Doctor's Review: Medicine on the Move

October 18, 2017

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A dietitian’s top 4 resolutions for doctors

The beginning of the year is when our attention turns to developing new habits. Here are some to help GPs and family physicians integrate good nutrition into their annual checkups — and even see results!

Stress the importance of a good diet

The yearly physical exam is a perfect time to speak diet — but don’t just ask a patient if he or she is eating well. It’s no longer about which foods to avoid, but about which to choose. Stress the importance of consistently making the best possible choices. More studies are suggesting that a whole-diet approach, like following a Mediterranean diet plan or the DASH diet, can be health promoting.

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Nutritional counselling takes special expertise and time, both of which dietitians have. So share the load and refer your patients to a registered dietitian. Like doctors, dietitians have specialties; some are better suited to work with patients with specific disorders. For example, one of my colleagues specializes in working with clients who have celiac disease and non-celiac gluten sensitivity, while another is a certified diabetes educator, and another still specializes in weight management. A client with COPD might not be a good fit for any of these dietitians. To find a list of specialized dietitians, consult the Dietitians of Canada website: dietitians.ca/Find-a-Dietitian.aspx or contact the College of Dietitians in your province.

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Record height, weight, waist circumference and get some nutrition-related labs done (for example, vitamin D and vitamin B12). Again, simply asking a patient if he or she is eating well doesn’t constitute nutritional screening. Some objective data is obviously needed. If a dietitian asks for specific labs, please have them done. Specify in the patient chart that he or she needs a nutrition intervention and that you have suggested that he or she see a dietitian, making it easier for patients to obtain either private health insurance or assistance from a government agency.

Make your office non-discriminatory

Overweight people are often discriminated against as soon as they walk in your door. Some don’t even fit in the waiting room chairs! Make sure that your staff is well trained in how to make overweight and obese patients feel comfortable. Place scales in an exam room or in a private setting. Teach the staff what to say/not say when they interact with overweight patients. Make sure you have appropriate BP cuffs and large-sized gowns available so that the exam goes as smoothly as possible. You want overweight and obese patients to come to their appointments and be more open to your advice. Making them feel comfortable goes a long way towards achieving that.

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  1. On January 28, 2013, G. E. Coppola said:
    At a time when we need to make sure that we are making fiscally responsible decisions in health care it is difficult to accept the recommendation to use "nutrition related labs" for screening assessments. Vitamin D levels are overused and a huge cost to the health care systems with no proven benefit in the normal population. While some patients, those whose absorption or action of Vitamin D might be affected, may need such monitoring, to recommend that Family Physicians implement resolutions that are costly and of little proven benefit is counterproductive.

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