If you’re ready to become a great nutritionist, there’s nothing more important in clinical nutrition than being able to justify your MNT decisions.
Becoming a great nutritionist
Picture this: You’ve just walked out of your office after spending a very long hour reading your new admit’s chart.
You’ve combed through the MD notes. You’ve reviewed the labs. You even read the notes from your patient’s previous admission, along with ALL the last dietitian’s notes. You are CLEAR what needs to be done to support your patient.
Now you’re up. You’re rubbing your head like you just finished taking an organic chem exam, because the resident heading up your patient’s team hasn’t returned any of your 4 pages. Which means you will have to do a face to face. And the stress of knowing they’ll question your recommendation, is making your lab coat feel a little tight.
The practice of being a good dietitian is something we have to learn as we become a nutritionist.
There were no classes in grad school on how to talk to doctors. There were barely any classes on how to talk to PATIENTS.
But this has to get done or your patient doesn’t get fed.
So, what do you do? You come prepared to justify your argument.
Remember that clinical nutrition is variable
If you ask 10 good dietitians how they would treat a complex patient, my guess is you’ll get about 10 variations of the same recommendation. 75g of protein instead of 80g? Sure. A low sodium diet instead of a low sodium AND low-fat cardiac diet? That can work.
This kind variability is why being able to justify your treatment decisions is so important.
If 2 dietitians looking at the same patient with the same information can create 2 different sets of MNT recommendations, you MUST be able to explain why you’re making the decision you’re making. Then you need to be able to back it up with medical references (lab work, current or past diagnoses) or information from an in-person visit.
Want an example? Here’s what justification might look like if you wanted to give your patient on HD (hemodialysis) a banana.
- Clearly state that your dialysis patient hadn’t eaten in the 2 days since they were admitted to the hospital and was refusing everything except a banana.
- You checked their K+ levels, made sure they were on a high protein, renal diet and was receiving Nepro TID.
- And then you approved their banana.
Case closed.
You are THE nutrition professional
Never forget that doctors are just people. It’s not guaranteed they’re going to be smarter than you, older than you or more even thorough than you.
What do doctors know about nutrition? Likely not much.
Most med students get about 20 hours of nutrition education in 3 years of med school. So a good rule of thumb is to assume they DO NOT know more than you about your patient’s nutritional status. There’s about a 99% chance that YOU know more than they do about nutrition.
The same way a cardiologist or gastroenterologist are specialists, so are you. And the same way those doctors make their recommendations known, so will you.
You might get some push back or a few pointed remarks about what they imagine is best. But remember, when it comes to nutritional status, feeding needs and healing – you are the expert in the room.
Wear that badge proudly and loudly. And then push back when you know you’re right. This is what a good nutritionist does.
And That’s It!
It almost doesn’t matter what kind of MNT you plan to use when supporting your patient.
What matters – maybe the ONLY thing that matters – is when you document your care plan, will everyone understand your reasoning. Because what goes in your documentation is the same thing you’ll say to the doctor you’ve spent an hour hunting down.
The other half is being able to justify your argument. This is what great nutritionists do. This is where you’ll start to shine. You got this!
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