Why I can't work as a hospital Dietitian
There was a period of time where I craved to work as a hospital Dietitian.
Mainly after graduating.
Then I worked in hospitals and changed my mind. I’ve experienced different behind-closed-door systems within Food Service Kitchens across Melbourne (i.e St.Vincent’s hospital, The Royal Children’s Hospital, The Royal Women’s Hospital, and Epworth Healthcare); as well as on the ward with patients and their families as a student Dietitian (The Northern Hospital and Austin Hospital).
Patients get admitted into hospital for a reason.
Something in their body is dysfunctional and they need investigation, treatment and monitoring under professional medical care. Hospital in-patients have increased dietary requirements. Especially protein and calories to support proper repair and recovery. Depending on the hospital, the quality of the food served to sick, rehab, aged care patients need to be looked at (1). Especially the frozen and reheated meals in public facilities. After all, you go into hospital to improve your health status. Not hinder your healing process.
Here I share my experience and honest thoughts as a healthcare provider during my hospital employment. Systems may have changed by the time of publishing this post. Disclaimer: The content here is for information purposes only. For healthcare support please consult your healthcare professional.
This realisation occurred to me during one of my shifts as a food service assistant. Though I worked in a private, high quality hospital, I couldn’t help but think the food wasn’t helping sick patients but rather causing different issues.
Patients ordered three meals in advance every day. A lot can happen in one hour, let alone the hours leading up to eating time. Such as medical emergencies, foul smells, distracting room mates, meal disruptions, changes in appetite and mood, and more, that interfere with proper intake.
What happens: Meals return to kitchen uneaten, or stay on the ward to be eaten later, or the kitchen needs to quickly plate up full meal trays as the patient is unexpectedly ravenous.
May lead to:
-Risk of patients missing out on a proper meal
-Risk of food contamination for immune compromised individuals
-Added stress for patients, families, nurses, and kitchen staff
-Excessive food waste (serious big problem)
At the time of my resignation, the hospital was transitioning into electronic food ordering. A positive to reduce food waste! I have a strong appreciation towards the developers that created this new system. Despite more blue light screen use, the patient can order closer to meal times rather than pre-ordering the day before. This is for a cook fresh Food System, unfortunately it's not feasible for public hospitals.
FED 6 TIMES A DAY Patients are offered to eat 6 times per day to prevent the risk of malnutrition (1). Understandably as poor appetite, nausea, vomiting, diahorrea, and increased nutritional requirements means "small frequent meals to help with nourishment"in dietetic terms. It makes sense for chronically malnourished individuals but not Joe who just broke his leg.
Constant eating is not good for digestion (2) or blood sugar control (3).
Also, say you've got a fever and you're sweating through your top. You're less keen on eating. This is normal. Your body prioritises infection fighting and recovery and less on appetite. Once the body stops fighting, you can return to eating main meals rather counting on snacks.
Hospital patients with normal appetites can overeat causing fat gain (3). Remember they aren’t burning excessive calories. Usually resting in bed or in their chair. Their energy requirements aren’t as high. I just don't see how inferior supplements and cheese and biscuits between meals are helpful.
SUPPLEMENTS Large food industry companies provide supplements for hospitals. Through clinical assessment, Dietitians would deem a supplement was clinically indicated and/or additional mid meal snacks.
Here's one common supplement’s Nutritional Information Panel:
Firstly, for the amount of calories in a tetra portion (250 calories per 235ml serving) is high given that 85% of energy is from carbohydrates (53.6g per 237ml) namely sucrose and maltodextrin.
Carbohydrate is a non essential macronutrient compared to protein and fat. I'm not saying that everyone needs to go low carb but rather should look at which macronutrient your diet is primarily comprised of.
> > 34.4g sugar is 8.5 teaspoons of sugar.
Rarely does anyone put 8 teaspoons of sugar into their tea, let alone into a nutritional drink.
Unless someone has life threatening hypoglycaemia (dangerously low blood sugar levels) and is at risk of dying, even so they would receive IV glucose and electrolytes, I can’t think of any indication to provide such a large quantity of sugar to any sick or healthy person.
Now lets talk protein and fat. Given how important protein is needed to prevent lean muscle wasting, that is the main objective in preventing malnutrition, provides 9.0g Protein and 0.0g Fat.
This is a meal replacement drink thus the calories are higher and palatable for patients with poor oral intake. But where is the protein needed for enzyme reactions, wound repair, neurotransmitter synthesis, tissue and cell regeneration (4)?
Where is the essential fatty acids needed for hormone and cholesterol production, nerve cell communication, brain cell function and absorption of fat soluble Vitamins A, E, D, K (5)? The supplement offers minimal fat soluble vitamins along with NO fat for absorption.
Let's say a person eats a few bites of their meal and has 1-2 of these drinks. They likely wouldn't meet their protein requirements ( for sick persons with no underlying kidney dysfunction I'd go with minimum 1.5g/kg/BW ).
Let's say a person doesn't eat at all but manages 1-2 of these drinks per day. Defiantly not enough protein.
Secondly, key nutrients responsible for immune cell activation and tissue repair requires Vitamin C to inform T-Cells to fight foreign invaders, to grow collagen and tissue, and fight inflammation from oxidative stress. For a fruit flavoured beverage, theres 15.6mg (RDI 45mg) per 237ml (6,7).
Zinc is critical for immune function, skin tissue repair, eye health and a whole host of roles. The beverage provides 1.7mg (RDI 15mg) (7,8).
Potassium and Magnesium are essential electrolytes needed for nerves to communicate with each other, to regulate blood pressure, calm the central nervous system, and prevent muscle wastage (9). The beverage provides 0.0mg (RDI Potassium 2,800-3,800mg | Magnesium 320- 420mg) (10,11).
They claim to be nutritionally complete. They are not. Thirdly, what is "Natural and Natural Identical Flavourings"? If they've used wildberry flavour and sweetened with sucrose, shouldn't that be sufficient?
As a food service assistant, I was conflicted in delivering ordered supplements. It was my role and I followed orders.
As a student Dietitian, I was unable to provide further care that deviated from clinical department policies and procedures. It was my role and I followed orders. WHAT STRUCK A CORD IN ME One memory I have was serving tea and coffee to a poor morbidly obese diabetic patient. They wanted a hot chocolate with 5 white sugars. I actually said “Isn’t that too much? It says you are on a Diabetic Diet.”
The patient said (and I still remember to this day), “Its fine, I’ll just increase my insulin units”.
It went against my value for good nutrition.
White sugar has NO nutritional content. Yet as a Food Service worker, you do what the patient asks. I stewed over this for awhile. Seeing more and more things like a nurse saying it was okay to give another diabetic patient ice cream as it was on the Diabetic Diet menu. I thought the medical system had failed us and I didn’t want to be apart of it.
That was it. I quit. If I had the resources, budget and capacity.. I would make the following changes: - Rather than supplement companies supporting hospitals, why not Bone Broth businesses?
>Collagen, Glycine, and minerals. Excellent for poor appetite and more nourishing than plain broth.
-Snacks: Sunflower seeds, pepitas, roasted seaweed, hard boiled eggs, veg sticks and avo, protein shakes
- Remove portioned white sugar and replace with stevia
-Limit to 1 dessert for diabetics (prevent 3 - 4)
-Remove margarine and keep pure butter
-High quality easy-to-digest protein and vegetables at main meals
-Order high quality nutritional supplements high in protein, low in sugar and carbohydrates
-Consider a quality multivitamin taken daily as an “insurance”
I could go on but obviously we need to consider cost effectiveness and individual acceptability. One can only dream! Your Tax dollars Your Tax money goes toward the public health system.
Your loved ones or even yourself could one day *knock on wood* end up faced with under nutrition. To get the most out of patients eating high quality food (just like home cooked), food systems such as frozen fresh have to be re-evaluated and restructured.
Instead of our tax dollars going towards inferior artificial supplements, wouldn't it be amazing if we could invest in real whole foods or high quality nutritional supplements? That will make a difference.
Invest in yourself today!
I share strong emphasis in promoting PREVENTIVE health. When you’ve witnessed the effects of leg amputation, Stage 3 Pressure Injury, Cancer, Liver failure, Obstructive Bowel disease on a person and their loved ones, it makes you realise Life is precious and doesn’t need to end in excruciating torment.
Invest in your health now. Do not wait until you’re under the surgeon’s knife or can’t enjoy your Life before improving your health. Health is your wealth.
Until next time, ~Bonny. C
Disclaimer: This is my personal experience from working in acute and sub-acute hospital settings. This post does not intend to criticise any person, profession, hospital system but rather to illuminate the significance of managing disease through real nutrition and education. I will however express my disappointment in the current medical system who fails to keep our community safe through encouragement of medical treatment rather than preventative health promotion.
2.Deloose, E., Janssen, P., Depoortere, I., & Tack, J. (2012). The migrating motor complex: control mechanisms and its role in health and disease. Nature reviews Gastroenterology & hepatology, 9(5), 271.
7. Wintergerst, E. S., Maggini, S., & Hornig, D. H. (2006). Immune-enhancing role of vitamin C and zinc and effect on clinical conditions. Annals of Nutrition and Metabolism, 50(2), 85-94.