Why Dietitians Can't Diagnose You
If you've ever wondered what an RD can and can't do, this is the place to find out...
Ever thought about seeing a dietitian, but didn’t know what to expect? Not sure what they can and can’t tell you?
In the past, there have been Nutrition Month campaigns promoting the power of dietitians in supporting health and wellness. “More Than Food” was a recent theme, touting not only choosing nourishing foods, but also the power of the environments we eat food in, the people we eat with, and the other factors that support healthy lifestyles! “More Than Food” also describes Registered Dietitians, who are regulated health professionals with expertise in nutrition and health. However, a common misconception about dietitians is their role in health care, especially from patients - we are more than just food!
Dietitians are trained to understand and interpret blood work results as well as perform nutrition-focused physical examinations. But did you know that a dietitian cannot diagnose you with conditions? Dietitians are also unable to order lab tests to monitor nutrition-related conditions, unless they are given or create a Medical Directive to do so! (This is an area we are continuing to work in, as we know the value of having dietitians monitoring blood work results and what it can tell us about nutrition status!)
Registered Dietitians fall under the Regulated Health Professionals Act (RHPA) and the Dietetics Act in Canada. The Dietetics Act states that: “The practice of dietetics is the assessment of nutrition and nutritional conditions and the treatment and prevention of nutrition related disorders by nutritional means.” With this in mind, RHPA outlines “controlled acts” - these are health care actions that can be potentially harmful if done by an untrained person. The practice of dietetics is not a controlled act, which is why you will see individuals practicing dietetics without a dietitian title (naturopaths, homeopaths, nutritionists) - these individuals are however not legally permitted to use the title dietitian, Registered Dietitian, RD or any of the other available dietitian designations used in Canada.
The first controlled act is: “Communicating to the individual or his or her personal representative a diagnosis identifying a disease or disorder as the cause of symptoms of the individual in circumstances in which it is reasonably foreseeable that the individual or his or her personal representative will rely on the diagnosis.” In other (and less) words, a Registered Dietitian cannot diagnose patients with conditions.
For example, if a dietitian has access within their work environment to blood work results, and follows a patient who undergoes repeat testing for diabetes, if the results come back within the diabetes range, that dietitian cannot tell the patient they have diabetes. What they can do is refer back to the primary care provider for discussion and the development of a care plan. The dietitian could also discuss general guidelines for reducing blood sugar for improved health until the patient is informed by their primary care provider about their condition.
This has been a frustrating piece in my role. I have had the unfortunate experience of being referred a patient for the purposes of reviewing their blood work results, and having to explain to the patient that their physician is responsible for communicating this information to them - and then calling the physician to tell them the bad news.
Despite this, there is one controlled act that dietitians can perform without a medical directive – skin prick tests! These occur when we check a patient’s blood sugar in our offices, otherwise called point-of-care testing. Even though we are allowed to perform this act, it’s important that dietitians are trained not only in how to perform it but to use health and safety guidelines to prevent infections. We’re working with blood and we need to keep our patients safe!
Hopefully with this campaign, and more to come in the future, the role of dietitians will be better promoted to help both the public and our teams understand what we do!