The Art of Imperfection

Today’s diet education has been a complete failure. Let’s all go home and we’ll come back tomorrow and try again.

That’s how I handle failure in my professional career as a dietitian. I’m not sure that’s the best, but with the fast-paced nature of healthcare, you don’t have the luxury of dwelling on mistakes. Unfortunately, my overanalyzing nature doesn’t let me off the hook that easily.

How many times do you leave a patient’s room knowing that you failed to educate them or provide the appropriate nutrition intervention? It’s a sad but inevitable reality that we can’t be perfect 100% of the time. Of course, we have clinical guidelines, education materials, and our own life experiences (limited though they may be), but I still experience a fair amount of failure on a daily basis.

Types of Failure

I consider there to be three types of failure when it comes to inpatient dietitians: dietitian-associated failure, patient-associated failure, and system wide-associated failure.

Dietitian-Associated Failure

I went to see a patient who was a type 1 diabetic, chronically non-compliant, and spent our entire conversation complaining about his life. I lasted about 30 minutes and then left and charted that he was “not open to education or change.” In reality, I didn’t do a great job as a dietitian. I didn’t address his lack of self-responsibility or ownership of his healthcare. That firm approach probably wouldn’t have gone over well, but it would have been an appropriate response. Instead, I took the easy way out.

We all fail our patients at times. Maybe we don’t use the appropriate counseling approach, prescribe the right diet, advocate appropriately, or any other number of mistakes. While some errors have a larger impact than others, they all represent a failing on our part.

Patient-Associated Failure

Going back to my initial example, my patient similarly failed in that situation and at other multiple points in his life. He had been in and out of the hospital multiple times, seen by dozens of dietitians, doctors, and diabetes educators. He was provided with medication, education, and resources to manage his condition. While type 1 diabetes is a constant challenge, he ultimately chose not to manage his health.

We face patients like this every day. It’s the patient who refuses to work with physical therapy. The one that doesn’t want to take medication or keep medical appointments. Of course, we have to understand that there are other factors causing failure outside of just our patients, but a complacent and unmotivated patient population is a separate and specific type of failure.

If you have the means to follow a prescribed diet and choose not to follow that diet, you are failing yourself. You cannot expect the “system” to create good health for you. You have to be responsible for managing your own health and wellness if you are mentally intact. Anything else is a burden on our healthcare system.

System Wide-Associated Failure

How many times have we discharged patients inappropriate, prescribed ineffective medical treatments, or failed to provide the resources needed for our patients to succeed? System-wide failure is less attributed to individuals and more the entire healthcare system. Examples of this include patients who don’t qualify for rehab and end up being discharged home where they continue to decline in health.

Every healthcare system in the world has faults and ours is no exception. I don’t have a solution, but it’s important to recognize that failures may be attributed not to individuals only, but also to the entire system’s rules and standards. I’m sure every person could think of an example of a system-associated failure in healthcare.

Growing and Learning

The bad news is that I can’t offer any advice on resolving patient or system-wide failure. However, all dietitians can and should address their own shortcomings.

Although I’ve only been a dietitian for two years, I’ve grown in both knowledge and

experience. The mistakes I made early on, I rarely make today. Slowly, I see improvements in my daily practices. These gains are best seen by working in a good healthcare environment, supportive/knowledgeable coworkers, and a desire to learn and grow professionally.

One particular piece of advice from graduate school has made a larger difference in my practice. The book Strengths Finder by Tom Rath recommends focusing on improving your strengths rather than working on improving every area or focusing on your weaknesses. I’ve tried to take the same approach in my field. Rather than learning how to cover outpatient counseling (that I loathe with every fiber of my being), I’m working on gaining a better understanding of clinical nutrition and nutrition in critical care. It’s made a difference.

I rarely tell people to follow their bliss as I think it’s mostly bad advice. HOWEVER, as you begin your career as a practicing dietitian, focus on the areas you love. You’ll see the results reflected in both personal and professional growth.