My title says it all. Most veterinarians are downright afraid to discuss nutrition with their pet owning clients. It’s perhaps the single one issue we feel most apprehensive about discussing freely. Only pet behavior challenges the ins-and-outs of nutrition for its many conversational intricacies and potential inter-personal pitfalls.
I should know. After all, I’m not immune to the phenomenon of exam room nutrition unease.
Not that it keeps me from tackling the topic. In fact, I probably bring up the subject with almost every single client interaction. Still, if I’m honest, I’m forced to confess that I always approach the issue of feeding with some trepidation.
How can that be, you ask? Isn’t nutrition and feeding the one thing veterinarians are supposed to know backwards and forwards? It’s so basic!
Agreed. Nutrition is as fundamental to veterinary science as it is to any other medical discipline. There’s just no getting around it. But that doesn’t keep veterinarians from harboring fears –– both rational and irrational –– with respect to the nutrition thing.
Which merits and explanation, of course. Here are seven reasons that’ll hopefully help explain the origins of our profession’s nutritional apprehensions:
#1 Not enough training in vet school?
I add a question mark here only because, contrary to much of the Internet chatter on this subject, all veterinarians have undertaken sophisticated schooling in animal nutrition. Trouble is, much of it is focused at the biochemical and physiologic level. Which is crucial stuff, of course, but it doesn’t necessarily translate into a working knowledge of nutrition in a clinical setting.
In fact, much of the practical nutrition coursework that’s offered in veterinary schools is almost exclusively aimed at feeding “food animals” in agricultural settings. For example, when I was in school, the only clinical nutrition rotation available was a two-week elective in dairy medicine. Which I loved, actually. But it wasn’t exactly applicable to my life in small animal practice. (I do keep dairy goats, though, so it wasn’t for naught.)
Why so little practical schooling?
That’s a sore subject, and one that’s worthy of its own entire post. Let it suffice to say, however, that veterinary programs have historically delegated much of their nutrition education to corporate stakeholders. As such, teaching students how to recommend therapeutic diets has been the focus of too many veterinary clinical nutrition curricula. Which is, of course, not a good thing.
#2 Too few independent nutritionists
General practitioners like me have local internal medicine specialists, veterinary surgeons, ophthalmologists and other specialists to call upon when we’re confronted with complex cases. However, clinical nutritionists aren’t available at these private referral facilities.
The vast majority of veterinary nutritionists in this country are channeled into animal agriculture or hired by pet food manufacturers. Only a small percentage remain in academic settings. Even these “independent” professionals often have their research and even their salaries funded by the pet food industry.
How is it, then, that veterinarians are supposed to receive balanced, independent information about nutrition during their education and indeed throughout their professional lives? It’s hard to be confident when discussing nutrition in an exam room when you’re not sure whether you’re inadvertently playing the role of yet another industry mouthpiece.
(For the record, there are a handful of clinical nutritionists I’m willing to recommend to my non-commercial feeding clients but most pet owners aren’t too interested in this approach yet.)
#3 Too sell-y
It’s probably precisely because of our vet schools’ approach to nutrition education that lots of us believe we have to discuss brands when we discuss nutrition. Which explains why plenty of us get to feeling squirrelly when it comes time to discussing our patients’ dietary needs. We don’t want to feel like we’re sales people. I mean, that’s just creepy, right?
Nowhere is this discomfort more acute than when it comes to recommending therapeutic diets (so called, “prescription” foods). Yet given the fact that there are so few brands of therapeutic diets on the market, it typically becomes necessary to discuss therapeutic diets.
To make matters worse, we often find ourselves in the uncomfortable position of having to carry these foods, retail-style. Which makes us feel that much more like we’re trying to hawk a product just for profit’s sake. And that’s simply not true (for most of us, anyway).
#4 Brand ignorance, the recalls and other pitfalls
Even when we’re talking about non-therapeutic diets, it’s nigh on impossible to skirt the issue of specific brands. Our clients expect that we know the manufacturers, the brands and the formulas. Some will even expect that we’ll know the ingredients, their sources and even the politics surrounding the foods (recalls and such).
Unfortunately, most of us don’t. Because, unless nutrition is a hobby area of interest, we’re not likely to know about these things. In fact, unless the news is about the therapeutic diets we recommend in-house, I’d venture to guess that most pet owners know about recalls well before we do.
Even though we know we can’t possibly know everything that happens in the world of pets, nutrition ignorance on this scale is kind of embarrassing.
#5 Too confrontational
We recognize that many of our pet owning clients care deeply about pet nutrition. We know that they want information we can’t always offer. Sometimes we even have to tell them things they don’t want to hear. And that sometimes leads to uncomfortably confrontational scenarios.
Whether they’re asking for a more palatable diet, refuting the need for a nutritional trial (for allergies or dietary intolerances, for example), or expressing indignation or frustration over a fat pet’s obesity diagnosis, nutrition is a fraught area.
#6 Not enough time
It takes a significant chunk of time to discuss nutrition properly –– more so when confrontation is a possibility. Though it doesn’t have to take more than discussing any other feature of a pet’s healthcare regimen, when you have a long list of topics to cover, it’s always more expedient to lop one off if you can.
That’s why, “Are you feeding your pet a commercial diet?” is often relegated to a line item on an intake form. As long as you’ve checked the “yes” box, you’ve met the requirements of 99% of US-trained veterinary nutritionists. The only reason to discuss nutrition, then, is when a nutrition-specific disease process is in evidence.
#7 Frustration and fear of rejection
Why bother explaining this stuff when so many of our clients are going to feed whatever they want to feed anyway? In my experience, nutrition and feeding is the one area where pet owners are least likely to take our recommendations. (For lots of the above reasons but also because of cultural pressures and personal preferences.) So why spend the time or energy?
Though I’d never abdicate the right to preach certain tenets of animal nutrition (I believe it’s my responsibility, after all), I completely get why some veterinarians give up the subject altogether in frustration. Moreover, the fear of one’s medical acumen being outright challenged is a common sentiment in the case of nutrition. Given how crappy that can make us feel, it makes total sense that some of us might steer way clear.
#8 We suspect our clients know more than we do
It often comes down to this reality. Because it’s true; our clients often do know more than we do (on this and plenty of other home care related subjects). However, I don’t believe that’s inherently threatening. In fact, it’s a good thing! Catch me on an off day, however, and it just just make me feel like I’m a sub-par veterinary healthcare provider. Which is, I suspect, what makes a minority of vets want to ignore clinical nutrition altogether.
That’s my list. So what do you say? Given all the reasons I’ve listed, do you blame us for being less than forthcoming with our nutritional recommendations?