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The Reply

      We appreciate this thoughtful letter and are in complete agreement with the comments that emphasize the specialized training and critical role of registered dietitian nutritionists (RDNs) in the health care team.
      The necessity of a team approach to maximize the benefits of nutrition in medical care is also exceedingly clear, and we concur that an excellent starting point is through interprofessional nutrition education, including medical and nursing students, dietitians, and other health professionals.
      We strongly believe that all health professionals involved in patient care have the potential to affect nutrition-based outcomes. We must do better at educating all members of the team responsible for patient care, including physicians, nurses, and RDNs, as well as chefs, community-based health workers, and health coaches.
      Our original commentary
      • Devries S.
      • Dalen J.E.
      • Eisenberg D.M.
      • et al.
      A deficiency of nutrition education in medical training.
      highlighted the deficiency of nutrition education among physicians and the missed opportunities for patient health that follow. Our goal is to ensure that physicians have the knowledge to meaningfully contribute to a nutrition team effort.
      As pointed out, it is unrealistic to expect that most physicians will have the time or expertise to deliver detailed dietary recommendations, including menu planning and assessment of complex nutritional needs, areas that are far better addressed by an RDN. However, it is unlikely that every patient in a physician's practice will have the opportunity to see an RDN for nutrition counseling. Herein lies the value of a team approach, one in which all members possess sufficient knowledge to affect outcomes, appropriate to the clinical situation.
      The letter calls for health professionals to practice “to the top of our competencies,” and we could not agree more. Some might argue that the highest competency of a physician is exemplified by the titration of multiple medications or the referral for a major procedure, such as coronary bypass surgery. However, we believe that physicians practice at the highest possible level of competency when motivating and counseling patients to make the nutrition and lifestyle changes proven to enhance health, reduce the need for medication, and avoid bypass surgery. Most of our patients would agree.

      Reference

        • Devries S.
        • Dalen J.E.
        • Eisenberg D.M.
        • et al.
        A deficiency of nutrition education in medical training.
        Am J Med. 2014; 127: 804-806

      Linked Article

      • Connect the Patient to the Expert: Referral to a Registered Dietitian Nutritionist
        The American Journal of MedicineVol. 128Issue 5
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          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.
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