A Dozen Lessons in a Dozen Years of Being a Registered Dietitian

 

I have been a registered dietitian for almost exactly a dozen years, which makes me want to write something to commemorate the occasion. Without further adieu, here are the top 12 things that I have learned in the past 12 years:

  1. It’s not really about nutrition a lot of the time. What is it about? To name a few: poverty, stress, abuse, addiction, grief, food deserts, access to healthcare, and emotion. To expect anything else is simply unrealistic.
  2. When it is actually about nutrition – it’s all about numbers, so get your calculator ready. If you are in a dietetics program, it doesn’t take long before you begin to think it terms of grams, ounces, milliliters, milligrams, International Units, and Daily Intake figures. If you work with nutrition support patients, just give up the idea of thinking in words during the workday.
  3. Health conditions travel like pack animals – you will rarely find one alone. This is why I get genuinely upset when I encounter a dietitian who doesn’t do a really thorough review of a patient’s health history. Shadow diseases are health conditions that tend to appear together, such as migraines and stroke or heart attack, endometriosis and melanoma, and hypertension and diabetes. If you can figure out a diet for one, you’ll also help to treat or prevent the other one. There are a lot of other pairings that you won’t find in the research, but that you’ll find often come and go simultaneously. If the idea of reading a medical chart pretty thoroughly, researching things you’ve never heard of before, and continually learning doesn’t interest you…clinical dietetics is probably not the right path for you. There’s nothing wrong with that and there are lots of other things that you can do within the field of dietetics that are of great value.
  4. It is crucially important to stay on top of not only legitimate clinical guidelines and research, but also all of the crap that your clients are reading and talking about. Guess what I found out today? There’s something called a Taco Cleanse. Really.
  5. Everything that you learn and experience will transfer and be useful later on (maybe much later on, so be patient). You won’t always think so, though. When you’re: ordering food for a Holiday dinner for 300 patients on a wide variety of diets, writing an RFP, explaining diabetes to a scared 7-year old, talking to an insurance broker about incentives, writing a menu for a vegan prison inmate, or taking a group of 20 unruly people on a grocery store tour…you might not really feel like you’re going to be able to call upon this particular experience later. Then one day, you’ll be doing some other job task and it will occur to you that it’s all related in one way or another. Weird. This is called getting old.
  6. Most people know how to eat a generally nourishing diet or what to eat to lose weight. They probably don’t like it much, because it’s NOT fun, but they know what to do. Ask anyone and they will tell you – eat unprocessed foods, fill up on fruits and veggies, don’t inhale potato chip crumbs or use cupcakes recreationally…if you let them talk, they know exactly what to do. They just don’t know how to do it and they don’t need a lecture; what they need is a tool – so give them a tool. Even if they don’t know a darned thing about a complicated condition and the appropriate diet for it, only about 50% of your entire conversation should be about “what”. The other half needs to be strictly geared towards “how”.
  7. It is our job as dietitians to be able to assert ourselves while both explaining and demonstrating our knowledge and skillset. It is our challenge to do it without coming across as super defensive. If Bob over in accounting thinks that you spend all day playing with pretend food and baking bran muffins…really, at the end of the day, it’s no skin off of your back. You don’t have to prove anything to him. This won’t become easy, but it might get easier.
  8. You can’t motivate anyone and that is a really tough thing to come to terms with. Motivation has to come from within. You can spend all day explaining to someone that they could lose a foot, die, have a stroke…it’s not going to make them jump up and change their lifestyle unless they’ve already decided to do so before coming to see you. Also, why are you trying to scare people? Do you somehow think that’s going to help them? Let’s be honest here – it’s not going to help them. It is going to make them hate you, though…so if that’s your goal, carry on.
  9. Everyone is doing something right. There will be days when you meet someone and think, “this person is doing everything completely wrong”. Dig deeper and then just keep on digging until you hit gold. Do they rarely eat at restaurants? Avoid fried foods? Eat whole grain bread? Consume a lot of fruit? Cook with fresh herbs and lots of spices? Not drink too much alcohol or soda? Eat very little red meat? Get some physical activity every day? It’s easy to focus on everything that someone is doing wrong, but it’s more important to start the conversation by finding something that they are doing right.
  10. College does not prepare you for how sick people can become (and at how young of an age it can happen). If you’ve led a pretty peaceful life and have never encountered chronically ill people with multiple comorbidities, it can be jarring to see exactly how badly things can go. If you choose to not read the medical charts or connect with the patients at all, you can easily go into denial if you wish. If you walk into the hospital room, wave some papers around, recite your little speech about diet, and hand them your card as you exit the room (knowing that they will never, ever call you), you can continue to live in this bubble for an indefinite amount of time. Not a good idea.
  11. You might as well just get used to saying, “I don’t know the answer to that, but I will find out” ten times a day. It is amazing and somehow inspiring (if not a touch disconcerting) to realize just how many really unexpected and unusual questions people can throw at you. You can prepare and over-prepare and someone is still going to ask you a question that completely floors you…just get used to it.
  12. Here’s the scary truth about research – it’s not worth much a lot of the time. Bias, emotion, flawed research design, variables left unaccounted for, industry backing, poorly written press releases…a lot of things can go wrong. The gold standard of all research, the meta-analysis, is only useful if it’s scrupulously conducted and includes a large pool of studies. Don’t get caught up in uncivilized arguments about research – nothing good ever comes of these sorts of fights. For every study that you pull out that “proves” something you believe in, someone else can go and grab another one that “proves” the opposite.

These are the sort of lessons that you don’t just learn once. Just when you think that you have it down, a situation will present itself that makes you review what you thought you already knew.

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