicians will attempt to manage tube feeds or TPN’s or blood sugars without consult of the RD. Nurses will not understand your request to see wound care descriptions/photos/treatment plans. Staff will start supplements or attempt to change diets without considering the RD. You must actively engage your care team and stand firm to your expertise in medical nutrition therapy. Your RD credential does not equate to a reputable spot on the IDT. You must use your knowledge, advocate for your patient, and earn your place with every practitioner in every care setting. You must be bold and courageous as well as level headed and friendly. You must be respectful of the intricate disciplines of other IDT care providers. You may also want to consider the occasional cookie plate to your nursing staff, just for good measure ;).

“Dietitians MUST fight for their place in the hierarchy of nutrition expertise in order to effectively advocate for EACH individual, not the masses.”

This point translates to RD’s working in any setting. The misinformation and replication of nutrition minutia is pervasive and unending. With every diet success story, new supplement endeavor, nutrition blog article read, IG “fitness” account, etc. a new nutrition expert is born. While I love for people to be excited about nutrition, educating themselves, taking ownership of their relationships with food and exercise, showcasing their excitement/successes on platforms, bring in extra money with supplement endorsement earnings; I do not love the negative impact I have seen this have on the appropriate use of contextual nutrition science, research, and promotion. A massive disconnect exists between varied health literacy levels, underprivileged populations, “magic pill” seeking audiences and the less than qualified “experts” of social media, the news, and entertainment industry. In the simplest of examples: just because Regina George wore a tank with boob holes does not mean it was a good idea. Just because someone with ___ # of followers promotes x,y,z does not mean it is for everyone. Dietitians must stay abreast nutrition research, education, diets, supplements, and news. We must strive to stay ten steps ahead so we may quickly dismantle the perpetuation of misinformation as we come across it. Dietitians MUST fight for their place in the hierarchy of nutrition expertise in order to effectively advocate for the individual, not the masses. This does not come from a place of pride, ladder climbing, or fame-seeking. It comes from the place that earnestly desires for people to find individual health as it relates to food and nutrition and nutrition related disease…free from the negative, potentially dangerous, impact that poor nutrition information, use, and application can have on health as a whole.

3. You will need to guard against stereotypes and bias.

I vividly remember sitting at my desk after a busy day of assessing 12 patients, preparing to chart on each of them. Most of the patients had a BMI of >35 kg/m. None of them had diabetes. I found my self truly surprised.

As I began to unpack this seemingly simple thought, I realized that in over a year of practice I had begun to attribute disease by weight, prior to actually meeting my patient. I would pull information from charts prior to assessment and would begin to develop assumptions over how the conversation, diagnosis, and intervention would go. Some people, physicians, practitioners would find no error in this. The general population is ignorant to the often intricate reasoning behind someone’s body size. By way of diet culture, people are hardwired to equate larger body size to disease. Some physicians and practitioners become numb to the human INSIDE the body they are treating. They are trained to treat problems and have seen a significant number of people living in larger bodies experience significant health problems. Therefore, they develop a stereotype that attributes all larger bodies with x,y,z disease. They assume the person living in a large body must be over-indulging in the “wrong” kinds of foods, failing to engage in the “right” kinds of physical activity, and are unmotivated to make lifestyle changes. They prescribe blanket recommendations for medications, diet restrictions, and lifestyle choices. Blanket goals for weight loss are set. They expect these recommendations and goals to desirably impact x,y,z disease parameter. When goals and parameters fail to be met with the prescribed recommendations, the assumptions towards this population are perpetuated and the stereotype further ingrained.

This is DANGEROUS. And a disservice to individualized patient care. While I ashamedly admit my own error in the same development of stereotypes, bias, and blanket diagnosis/intervention assessing; I am grateful to have had the experience, recognition, and opportunity to grow as a practitioner {and compassionate human being}. I have a deeper understanding of WHY and HOW these stereotypes and biases develop after realizing them for myself and seeking to stop them in their tracks. It is psychological to allow our experiences to govern our initial thoughts on a subject, yet our experiences cannot be attributed to individuals who are different in every essence of the word. I am better capable to advocate for change. Change in my own personal practice as well as throughout my personal conversations and professional platforms.

I now approach each individual/patient, without any preconceived ideas of what I may find based on their medical chart review or observation of their outward physical body size. Weight is simply a number and aside from a small number of specific pertinent medical conditions, it is not applicable to a discussion or assessment regarding health. You see, we have the science and research that tells us weight is just a number and it’s pervasive inclusion into conversation whether in healthcare or not, has detrimental, negative impacts on individualized health. We also have the science and research that offers us alternative, more effective ways of assessing health than body weight ever will. I can gather significantly more information regarding someone’s overall health by having an honest, open conversation, reviewing labs, and measuring physical function, than I can by a number on a scale.

“You see, we have the science and research that tells us weight is just a number & it’s pervasive inclusion into conversation whether in healthcare or not, has detrimental, negative impacts on individualized health.”

There are not likely enough available characters {or interested readers} to fully divulge everything I have learned in my past 5 years as a clinical dietitian. But my experience with and knowledge of these three points have changed and molded me for the better as a person, a dietitian, and for the health of my patients. I may not be an award winning, book writing, million follower platform RD, but I most definitely am a much better, more compassionate empathetic dietitian and person than I was 5 years ago…and that is #goals in my humble opinion :).

 

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