Until a decade ago, most dietitians were thought of as “food service people”. E.g. they didn’t so much see and diagnose patients as they helped get them the right meal, with the right consistency, at the right time.
Granted, that component of Dietetics is very much alive and well, despite the hopes of many a new Dietitian. I think there’s a huge disconnect between Dietitians who want to be “Diet Doctors” so to speak, and those who understand that in many respects, Dietetics is a branch of foodservice. Within the hospital, we are the mediators between what the patient wants (tasty food), what the patient needs (nutritious food), and what the doctor wants (easy food). Trying to say “we’re too good for food service” is akin to saying the architect of a building is too self-righteous to deal with the construction crew. Certainly a good way to isolate yourself from the rest of the medical team.
All that being said, it is more common nowadays to see dietitians sitting in their “ivory towers”. No longer integrated with food service, not yet unified with the doctors and nurses.
Which brings me to my next point, where the profession is heading. In many respects, the profession is headed in all directions.
In California, the auditing agency CMS (Centers for Medicare and Medicaid Services) has recently decided to encourage all Nutrition and Food Service Directors to carry an RD credential. Good for Dietitians, bad for the rest.
This is actually great news, because it means that the whole system, from nutrition diagnosis to tray, will be appropriately integrated. I suspect the statement “As California regulates, so regulates the nation” will hold in coming years.
As far as Clinical Dietitians go, the industry is pushing a medical nutrition therapy system that allows appropriate coding (and subsequent billing) for care. What this means is that a code for “Diabetes” gets treated with a specific plan of action, diet, education, and needed supplements. This benefits both patients and Dietitians because it means better justification of our service, and more thorough care for the patients.
Lastly, the Consulting Dietitian. This is the part where non-dietitians can tune back in, the part that could actually affect you. It has long been my hope that the future Dietitian will be seen more like a Dentist than anything else. Not in the sense of “Awesome… another painful appointment”, rather, people will visit them once or twice a year for a checkup.
Imagine a world where every six months people visited their family Dietitian, had their diet analyzed, their blood work interpreted in terms of nutrition, and sent home with nutrition prescriptions. So long as insurance companies would get on board with reimbursing Dietitians, they could even integrate the service with private MD practice.
Visit your Doctor, get blood work, get a prescription, talk to the Dietitian, get a diet/supplement recommendation. Bam! That is the future I want to live in. Medicine and Food working together, to help the patients meet their goals.
And I think it’s happening, but not without birth pangs. Change like that takes decades to come to fruition. Regulations have to change, the nursing union has to loosen it’s grip, health care has to understand the benefits.
It could very well be easier to change peoples behavior then fighting uphill against the agencies meant to “protect” them.
Be good to each other.
– Joshua Iufer, RD