Thursday, 4 September 2008

Not much longer now

Only one day to go, my internment is nearly over. That feels great. Today I don't have anything to do except turn up for another student's buffet at lunchtime, and then go out in the afternoon to see something about an infant feeding programme. Tomorrow morning my workbook is reviewed, and I'm free!

My buffet on Monday went very well. I provided shop-bought quiche, made potato salads with standard and low fat mayonnaise, and a lettuce, tomato and cucumber salad. For the required standard and low sugar desserts, I bought ready made jellies in standard and 'no sugar' versions, and put a dollop of creme fraiche and a couple of segments of mandarin from a tin on top. They were horrible, but that wasn't the point.

Four of the dietitians reviewed what I'd done, and pointed out that my analysis of 1385 calories per 144g portion of potato salad was likely to be a mistake - true enough. We were fine on the rest of the review, although we agreed that the lunch overall was a bit high in fat. The budget came in at less than my allocated £1.50 per person, and there was food left over.

Apart from kicking myself for getting the figures wrong, my other buffet-related faux pas was to notice that one of the dietitians hadn't signed up for the buffet but was in his office, so I went to ask him if he'd like to have some anyway, seeing as there was plenty left. What I hadn't realised was that it was the first day of Ramadan.

The workbook was pretty much finished by Monday, so I wandered from person to person trying to get them to sign off the different sections. One section about the British Dietetic Association Code of Conduct ended up with the manager of the department, who'd given me such a hard time over the stupid uniform. She grilled me for half an hour on three pages of the workbook. She is actually a very good manager, and the department is run extremely well, but that business of the dress cast rather a shadow, particularly over the first two weeks of my time here.

This week I've sat in on a paediatric clinic, done a home visit, spent some time with one of the Dietetic Assistants, seen patients on a couple more wards, and attended the departmental service meeting. No new inspiration, although the meeting was very well managed and the time with the Dietetic Assistant was interesting. Her job covers two completely opposing topics: she runs weight management groups for people who want help losing weight, and advises on ways to lower calorie content of meals and control overeating behaviour. At the same time she's advising on nutritional support, usually for older people in nursing homes who are losing weight, including ways to boost the calorie content of every mouthful they manage to eat.

The referrals for the weight management groups come from GPs, and the rate of response is very low, maybe one in fifty. I read the letter sent to a new patient. It was like a slap in the face, a real piece of hospital-speak, including the phrases "If you do not respond to this letter within 4 weeks then we will assume you do not wish to change your lifestyle," and "We will inform your doctor of the outcome of this referral." I asked if it would be OK for me to draft an alternative, more sympathetic letter, which I did. I hope they consider using it.


Anonymous said...

That referral letter sounds really harsh! I hope they'll start using your version instead.

And congrats on making it through your placement! I hope you'll be having a great time at home soon.

Lola said...

One of the dietitians did tell me that my letter was better than the standard one - but she's leaving in a week and probably won't pass the message on.

Yes, I'm having a great time at home now! if you count cleaning the entire house as 'having a great time'!