When I started my career in 2000 as a registered dietitian, I was the prototypical new practitioner. I followed all the rules. Diet recommendations were driven by protocols, precise mathematical calculations, and solid scientific research. Perfection was the objective, and there was little that could be left to common sense.
As a consultant for a number of long-term care facilities, my job was to ensure that residents were offered diets that not only supported their health, but hopefully improved it. But chronic medical conditions often made that challenging, as many illnesses required dietary restrictions.
I remember one resident in particular. She was undergoing dialysis treatment and wasn’t eating well. After carefully studying her lab values and assessing her nutritional status, I constructed what I thought to be the perfect diet.
It outlined a laundry list of forbidden foods. If it was high in potassium, forget it. High in phosphorus? No way. I can’t even remember how many restrictions there were, but I’m fairly certain it sounded something like Ralphie’s letter to Santa: I want an official Red Ryder, carbine action, two-hundred shot range model air rifle (with a compass in the stock)!
I confidently faxed over my my recommendation to the physician, satisfied that I had just executed the most evidence-based recommendation possible. It was perfect! Of course it would be approved. I’d thought of everything.
But I was crushed when the fax was returned with these words:
“What’s left sawdust?”
Those words, in barely legible handwriting across the top of the faxed form, felt like a punch in the face. It made my heart sink to think the perfect diet had not been approved.
But I then realized that physician knew something that I hadn’t quite figured out yet: Good medical care is not about some know-it-all provider dictating how we get to live our life. Good medical care considers our quality of life as much as it does treating what ails us. It’s a balance that the healthcare industry struggles constantly to achieve.Good care understands that what's right isn't always perfect, and what's perfect isn't always right. Click To Tweet
Likewise, good care understands that what’s right isn’t always perfect, and what’s perfect isn’t always right.
In this case, my perfect diet wasn’t right for this patient because it robbed her of the joys that come with eating.
Now, every time I see sawdust I’m reminded that perfection isn’t real; it’s an illusion.