Nutrition Support Blog: Prepared as Medical Professionals for Inevitable Conversations
“Be Prepared” is the motto of the Boy Scouts, and between my scout training and reading Jack London in my formative years I won’t even go for a day hike without being equipped suitable for a polar expedition.
Unfortunately, in many other areas of my life I have a terrible tendency to just “wing it” and let the chips fall where they may. Shortly after starting my first job as an RD I had a conversation with my old graduate school roommate, who had just completed his PhD in psychology, and we discussed our transition from students to “real people” with jobs and new responsibilities. When I described my work in the ICU, he asked me (knowing my “wing it” tendencies) about my strategy for dealing with the stress of working with critically ill patients that had a relatively high mortality. I jokingly responded “Intense workouts, as usual,” but his comment made me realize that I had not even considered the possible effects of such an environment. My friend knew that being prepared for difficult situations and conversations was important – both for me and for the benefit of my patients. Inevitably, working with nutrition support, I found myself involved with patients and families in unfortunate and difficult circumstances that I was not adequately prepared to handle. Although there is no substitute for life experience and compassion, a little advance preparation and education can go a long way towards avoiding uncomfortable mistakes and helping everyone involved cope.
Certainly, nutrition support professionals do not interact as intimately with death and dying issues as many physicians and nurses do. However, over the past 25 years I have interacted with a variety of patients and families dealing with end of life or the, “should we place a feeding tube” type issue – especially as I became involved with home nutrition support and clinic patients who we have worked with over several or many years. My dietetics education was woefully inadequate to prepare me to be helpful to patients and families, or to help me cope with that kind of environment.
Conversations with RDs who work with oncology, ALS, cystic fibrosis, neonatal and many other types of patients made me realize that many medical nutrition professionals find themselves in situations where they had to learn how to function with little or no preparation. They learned, “by the seat of their pants” on the job, and sometimes, by doing it badly, crying about it later, and making a vow to do better the next time. Inadequate preparation to deal with the stress of very sick and dying patients is also one possible contributor to the high turnover in some clinical positions.
Part of the reason why we do not get advance training is that medical nutrition therapy is only one facet of dietetics, and there is just no way to fit in the degree of class work required to prepare us, and still find room for all the critical information we need about scoop sizes, No. 10 cans and crystallization of sugar solutions. There is, perhaps, some consolation that most physicians decry the limited curricula on death and dying in many medical schools, and only in recent years have some institutions started to modify their programs:
However, just because other professions still have room for improvement is no reason why dietetics should not do a better job of preparing medical nutrition professionals. Now that we are on the verge of an upgrade to our educational requirements (see my February 28th blog), it is time to consider including the type of courses that medical professionals need – including dealing with something we will all, inevitably, face someday. While there is no way to get everything that we need in a classroom to help our patients, families, and ourselves cope with these issues, doing as much as we can while we are in school, and sharing what we have learned from our good and bad experiences is a start. Be Prepared is as good advice for nutrition professionals, as it is for Boy Scouts.
While I don’t know that there are any “perfect” questions – this is worthwhile reading:
“Be Prepared... the meaning of the motto is that a scout
must prepare, by previous thinking out and practicing how to act on any
accident or emergency so that he is never taken by
- Robert Baden-Powell (founder of Boy Scouts)
Hobbes: “Are you making any resolutions for the New Year?”
Calvin: “Yea, I’m resolving to just wing it, and see what happens.”
Hobbes: “So, you’re staying the course?”
Calvin: “I stick to my strengths.”
- Calvin and Hobbes, Bill Watterson