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Jack of all trades, master of none: Musings of a small town dietitian

By Laurel LeConte, RD

If you work in a large city, I hope you don’t take for granted the anonymity you might have as a dietitian working in an urban center. You certainly don’t have that in a small town!  As a small town dietitian, it’s not unusual to be the inpatient clinician, outpatient diabetes educator, diabetes education program coordinator (for five communities) and foodservices manager (for a two site hospital). Yes, that’s me! As a result, you’re positioned in the interesting role of knowing a little about a lot of food and nutrition issues. You also get to know every person in town. They are all your patients, or friends and relatives of your patients. This means you are reminded of your respective roles and relationships everywhere you go. Here I describe just some of my day to day experiences as the Manitoulin Island dietitian.

At the Grocery store… Brace yourself before going to the grocery store. Pull down your ball cap, put on your glasses and keep your eyes glued to your list so you don't make eye contact with another shopper. Be prepared to make that person (who happens to be the guy you counselled about his cholesterol the day before) feel like he is naked. The look on his face will say it all. The fact that you might see what’s in his cart is making him feel very, very uncomfortable.  
And feel like chips or maybe some ice cream for yourself? You better have them surrounded by veggies and whole grains in your cart because you will get a running commentary from the cashier, who is also most likely one of your patients. 

Patients tattling during their appointments… In a small town everyone is related. Be prepared to have your counselling sessions derailed by patients who simply want to tell you how much worse their cousin/sister/aunt/friend’s eating habits are.  Said people are also your patients. You will be constantly on guard about maintaining patient confidentiality and to neither agree nor deny that so-in-so is also a patient.

Defending the menu… Being the jack-of-all-trades dietitian means that not only do you have to talk to your patients about healthy eating, you also have to try to implement those recommendations in a practical way by planning the hospital menu. The inpatient you had yesterday for clinical assessment is your outpatient for diabetes today.  Be prepared to be challenged by patients about your decisions.  Why did you serve me juice at breakfast when you clearly told me the whole fruit was better than the juice last week? If whole grains are good for my blood sugars, why did I get white crackers with my soup at lunch? You may spend your whole visit with a patient discussing the complexities of the hospital foodservice operation instead of their most recent A1C.

Restaurant experiences… I once went out for breakfast and literally every single patron of the restaurant was a patient I had seen within the last two weeks. I tried not to look at what they had ordered, honestly I tried not to…but I couldn’t help myself! And even though I really, really wanted bacon, I felt I couldn’t because they were also looking at my plate too. Don’t even get me started about what happens when I might want to go out to the one and only bar in town for a drink on a Saturday night!

Sheesh. Small town dietitian problems. But it’s not all “bad”. The great thing about being the small town dietitian is the rapport you develop with patients. They appreciate seeing you at community events and knowing a little about you as a person. It makes the relationships you build with patients more rewarding and potentially more effective. They also get very attached to their dietitians! I remember how many times I heard when I first started: "You’re not going to leave us like the last dietitian, are you?” No, I’m not leaving. I’m here to stay!

Laurel Leconte has been a jack-of-all-trades dietitian on Manitoulin Island for the past 8 ½ years. In her spare time she enjoys running, cooking and wearing disguises to the grocery store. She appreciates the broadened perspective that being a mother of small children brings to her dietetic practice. She would love to network with other dietitians working in similar practice situations. Email her at

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