Professional Development | Feb 19 2020

When you disagree with a physician: A registered dietitian’s perspective 

Doctor Nurse Conversation

Registered dietitian nutritionists are the nutrition experts. We are trained to be the nutrition expert through rigorous education programs, usually unpaid supervised practice training, standardized testing, then routine continuing education to maintain this expertise. Physicians are trained and qualified to practice medicine, which includes the use of nutrition interventions to treat disease or medical conditions.

With the recent paradigm shift in healthcare toward interdisciplinary teams, many physicians and mid-level providers are happy to consult field specific experts such as registered dietitians, physical therapists, pharmacists, or speech language pathologists for their recommendations on specific patients and their treatment. However, physicians do not have to consult dietitians when using nutrition or nutrition support in the practice of medicine.  

So what happens when you, the rightful nutrition expert, have a different opinion than the physician about a nutrition intervention? What happens when it moves beyond opinion and a physician implements a nutrition intervention that is not evidenced based? For some RDNs, this is a rare occurrence. For others, this happens almost daily. A common example is the use of parenteral nutrition when enteral nutrition is indicated according to evidenced-based practice, such as a functioning gut. How do you navigate this? 

Here are some practical tips to help bridge that divide:  

Respect the physician. The training to become a physician is extremely rigorous. The work they do to care for patients is tough. The knowledge they have to maintain is vast. You are the nutrition expert, but you are not a physician, so respect the work they have done to earn their credentials. You can respect a person and completely disagree with them at the same time.  

Establish a relationship. Try to introduce yourself and communicate personally to any physician you disagree with. Explain why you disagree, provide an alternative, and welcome a dialogue about this issue. This is very different than just telling someone what to do.  

Speak the language. Know fully what you’re talking about. Find out what resonates with that physician – is it research? Another facility’s protocol? Evidence-based guidelines? Find out what resources the physician would need to change his or her mind then provide those resources.  

Document your recommendation. Always document your recommendation but never throw another member of the healthcare team “under the bus.” Your note can say, “Recommend XYZ, physician notified” and leave out a description of the conversation or disagreement. You are responsible to recommend appropriate nutrition interventions. Whether or not those recommendations are implemented is outside of your scope of practice.

Ultimately, everyone on the healthcare team has the same goal—to provide the best care to the patients. There are always multiple ways to approach a problem and medicine is no different. Evidenced-based guidelines give us structure in making our nutrition recommendations, but ultimately the physician is responsible for all the medical care provided to the patient. Work hard to establish your role on the interdisciplinary team so you can shine as the nutrition expert in your place of work!  

Dietitians On Demand is a nationwide staffing and recruiting company for registered dietitians, specializing in short-term, temporary and permanent-hire positions in acute care, long term care and food service positions. We’re dedicated to dietitians and helping them enhance their practice and excel in the workplace. Check out our job openingsrequest your coverage, or visit our store today!

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About Courtney Lee

Courtney Lee, MS, RDN, CLT, CFCS has a virtual private practice specializing in personalized nutrition and anti-inflammatory diets. She loves helping people use nutrition to change their lives and enjoys empowering other RDNs to do the same!

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