Nutrition Support Blog: Courage, and Being a Clinical Dietitian
September 22, 2011
Recently, I found a worksheet from an undergraduate Food Science course among some old papers. It was a lab on crystallization in foods, with the stated purpose of “finding the interrelationship between boiling temperature of a sugar solution and the firmness of candy.” I hung it above my desk to remind me of what I had to endure to become a Registered Dietitian. Granted, this does not compare with crossing open ground under enemy fire, or standing for hours in the OR delaying micturition while retracting organs. Nevertheless, there are all kinds of courage, and sometimes the most mundane labors can be the most difficult to endure.
Clinical dietitians must have a compelling sense that nutrition is important to get through the “food for 50” portion of our education in order to become registered as the legitimate medical nutrition professional. However, what follows once you start work as a clinical dietitian can be even more daunting because you soon realize that during the time you were planning the layout for a hospital kitchen and learning how many servings are in a number 10 can, what you were not getting was a course in pharmacology, endocrinology or an in-depth understanding of GI anatomy and physiology, and some of those other trifling details necessary to understand what is happening with your patient. Clinical nutrition professionals that I know who wanted to be a credible, contributing part of the medical team have learned much of what they really needed by working with a physician or other experienced clinicians to complete their education.
I have been extremely fortunate to work with physicians possessing gifts of both intellect and teaching skills who were willing to expand on my education, and even retrain me where necessary (what do you mean “prealbumin is not a marker of nutrition in the ICU?”). I was equally fortunate to have co-workers that shared an interest in learning and conviction for the importance of nutrition.
In addition to discovering that I needed to do some double-time education once I started work, what I also learned was that there was an even greater need for competent clinical nutrition professionals than I realized. Early on in my career, physicians who made statements that an obese postoperative patient, “could go for weeks without nutrition,” or trying to start TPN with 60 calories/kg in very malnourished patients to “beef them up quick” were among the many eye-openers of the importance of our role. Attempting to actually change outdated nutrition support practices required more courage and even greater expertise--courage to question the status quo, or speak up on rounds, present to a roomful of gastroenterologists, or even to ask questions at times.
Eventually, it became apparent that nutrition clinicians who had earned credibility and built respect for evidence-based practices could affect change for the better, and just maybe in the process, alter perceptions of what a clinical dietitian was and did. Realizing that some of these changes have taken hold makes it feel worthwhile, and passing on what we have learned the natural next step. There are still barriers and frustrations – especially about misperceptions of what the clinical nutritionist is and does. Some days take more courage than others, but what we do is important enough to get through the hard parts, whatever they are. I would encourage everyone to accept the challenges, agree to the talks, start the research, submit the poster, write the article – to do the very thing that makes your leg tremble a bit and puts a shake in your voice, because in the end THAT is what makes it worthwhile. Meanwhile, can we agree to keep our knowledge of cantilever shelves, Maillard browning and No. 10 cans our little secret?
"At times, although one is perfectly in the right, one's legs tremble, at other times, although one is completely in the wrong, birds sing in one's soul." --V. V. Rozanov
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