Five Surprising Truths I Learned During My Dietetic Internship
Before my dietetic internship, I remember reading website after website in efforts to prepare myself for the next 10 rigorous months. I feel like I read every dietetic intern blog post, collected a binder of calculation sheets, and watched numerous vlogs that painted the internship as a battlefield (it’s not). Despite putting hours into preparation, I found myself continually reframing my perspective and drawing lines through preconceived notions. Here are five surprising truths I learned during my dietetic internship:
1. You won’t have as much time with your patient as you would like
I’m starting off with this truth because it’s the one I struggled the most with during my clinical rotation. As much as dietitians would like to spend an hour connecting with every patient, there simply isn’t enough time in the day when you’re in an acute care setting. Researching patients’ medical histories, sifting through medications to account for drug-nutrient interactions, calculating tube feedings, and writing admission/follow-up notes are just a few of the “behind the scenes” tasks of a clinical dietitian. It’s important to remind yourself that your job in acute care is to plant the seed when it comes to diet education. Patients in acute care are likely to be overwhelmed by a detailed lesson and motivational interviewing session. Clear and concise communication goes a long way in the hospital.
2.Weight loss is not the focus
While weight loss may reduce an individual's risk of developing type 2 diabetes, hypertension, cardiovascular disease, and some cancers, we aren’t excited to see it in an acute care setting. This is because rapid weight loss is a sign of muscle deterioration, not fat loss. While a long-term goal of the patient may include weight loss, an acute care dietitian focuses on SMART goals that will improve the patient’s health status while hospitalized. Shifting our focus from weight allows us to view a patient’s health with a more objective lens and tackle nutrition issues head-on.
3. Size is not synonymous with health
The impact of weight stigma can undermine an individual’s health by promoting disordered eating behaviors, increasing one’s risk of depression, and decreasing one’s self-esteem. Time and time again, I’ve had patients who were excited by their weight loss, even if it was due to uncontrolled diabetes or cancer. I’ve also had patients who were upset that they have gained weight in the hospital, despite having a huge improvement in lab values. There is so much more to health than one’s BMI. Adjusting our perspective to celebrate body diversity and challenging cultural assumptions of health helps us become more ethical and unbiased professionals.
4. Meal plans are not the way to go
It seems as if every blogger is designing “life-changing” meal plans for their clients to purchase. While meal plans are a useful tool to give individuals an idea of what an average day of eating should look like, they are not effective for long-term lifestyle changes. Meal plans only offer one way to eat and turn a blind eye to the hundreds of substitutions with similar macro and micronutrients. It’s more important for a client or patient to understand how to build a healthy diet and function autonomously than to rely on a one-size-fits all plan. As much as we would like to change sub-optimal habits with the snap of our fingers, maintainable lifestyle changes take time and patience.
5. Roll with the resistance, don’t run from it
Although we read nutrition research for fun (I know I’m not the only one), not everyone is excited to talk to a dietitian. I’ve had patients blatantly reject my offer of giving a diet education. When this happened the first time, I just walked out of the room unsure of what to do next. While it’s important to honor the patient’s request, it’s also important to understand why they don’t want to see you. Reflecting the resistant statement or tone is an effective way of gaining more insight to why the patient is oppositional. Addressing the resistance appropriately can have a profound effect on the relationship you have with your patient.
Just like the nutrition field, I feel like I’ve grown and changed so much during these nine months. If you’re nervous about starting a dietetic internship, remind yourself that welcoming change and the obstacles that come with it is what makes life so exciting!