Twelve participants agreed to participate and took part in the study (Table 2). Of these participants, nine were doctors and three medical students. Additionally, eleven (92%) of these participants identified as female and one as male. The majority (42%) of participants were aged 25 to 34. Those who had completed their medical specialty training had between five and ten years of medical experience (58%). Most were general practitioners (58%) and had completed a bachelor’s degree in nutrition and dietetics (58%) before starting medical studies.
The qualitative analysis identified four key themes which are described below and further illustrated by the quotes provided.
Theme One: Identifying the Role of Physicians in Nutritional Care
Participants expressed mixed opinions regarding the role of physicians in nutritional care. Individuals with a degree in dietetics were more likely to perceive the role of physicians as facilitating referral to dietitians. “I guess I see my role as more of that ability to facilitate a referral. And knowing (how) to know, I hope to make this referral as soon as possible to help the dietitian be able to provide the best care. (P7, Dietetics training).
Knowing when and how to contact dietitians took priority over specific nutrition knowledge. Those who prioritized recognition of credentials believed that different healthcare professionals had strict roles in providing nutritional care and felt that dietitians were the only providers of nutritional care, not wanting towalk on toes of dietitians (P7, training in dietetics).
Participants placed a high priority on nutritional care provided by practicing dietitians over providing nutritional care themselves, as one participant illustrated when describing how he would describe this to a patient: “Now I will refer you to the dietitian who will spend more time and give you current and up-to-date information. And I want you to follow the advice of this dietitian because they are the experts or specialists on the subject. (P10, Background in dietetics).
Despite formal nutrition training, some participants expressed a lack of confidence in providing nutrition care, citing lack of practice, time, and outdated nutrition knowledge. For these participants, confidence and having a role in providing nutrition care seemed to go hand in hand: the less confident participants felt, the more likely they were to refer to dietitians.
“I refer to dietitians a lot. I don’t think I can replicate what they do; partly because I’m not experienced, and partly because I don’t have time. (P11, Dietetics training)
Conversely, other participants believed that physicians should provide prescriptive nutritional advice to patients as part of holistic care. These participants noted that doctors’ advice is highly valued by patients and as such, they have a responsibility to provide nutritional advice.
“It’s this reinforcement that you all convey the same message. Which I think is really helpful. Because when people receive mixed messages, they get really confused and don’t know who to believe. (P5, Dietetics training).
Theme Two: Understanding the interdependence of social determinants of health and nutritional status is essential
Participants with a background in dietetics emphasized that physicians need a better understanding of the social determinants of health when providing nutritional care. These participants noted a lack of content in medical school curricula regarding the impact and interdependence of social determinants on food choices, nutritional status, and health.
“I think (in the dietetics degree) we had a whole semester on the social determinants of health and nutrition. Like, what influences that and we’ve done a lot of activities, you know, where we’ve looked at what influences our own food choices and what might influence other people and I think that’s probably very misunderstood among doctors. (P3, Dietetics training).
Many participants observed a lack of empathy from physicians regarding a patient’s social, emotional, or health state, particularly in the context of obesity, with physicians downplaying symptoms such than muscle pain due to the prejudice that this was due to patients’ poor dietary choices. “It’s just a very complex mix of things; reasons they may be overweight and they’re not…I don’t know, they ate too much and were lazy, regardless of the general stigma. Sometimes we hear people say things and it’s very obvious that they lack a little compassion. (P12, Background in dietetics).
Participants also reported that a lack of understanding of the social determinants of health can leave patients feeling stigmatized and lead to a lack of trust in the medical profession.
“In fact, I think it’s no wonder that many patients have recently spoken out publicly saying, ‘Why does the doctor weigh me every time I have a cold?’ Why are they telling me to lose weight? And I don’t really think that’s an overreaction. I see it all the time.” (P3, Dietetics training).
Theme Three: Optimizing Nutritional Care Through Multidisciplinary Collaboration
Participants reported a lack of collaboration between physicians and allied health professionals. Many have called for stronger professional relationships between doctors and dietitians to ensure continuity of care. “More emphasis needs to be placed on the support factor of doctors and GPs, team cohesion, communication between the team, including paramedics. » (P1, associated with a specialized nutrition interest group).
Those with a background in dietetics noted that collaboration between doctors and dietitians was limited and that both parties had preconceived ideas and attitudes towards their respective disciplines, citing a lack of understanding and respect for the skills of each profession.
“It’s really interesting when people or how people change their minds, communicating with me as a medical student, for example, like nurses or paramedics, when I like to tell them my background.” (P7, training in dietetics)
Theme Four: Providing evidence-based nutrition care
Participants believed that nutrition education and advice given by doctors should be evidence-based. “I think because doctors respond to evidence, there are some…I don’t know, present and find some landmark studies on what this can do for your long-term cancer risk, what it can do for your (heart) risk. long-term illness, longevity, that sort of thing. (P12 Dietetics training).
Concerns have been raised about nutrition practice occurring outside of evidence, with stories of fellow doctors promoting “fad” or non-evidence-based diets. When asked to find a solution to this problem, many recommended that graduates have the skills to critically evaluate nutrition literature, just as they would other aspects of medicine, and that they always provide evidence-based care.
“I personally went to a doctor who said, ‘Ah, you know, keto is really good. You should try keto. But actually when you look at it, it’s like A. It’s not sustainable. And when you’re changing your diet, you really want it to be sustainable and all that kind of stuff. And B. probably not great because there’s a lot of saturated fat and that sort of thing. Like you could lose weight, but at what cost? » (P3, training in dietetics)
