Issue 117 freelance practise

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SKILLS & LEARNING

FREELANCE PRACTICE: MANAGING CANCER CARE CLIENTS Anne Wright Registered Dietitian, AM Dietetics

Anne has extensive experience in many areas of Dietetics including clinical roles in Australia and with the NHS, in Higher Education and now is a freelance practitioner with AM Dietetics.

For article references please email info@ networkhealth group.co.uk

There is no doubt in my mind that freelance practice is a wonderful place to be for a dietitian. It comes with a long list of benefits such as variety, being able to manage your own appointment books, flexible working hours, strong and supportive freelance networks and being able to utilise a range of different practice models. Freelance does, however, come with special concerns and particular issues around which the registered dietitian needs to be mindful. Opening my daily emails brings a raft of different requests: weight management, women’s ‘issues’, IBS, allergies and intolerances, inflammatory conditions and more. Then, there it is: the cancer question arises. In my practice, I receive at least three emails a month from prospective clients or their relatives asking for help with a cancer diagnosis. The emails are usually asking for help ‘fighting the cancer’. My emails this month have included: “Hi, my Dad has been diagnosed with multiple myeloma; looking for a diet not to feed the cancer.” “I have stage 3 breast cancer and am going through my third chemo course. I would like some help with some meal plans, getting my energy back and fighting the cancer. I eat a raw diet.” “You are my last hope; my husband has a rare brain cancer and needs a ketogenic diet. Are you familiar with using cannabis oil therapy?” My heart sinks when I read emails like this. As a dietitian, I want to help. That’s what we do. There is nothing more rewarding that being able to help someone feel better, or to manage their condition with dietary changes. There is nothing better than seeing that your clients have gained from your support and guidance. Then there is the fact that, when it comes down to it, freelance practice is a business.

The temptation in freelance is to ‘take everything’. The temptation is to assume that your knowledge base is so broad that you can advise on any condition that comes your way. When dealing with freelance clients, paying clients, there is an emphasis on client choice. The issue of payment potentially adds to dilemma in practice. Questions arise for freelance dietitians such as, “Do I give them what they want?” and “If I say no, then where will the client end up getting their advice? Will it be safe?” So, what is the problem? The issue with taking on and assisting cancer care clients in freelance practice is around professional ethics and the very real issue of protecting yourself legally. In freelance practice, ethics are more important than ever. You are still bound by the HCPC standards of proficiency and, potentially, are at greater risk of exposure to unsafe practice allegations due to the single practitioner care model. Managing cancer care clients can put a practitioner at a risk due to the issues arising from the emotions and fears that may come with cancer care clients and their families. These include hope and desperation, unproven diet therapies being touted as miracle cures and the phases that come with the grieving process. To demonstrate context, many years ago, whilst working for the NHS, I witnessed a series of complaints against a well-meaning dietitian who offered to remove the enteral feeding equipment from the home of a gentleman who had recently passed away. The relatives saw

www.NHDmag.com August / September 2016 - Issue 117

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