Perceptions of clinical decision making by dietitians and physicians

Role delineation is an ongoing process and must be evaluated within the health care team framework. The specific interactions between dietitians and physicians in the nutrition care of patients is one aspect that needs to be more clearly defined. This study examined selected practice issues by surveying physicians and dietitians to identify perceptions of ideal and actual performance. Role disparity was found between the responses of the dietitians and those of the physicians. Dietitian respondents identified themselves as the primary decision makers more than 50% of the time in all circumstances queried. In contrast, 10% or less of the MDs saw the dietitians as the primary decision makers in any area except selection of caloric supplements. In the ideal setting, the dietitian desired a greater degree of autonomy than the physician was willing to grant. Our findings were not explained by demographic differences. Perhaps faulty communication between the physician and the dietitian or unclear medical-legal issues may explain our findings of perceived role disparity.