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Connect the Patient to the Expert: Referral to a Registered Dietitian Nutritionist
LETTER
Connect the Patient to the Expert: Referral to a Registered Dietitian Nutritionist To the Editor: The Commentary “A deficiency of nutrition education in medical training”1 correctly points out longstanding issues affecting physician education, patient treatment, and issues of cost and reimbursement for nutrition care. Each of these issues can be appropriately addressed through a team setting—a critical member of which is a registered dietitian nutritionist (RDN) providing medical nutrition therapy. We members of the Academy of Nutrition and Dietetics agree that the nutrition competency of physicians should be more adequately addressed both in their educational training and on an ongoing basis, particularly as nutrition science evolves. An excellent starting point is interprofessional education that includes medical students and dietetics interns, among others. It is unfortunate that the American Association of Medical Colleges does not include tracking exposure to dietetics; we call on medical educators to include dietetics to meet their interprofessional education competencies. Physicians need to stay up to date on recent scientific information regarding nutrition, but they realistically do not have time to provide patients with the depth and breadth of medical nutrition therapy provided by an RDN. Studies confirm positive outcomes and cost-effectiveness of medical nutrition therapy,2 and recent surveys show that the public recognizes RDNs as a credible source of services.3 Moreover, increasing numbers of third-party payers are reimbursing for RDNs’ services. Because the optimal approach to keeping people healthy involves a team effort, we encourage physicians to include RDNs as part of their team, either in their offices or via referral. Patients correctly view physicians as a trusted source of information and treatment, and physicians need to determine the nutrition and obesity prevention and treatment messages they have Funding: None. Conflict of Interest: None.
0002-9343/$ -see front matter Ó 2015 Elsevier Inc. All rights reserved.
the time and skill to provide to their patients.4 However, there is an important difference between advising patients on the basics—promoting lifestyle changes and adopting a healthy diet, which most MDs, physician assistants, health coaches, and other professionals can do—and the counseling provided by an RDN who has the knowledge and skills needed to help individuals make changes that can impact outcomes. Referring patients to RDNs “could be one of the most important ways that health care professionals help patients learn about, implement and sustain behavior changes”.5 The Academy of Nutrition and Dietetics maintains a national, searchable online referral service enabling consumers and health practitioners alike to locate an RDN in their area: www.eatright.org/programs/rdnfinder/.6 If all health professionals practice to the top of our competencies, patients will benefit through consultations with the most highly educated and experienced professionals in the area of food and nutrition: registered dietitian nutritionists. Sonja L. Connor, MS, RDN, LD 2014-2015 President Academy of Nutrition and Dietetics Chicago, Ill
http://dx.doi.org/10.1016/j.amjmed.2014.12.021
References 1. Devries S, Dalen JE, Eisenberg DM, et al. A deficiency of nutrition education in medical training. Am J Med. 2014;127:804-806. 2. Bradley DW, Murphy G, Snetselaar LG, Myers EF, Qualls LG. The incremental value of medical nutrition therapy in weight management. Managed Care. 2013;22:40-45. 3. International Food Information Council Foundation. 2014 food and health survey. Available at: www.foodinsight.org/surveys/2014-foodand-health-survey. Accessed December 8, 2014. 4. Kolasa KM, Kay C, Henes S, Sullivan C. The clinical nutritional implications of obesity and overweight. N C Med J. 2006;67:283-287. 5. Bipartisan Policy Center. Teaching nutrition and physical activity in medical school: training doctors for prevention-oriented Care. Available at: http://bipartisanpolicy.org/library/report/teaching-nutritionand-physical-activity-medical-school-training-doctors-prevention. Accessed December 8, 2014. 6. Academy of Nutrition and Dietetics. Find a registered dietician. Available at: www.eatright.org/programs/rdnfinder/. Accessed December 8, 2014.
Connect the Patient to the Expert: Referral to a Registered Dietitian Nutritionist To the Editor: The Commentary “A deficiency of nutrition education in medical training”1 correctly points out longstanding issues affecting physician education, patient treatment, and issues of cost and reimbursement for nutrition care. Each of these issues can be appropriately addressed through a team setting—a critical member of which is a registered dietitian nutritionist (RDN) providing medical nutrition therapy. We members of the Academy of Nutrition and Dietetics agree that the nutrition competency of physicians should be more adequately addressed both in their educational training and on an ongoing basis, particularly as nutrition science evolves. An excellent starting point is interprofessional education that includes medical students and dietetics interns, among others. It is unfortunate that the American Association of Medical Colleges does not include tracking exposure to dietetics; we call on medical educators to include dietetics to meet their interprofessional education competencies. Physicians need to stay up to date on recent scientific information regarding nutrition, but they realistically do not have time to provide patients with the depth and breadth of medical nutrition therapy provided by an RDN. Studies confirm positive outcomes and cost-effectiveness of medical nutrition therapy,2 and recent surveys show that the public recognizes RDNs as a credible source of services.3 Moreover, increasing numbers of third-party payers are reimbursing for RDNs’ services. Because the optimal approach to keeping people healthy involves a team effort, we encourage physicians to include RDNs as part of their team, either in their offices or via referral. Patients correctly view physicians as a trusted source of information and treatment, and physicians need to determine the nutrition and obesity prevention and treatment messages they have Funding: None. Conflict of Interest: None.
0002-9343/$ -see front matter Ó 2015 Elsevier Inc. All rights reserved.
the time and skill to provide to their patients.4 However, there is an important difference between advising patients on the basics—promoting lifestyle changes and adopting a healthy diet, which most MDs, physician assistants, health coaches, and other professionals can do—and the counseling provided by an RDN who has the knowledge and skills needed to help individuals make changes that can impact outcomes. Referring patients to RDNs “could be one of the most important ways that health care professionals help patients learn about, implement and sustain behavior changes”.5 The Academy of Nutrition and Dietetics maintains a national, searchable online referral service enabling consumers and health practitioners alike to locate an RDN in their area: www.eatright.org/programs/rdnfinder/.6 If all health professionals practice to the top of our competencies, patients will benefit through consultations with the most highly educated and experienced professionals in the area of food and nutrition: registered dietitian nutritionists. Sonja L. Connor, MS, RDN, LD 2014-2015 President Academy of Nutrition and Dietetics Chicago, Ill
http://dx.doi.org/10.1016/j.amjmed.2014.12.021
References 1. Devries S, Dalen JE, Eisenberg DM, et al. A deficiency of nutrition education in medical training. Am J Med. 2014;127:804-806. 2. Bradley DW, Murphy G, Snetselaar LG, Myers EF, Qualls LG. The incremental value of medical nutrition therapy in weight management. Managed Care. 2013;22:40-45. 3. International Food Information Council Foundation. 2014 food and health survey. Available at: www.foodinsight.org/surveys/2014-foodand-health-survey. Accessed December 8, 2014. 4. Kolasa KM, Kay C, Henes S, Sullivan C. The clinical nutritional implications of obesity and overweight. N C Med J. 2006;67:283-287. 5. Bipartisan Policy Center. Teaching nutrition and physical activity in medical school: training doctors for prevention-oriented Care. Available at: http://bipartisanpolicy.org/library/report/teaching-nutritionand-physical-activity-medical-school-training-doctors-prevention. Accessed December 8, 2014. 6. Academy of Nutrition and Dietetics. Find a registered dietician. Available at: www.eatright.org/programs/rdnfinder/. Accessed December 8, 2014.