Do you need a dietitian? I received tons of emails about what I think about patients who don’t follow diet advice. And that opened a whole can of worms. Should I study more? Should I hire one for the practice?
Before we get into this there are a few things we must address, doctors don’t get a lot of nutrition education during medical school. We study lots of biochemistry which is how molecules work in the body, their interplay, and how drugs affect them.
We’re programmed to be reactive. Nutrition factors in more along bedsides in hospitals but OPD’s and private practices focus on the temporary. But otherwise we’re not trained about food.
How you can work better with a dietitian?
Learn Yourself
Once I shifted to practice, I realized I was seeing far more chronic care. That required more education on diet and I took a few courses just to get the basics right. There was a paper on this subject, that clearly shocked everyone, “How can doctors not be required to know about nutrition?” You may want to take a look at it.
I’m one of those people who has come to understand that food is medicine. You are what you eat. And once you take care of the diet, a quarter of the problems can be taken care of.
Work with a dietitian
I asked Sheba Syed, a nutritionist about the difference between a nutritionist and a dietitian. She tells me, “MSc or post graduate folks in Food Science and Nutrition can call themselves nutritionist. Those who clear RD i. e Registered Dietitian exams are basically Dietitians.” There are plenty of people today calling themselves ‘nutrition experts’ today. Be careful about whom you hire, but you have to work with one. I feel this has changed the way my patients respond for the better, with tailored diets that are suited to their likes and dislikes. This is a very good investment if you’re seeing lots of chronic care.
No ONE SIZE FITS ALL APPROACH
There is really no one size fits all approach when it comes to food. I cringe when people show me they’ve been given some pamphlet with diet information by a doctor and told to follow this. The compliance to this is low. I understand we all want doctors to spend more time with patients and even more time being glorified receptionists filling reams of paperwork. But you need to tailor things.
I recall one DM patient not keen on diet. He kept saying, “there are so many foods, what is good and bad, how am I supposed to know?” So I prepared a list of high glycemic index and low glycemic index foods. It took me a while but I handed it to him. Days later he said, “My wife fixed it on the fridge, the diet is being executed at home, we just look at the list and avoid the foods that are bad for me.” Yay! A small step but a step in the right direction.
WHO’S TOP DOG
I hate it when medical decisions are “who can piss farther” contests. The best dietitians are the ones who are willing to discuss cases with you. Those who are open to your feedback. Because while they’re working with food, you’re factoring in medication. So don’t get into this top dog contest.
Retain dietitians who understand your goals for the patients, who can take a step back and look at the whole picture. Someone who wants to partner with you. At this point, I’ve studied a lot about diets, because I’m using it so often with patients and myself. So I know when someone just wants to play games and someone has the patient’s best interest at heart.
Sit in on diet consults
I usually sit in at the end of diet consults because that reinforces the message. Sometimes people especially the elderly, tend to brush off the dietitian as a waste of time. So I have a system. First, when my consult is over to hand off patients to the dietitian so that the patients know I’m endorsing this person. And then I go over at the end and sit in to make sure the patient understands everything, has questions and repeat the goals I have set. The compliance is much higher when patients see this unifying force and then tend to take it seriously.
FOLLOW UP IS KEY
This is a must. When I do general follow-ups with patients I ask about the diet. If there is a problem, then I ask the dietitian to reevaluate everything, because now I need to reevaluate my goals too. Its a good time to tweak and fine-tune the system. Effective followup will ensure long term results. So have your dietitian call or email the patient to find out how they’re doing with the diet.
Back up with Stats
You need numbers. You can’t say you’ve got to lose weight. No.
Lose 1 kg/ per two weeks, so that we hit 75kg weight in x time. Or A1C’s have to be x. Or TG’s should be Y.
You have to set goals with the numbers and back it up with numbers on the lab tests or metrics. If they don’t see progress, you’ll be going nowhere fast.
Motivate
Half of this diet process is about mindset. It requires a huge cultural shift where its okay to binge drink in the weekend. NOT. Or its okay to do a mukbang when your friend comes over and your cholesterol is touching the sky. Watch the cooking channels and you can see how outrageous food has become. The shift to a more healthier diet is going to be monumental. So motivate. My practice always send weekly motivattional stuff in the newsletter to make sure people are reminded they’re doing something good.
I hope this answers your questions. I know some will ask which diet is better and all that. I’d say follow the rules, if you’re not making headway, look at alternatives. I’ve started considering keto diets for DM patients but don’t keep them too long on it, factoring its effect on the kidneys. So be open and read, extensively. There’s lots of debate about the role of doctors and nutrition.
But you need to consider food as medicine and what role diet is playing in the disease cycle. I hope this helps answer the diet questions. I know I’m doing these questions slowly. The last one I posted was on the GDPR affects doctors back in May. But as you can see I wear many hats. With the podcast and three books coming out this year and quite a few for next year, I’m juggling things precariously, with a medical writing business and practice. I hope to do more of these, but I apologize for the delay.
Have any questions? Do you work with a dietitian? What are your tips?