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News & Views
Doctors falling short when it comes to nutrition
Date: 09/04/10
Keywords: Nutrition, Malnutrition
The British Association for Parenteral and Enteral Nutrition (Bapen) campaign group has warned that doctors working both in hospitals and as GPs often miss the signs of malnutrition. Dr Penny Neild has revealed how training on how to spot and tackle malnutrition was "patchy", and that medical schools and junior doctor programmes were focusing too much on the science of being a doctor rather than basic care.
Nutrition training for doctors “must be improved”... I smiled from ear to ear when I came accross that quote recently. Not just because it’s true but also because the remark comes from Dr Penny Neild, a leading Gastroenterologist at London's St George's Hospital.
Straight from the horse's mouth
Worrying new research shows that up to one in four patients may be at risk of malnutrition.
The British Association for Parenteral and Enteral Nutrition (Bapen) campaign group has warned that doctors working both in hospitals and as GPs often miss the signs. Dr Penny Neild has revealed how training on how to spot and tackle malnutrition was "patchy", and that medical schools and junior doctor programmes were focusing too much on the science of being a doctor rather than basic care.
Dr. Neild said that as a gastroenterologist she had to deal with the consequences of severe malnutrition which requires tube-feeding to be introduced.
So, how is it possible that doctors simply don’t recognise severe malnutrition when it is right in front of their eyes?
While the issue of nutrition is covered in the first year of a junior doctor course, but it is not a mandatory part of medical school curriculums or many specialist training courses in the latter part of the junior doctor training programme.
The introduction of nutrition in the first year of junior doctor training has only been rolled out in recent years, while the royal colleges are looking at devising a standardised curriculum for medical schools which may have more emphasis on nutrition.
Ok, so they’re working on it... but I wouldn’t find instant comfort in The General Medical Council’s (GMC) response, which said that by the time medical students graduate they should already have a "good understanding" of nutrition. Based on what is anyone’s guess!
From April 2010 the GMC are taking responsibility for all stages of doctors' education and training. The GMC outlines the knowledge, skills and behaviours that UK medical students should learn in its guidance, Tomorrow's Doctors.
Tomorrow’s Doctors also specifies that newly qualified doctors must be able to make an assessment of a patient's state of nutrition; discuss the role of nutrition in health; and be able to apply to practice the scientific principles on nutrition...
Signs of malnutrition
While we wait for tomorrow’s doctors to be trained and get up to speed, I can’t help but wonder what this means for older doctors who may stubbornly refuse to recognise the important role nutrition plays in healthcare ... surely they’ll have a lot of catching up to do both in terms of their training and change of mindset...
Perhaps this little bit is just for them...
Malnutrition occurs when a person's diet and/or dietary supplements fail to provide the nutrients necessary for health, growth and normal body function. Malnutrition can affect every system in the body, depending upon the cause of the malnutrition. In mild to moderate cases of malnutrition, no symptoms or signs may be evident; however, as the condition persists, the signs and symptoms will become more pronounced:
Unintentionally losing (4.5 kg) or more may be a a sign of malnutrition
Their skin is pale, thick, dry, rashes and bruises easily. People with malnutrition may develop abnormally dry skin, despite the use of lotions and creams. In severe cases, the skin may begin to crack.
Hair is thin, tightly curled, and pulls out easily.
Joints ache and bones are soft and tender.
Bleeding gums.
The tongue may be swollen or shrivelled and cracked.
Visual disturbances include night blindness and increased sensitivity to light and glare.
Other symptoms include: anaemia, diarrhoea, goitre (enlarged thyroid gland), loss of reflexes and lack of coordination, muscle twitches, scaling and cracking of the lips and mouth.
Organs may begin to function less efficiently. This can lead to heart problems, decreased liver function, kidney failure, decreased lung capacity, intestinal problems, stomach irregularities and abnormal menstrual cycles in females.
Ascites, which manifests as a swollen or bloated abdomen, is a sign of malnutrition. This condition is exacerbated when the liver, kidneys or intestinal tract is affected.
Fragile bones, osteoporosis and muscle loss and/or weakness are symptoms of malnutrition. When calcium or vitamin D are the nutrients lacking, these symptoms may manifest shortly after the body becomes malnourished.
Of course, let’s not forget that many patients suffering from malnutrition are not always underweight – many are in fact overweight, but following a diet containing little, if any, nutritional value. Their health is equally at risk. However, who knows how long it’ll take doctors to recognise and treat this side of the malnutrition coin?
Sources:
‘Nutrition training for doctors 'must be improved'’, published online 18.03.10, news.bbc.co.uk
‘What Are the Signs & Symptoms of Malnutrition’ by Casey Holley, published online, livestrong.com
Back to topStraight from the horse's mouth
Worrying new research shows that up to one in four patients may be at risk of malnutrition.
The British Association for Parenteral and Enteral Nutrition (Bapen) campaign group has warned that doctors working both in hospitals and as GPs often miss the signs. Dr Penny Neild has revealed how training on how to spot and tackle malnutrition was "patchy", and that medical schools and junior doctor programmes were focusing too much on the science of being a doctor rather than basic care.
Dr. Neild said that as a gastroenterologist she had to deal with the consequences of severe malnutrition which requires tube-feeding to be introduced.
So, how is it possible that doctors simply don’t recognise severe malnutrition when it is right in front of their eyes?
While the issue of nutrition is covered in the first year of a junior doctor course, but it is not a mandatory part of medical school curriculums or many specialist training courses in the latter part of the junior doctor training programme.
The introduction of nutrition in the first year of junior doctor training has only been rolled out in recent years, while the royal colleges are looking at devising a standardised curriculum for medical schools which may have more emphasis on nutrition.
Ok, so they’re working on it... but I wouldn’t find instant comfort in The General Medical Council’s (GMC) response, which said that by the time medical students graduate they should already have a "good understanding" of nutrition. Based on what is anyone’s guess!
From April 2010 the GMC are taking responsibility for all stages of doctors' education and training. The GMC outlines the knowledge, skills and behaviours that UK medical students should learn in its guidance, Tomorrow's Doctors.
Tomorrow’s Doctors also specifies that newly qualified doctors must be able to make an assessment of a patient's state of nutrition; discuss the role of nutrition in health; and be able to apply to practice the scientific principles on nutrition...
Signs of malnutrition
While we wait for tomorrow’s doctors to be trained and get up to speed, I can’t help but wonder what this means for older doctors who may stubbornly refuse to recognise the important role nutrition plays in healthcare ... surely they’ll have a lot of catching up to do both in terms of their training and change of mindset...
Perhaps this little bit is just for them...
Malnutrition occurs when a person's diet and/or dietary supplements fail to provide the nutrients necessary for health, growth and normal body function. Malnutrition can affect every system in the body, depending upon the cause of the malnutrition. In mild to moderate cases of malnutrition, no symptoms or signs may be evident; however, as the condition persists, the signs and symptoms will become more pronounced:
Of course, let’s not forget that many patients suffering from malnutrition are not always underweight – many are in fact overweight, but following a diet containing little, if any, nutritional value. Their health is equally at risk. However, who knows how long it’ll take doctors to recognise and treat this side of the malnutrition coin?
Sources:
‘Nutrition training for doctors 'must be improved'’, published online 18.03.10, news.bbc.co.uk
‘What Are the Signs & Symptoms of Malnutrition’ by Casey Holley, published online, livestrong.com
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