Should Doctors Learn Nutrition? (On hiring subcontractors)

Disclosure: I’m a dietitian. My sister is also a registered dietitian. My brother is a physician (Emergency Medicine). My sister-in-law is a physician (board-certified allergist)

The Right Person for the Right Job

My husband and I were taking a walk around the lake near our home recently and I was telling him about how some people think that medical students should be taught more about nutrition. While I see the utility of doctors understanding the basics of nutrition, I was trying to think of an analogy of why I think it’s as important that doctors be taught when and why to refer to Registered Dietitian Nutritionists, trained in medical nutrition therapy. My husband said, “Well, it’s kind of like when we remodeled the house. John, (our general contractor) was responsible for the whole project but there were aspects of the remodel that he subcontracted out…electrical wiring and plumbing were jobs that he hired others to do because he knew that they had more expertise and had the skills and tools.” That’s it I thought…doctors should be referring patients to dietitians to subcontract nutritional care because we have the skills and tools and are specialists!

What often happens in Real Life

Twenty years ago when I was a clinical dietitian in the U.S. Army working at a small Army hospital in South Carolina, I found that doctors fell into 3 categories:

1. The doctors who frequently did consults to dietitians so we, as part of the treatment team, could help address issues like underweight, overweight, special dietary needs, food allergies, problems with digestion, tube feedings, parenteral nutrition etc. Often these consults were generated by issues flagged at admission, or when a medical history was taken or after various surgical procedures.
2. Physicians who had to be asked or reminded to write a consult to dietitians.
3. Doctors who ignored dietitians.

The Making of a Dietitian

Many people don’t realize the amount of education Registered Dietitian Nutritionists have.

• At least an undergraduate education with many classes in anatomy, biochemistry, food science, organic chemistry..
• 1200 hours of a dietetic internship. ( Getting an internship is intensively competitive. Only about 50% of those that apply for internships are accepted.) During the internship dietetic interns complete competencies in clinical, community, food service and administrative rotations.
• Must pass a multi-hour nationally administered board exam.
• Required to complete and submit annual continuing education.

Unreasonable Expectations vs Subcontracting

So, how could a medical student, with all of their required course work, internship and residency, add additional time and hours to provide them with the experience necessary to counsel patients in nutrition? Could they be expected to spend the time to ascertain the nutritional needs of someone with Type 1 diabetes, provide them with information on carbohydrate counting? Would they know the nutrition profiles of supplements and be able to determine the best supplements for patients with difficulty eating or swallowing? Do we expect doctors to counsel patients in exercise techniques or social work? Provide physical therapy or dental care? No, medical residents and physicians are taught and know to “sub-contract” out to physical therapists, social workers and dentists…and they should also be taught to refer patients to dietitians.

Bottom Line — Know your Dietitian

Instead of expecting or demanding doctors to learn more about nutrition. Let’s encourage them to be team players and recognize the value of “subcontracting” to Registered Dietitian Nutritionists as the experts in medical nutrition therapy.