Med-Surg, Outpatient, and Change, Oh My!

Boy has this semester flown by! I am officially 1/3 of the way done with my Dietetic Internship and Monday is my last day of class for the semester. Last week marked the end of my general medical-surgical (med-surg) rotations in the hospital, which were a total of eight weeks: two weeks in cystic fibrosis and telemetry, two weeks in geriatrics and trauma step-down, two weeks in cardiac, and two weeks in bone marrow transplant. While I liked some rotations better than others, I honestly didn’t love any of them. Most of the time I was seeing patients due to unintentional weight loss and decreased appetite (both of which are major issues in the hospital). Unfortunately, the standard of practice for these patients is to recommend using high calorie/high protein supplements (which are filled with sugar) and encourage high calorie foods. I also didn’t feel like seeing a patient for 10 minutes, one or two times during their hospital stay really made an impact on their health. I wasn’t encouraging them to eat healthier or make better food choices in their daily life, I was just trying to manage symptoms and ensure they could be discharged as soon as possible. Besides all these dislikes, I did learn that I loved doing calculations for enteral and parenteral nutrition (feeding via a tube or IV) in patients that couldn’t eat food orally.

The past week I have been in my adult outpatient rotation, and I have absolutely loved it so far (which is very reassuring after not loving my previous eight weeks). My preceptors are amazing and I definitely see it as an area I am interested in working in in the future. You get to spend so much more time with the patients and it is exciting to see them learn and make progress with improving their diet. I have also learned a little bit about integrative and functional medicine, which also sparked my interest. It is a growing field and focuses on a mix of different eastern and western medicine techniques, plus uses food as a method of healing different types of diseases.

With all of my experiences this past week in outpatient, I thought I would share a few words of wisdom (per usual). It has been exciting to see all of these patients be so eager and motivated to make change (which is definitely different from the patients in the hospital). But, at the same time, change is difficult and it requires work. You can’t expect to just show up and meet with a dietitian and, poof, you start losing weight or controlling your diabetes. The same thing goes for reading my blog. While I love that people are reading my posts and I am able to share information, reading doesn’t translate to results. In fact, we only remember about 10% of the things we read. In order to make positive changes, you have to take the information you read and hear, and put it into action.

Since this post is getting a little lengthy, I’ll leave it at that for now, but I’ll share more about making changes in my next post!

Internship Update: Finally Time for Clinical

Last Friday marked a very exciting day…the last day of my food service rotations in my Internship. After 2 long weeks in the kitchen cutting fruit and making sandwiches, 1 week in the storeroom and purchasing, and 3 weeks working with a patient meal service manager, I am finally on to my clinical rotations!

As much as I don’t enjoy food service and could never see myself working in the field, I did have some valuable experiences. I learned just about everything there is to know about what patients can order, how patients order, where their food comes from, how it gets to them, and everything in between. As a dietitian, I can definitely see why it might be important to know what options the patients have while they are in the hospital.

Having my food service rotations first gives me good background knowledge on how the nutrition and dietary departments run, and I think I am well equipped to give patients meal recommendations based on their individual diet needs. I guess that I one perk of getting food service out of the way at the beginning (and I am glad I never have to put on another hair net again!).

Now, I have just finished day 2 of my clinical orientation. Day 1 was learning a lot about the electronic medical record and how the healthcare system works, but I am quickly getting the hang of it. My preceptor covers telemetry, general medicine, and adult cystic fibrosis floors so I have seen quite the variety of patients so far. I got to do my first note on my own today, and diagnosed a patient with moderate malnutrition. The patient’s doctor agreed with my diagnosis, which means the hospital gets reimbursed for my patient visit. I also feel very official (and old/not smart enough) wearing my white lab coat around 😉

That is pretty much all that is going on in the hospital. October is my busiest month with class work so I have been a busy beaver working on all my assignments every day after work. That unfortunately leaves me little time for any new recipes, but I have been enjoying a super simple (and of course, healthy) spaghetti squash bowl for dinner. I just mix spaghetti squash, steamed broccoli, peas, and chicken or ground turkey with some pasta sauce and wah lah… dinner is served.

Internship Status: Week 9/49

Nutritionist vs. Dietitian

One of the most common things people ask when I tell them that I am a nutrition major is… “Oh, so you want to be a Nutritionist?”. Well, not exactly; I want to be a Registered Dietitian (RD). There is a difference and it is important to understand this difference to know where to get reliable nutrition information.

Anyone can call themselves a Nutritionist. There is no education, class, test, or experience you need to be a Nutritionist, so theoretically we are all Nutritionists.

In order to become a Registered Dietitian, it gets a little more complicated. Registered Dietitians are food and nutrition experts that are certified by the Academy of Nutrition and Dietetics. To be an RD, one must complete a bachelor’s degree, Dietetic Internship, and pass a national exam.

A Dietetic Internship is 1200 hour supervised practice program that is accredited by the Academy of Nutrition and Dietetics. To be eligible to apply for this program, one must complete the DPD (Didactic Program in Dietetics) classes. These include Nutrition classes along with Microbiology, Organic Chemistry, Statistics, English, plus many others. The DPD program is usually completed at the same time as a bachelor’s degree, which is the point in the process that I am at now.

Once accepted to a Dietetic Internship, one completes different rotations in three areas: Clinical Nutrition, Food Service, and Public Health/Community Nutrition. Depending on the internship, different amounts of time are spent in each of these three areas. Once one completes the Internship, he/she is eligible to sit for the national exam to become a Registered Dietitian.

Besides boring you to death with my education plans for the next few years, the point of this is so you understand where nutrition information is coming from and how accurate it is. Books and articles that have authors who put “Nutritionist” in front of their name may not contain the most reliable information. Those who have RD (Registered Dietitian) or RDN* (Registered Dietitian Nutritionist) after their name have gone through extensive coursework and are probably sharing more accurate and trustworthy information. For now, I am just a Nutritionist but give me a few years and hopefully I will be Dana Goldberg, RDN!

*RDN is a new title that is being given out in place of RD. They are exactly the same thing just different words.