This month, I thought it would be a nice idea to give you a snapshot of a typical working week for me! I am always trying to explain what a varied job dietetics is. Of course – the type of job I do is just one of the many, many different roles a dietitian can have. There is certainly no excuse to be bored!
As COVID-19 cases are rising in my area, today I am back on the Intensive Care Unit after a gap of a few months, when I hadn’t been needed. Have a look back at my previous blog article if you are wondering why dietitians are so essential on ICU! It was a little bit daunting getting back into all the PPE –and trying to get used to working without being able to breathe, see or speak clearly! We dietitians all have so much respect for the nurses who do this for many more hours at a time than we do. For me, it’s only for the morning.
At lunch-time, I attend an MDT – a multi-disciplinary team meeting. This is where a group of specialists (in this case, Gastroenterologists, Surgeons, Nurse Practitioners, a Radiologist, a Histopathologist and a Dietitian) get together to discuss the way forward for particularly complex patients. In the afternoon I finish writing up my clinic from last week and then go to the ward to review a patient on a tube-feed.
The first of my two weekly freelance days. It’s nice to have the flexibility to start a little later, so that I can get my morning run done and enjoy a big breakfast without rushing! Being able to work later into the evening, instead, suits some of my patients better too, as they don’t have to take time off work to speak to me.
I spend an hour or so in the morning catching up on emails and thinking of new topics for my blog. I like to highlight important events on my Facebook page, too – e.g. Awareness Days for certain medical conditions that deserve more recognition, or de-stigmatisation. I am not very good with technology though – so although I write everything myself, I have some help with the “publishing” bit – thanks Stephen!
In the afternoon I do some research for upcoming patients. In the NHS, I tend to specialise in a smaller number of conditions, and so I’m generally able to keep up-to-date with all the latest guidelines. In private practice, however, anything might come up.
Of course, it’s easy to feel that all the knowledge in the world is there at your fingertips with the internet – but many patients come to me completely confused about all the conflicting things they have read. Anyone who knows me will be aware than inaccurate, unqualified (and sometimes quite dangerous!) nutritional advice on the internet and social media is one of my top complaints in life!
Dietitians have the skills to identify the best quality research to date, and to translate this into real, practical guidelines for people. Moreover, many people have more than one condition to cope with – again a Dietitian can take a holistic view of an individual and help them to plan a safe and effective nutritional plan.
I’ve got an online consultation quite late this evening, so I put something in the slow-cooker before getting myself set up on Zoom to meet my new patient.
Another NHS day – this one is half wards and half clinic.
I work on the gastro and surgical wards in the morning, seeing an interesting mix of patients. Today, I see someone who is struggling to cope with a high output stoma after a bowel resection, a gentleman with liver disease (related to an auto-immune disease, not alcohol) and an elderly lady with dementia who is not eating and has lost a lot of weight.
In the afternoon, I go down to the outpatient department with a laptop. We are not seeing patients face-to-face at present, but the Health Board has set up a system of video calls. The outpatient department is currently a nice, quiet place to sit and make these calls in private!
We HAD started to think about doing video calls before the pandemic hit – but then, I was really resistant. For some reason, I had always had a horror of video calls – since trying many years ago, and finding it “clunky” and awkward. I’m also one of those people who hates seeing their face on screen! It can still depend a little on the quality of people’s wi-fi signal, but generally technology has moved on, and I am finding the video calls a really good substitute for face-to-face contact. They are certainly better than a phone call! I do miss being able to make scribbled notes for patients as we go (and of course I am not able to weigh them, or do other routine tests such as hand-grip strength and arm or waist circumference). It’s certainly much better than the patients being left with nothing though.
And, we are all aware of the pressure on NHS waiting lists!
This is quite a busy freelance day.
In the morning I have a patient via Zoom. It is a complicated case, with a lot of different factors to take on board. It takes us a good hour to discuss everything, and come up with a plan. It then takes me the same time afterwards to write up everything we have said so that the patient has a written summary (and of course I was quite a while researching various bits-and-pieces on Tuesday – the work the patient doesn’t see!). We (sadly) would never have this amount of time for just one patient in an NHS outpatient clinic and I get great satisfaction from giving someone such detailed help.
I have time for a quick lunch and then I pack up my laptop and head off for a home visit. I am still able to see patients face-to-face for this type of health-care appointment – but of course I wear a mask and take great care with cleaning my hands before entering their home! A home visit is great because I can look at people’s environment and meet their family too. On this occasion, we were talking about portion control and I was able to see the size of the client’s plates and bowls as well as look at some food labels from their cupboards with them.
Usually a long day for me, as I like to put in a good session of weight-training before my day starts. I would usually go to the gym, but since the travel restrictions I have been doing what I can in the house (trying not to go through the floorboards), like so many people! I have my usual big breakfast (not everyone likes breakfast, I know, but I absolutely LOVE it) then head to the hospital.
Today is a day of mixed ward work and ITU. Today’s jobs include advising someone with pancreatitis on how many of their enzyme replacement tablets they need, liaising with the hospital catering department about a patient needing a special low-residue diet, seeing one patient with a flare-up of their Crohn’s disease, and one with newly-diagnosed ulcerative colitis and finally, two patients with alcoholic liver disease (a common condition on a gastro ward, and one where nutrition is a central part of recovery).
I have a student working alongside me today, so I teach as we go. Training students is a very important part of the job and something I really enjoy.
This year, we Dietitians have learned to adapt far more quickly than we ever thought we would. And, some of these new things are going to be helpful in the future. For instance, video calls are going to suit some patients so much more than having to travel into a clinic (I am thinking in particular of my patients with bowel problems who do not like to be too far away from a toilet).
Will anything good come of this pandemic? Of course, we hope that Dietetics as a profession has gained recognition and respect for the role that it plays in so many areas of healthcare. We have all learned new things – not least, to appreciate every little thing that we have. And, on a personal level, I have finally conquered my fear of video calls!