PUBH1382​ ​Australian​ ​Health​ ​Care​ ​System  

Week​ ​9​ ​(Section​ ​C):​ ​General​ ​practice,​ ​CAMS​ ​& 
nutrition 
INSTRUCTORS:​ ​Mervyn​ ​Jackson​ ​&​ ​Amy​ ​Loughman 
 

Learning​ ​objectives 

1. What​ ​is​ ​the​ ​role​ ​of​ ​general​ ​practice​ ​in​ ​primary​ ​health​ ​care? 
2. What​ ​is​ ​the​ ​patient-centred​ ​approach?​ ​How​ ​is​ ​this​ ​integrated​ ​into​ ​the​ ​work​ ​of 
general​ ​practice? 
3. What​ ​are​ ​CAMs​ ​and​ ​what​ ​are​ ​the​ ​common​ ​features​ ​of​ ​all​ ​CAM​ ​practices? 
4. Describe  
a. at​ ​least​ ​three​ ​modalities​ ​of​ ​CAMs. 
b. Who​ ​seeks​ ​CAMs​ ​and​ ​describe​ ​the​ ​trend​ ​in​ ​consumer​ ​confidence​ ​in​ ​CAM. 
c. The​ ​current​ ​recognition​ ​of​ ​CAM​ ​(including​ ​the​ ​regulation​ ​and​ ​registration​ ​of 
CAM​ ​practitioners). 
5. Discuss​ ​the​ ​the​ ​challenge​ ​of​ ​evidence-based​ ​medicine. 
6. Briefly​ ​outline​ ​the​ ​development​ ​of​ ​nutrition​ ​and​ ​dietetics​ ​as​ ​a​ ​profession. 
7. Describe​ ​the​ ​range​ ​of​ ​roles​ ​of​ ​the​ ​dietitian​ ​with​ ​the​ ​Australian​ ​Health​ ​Care​ ​System. 
 
 

 
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Notes 

1. General​ ​practice 

General​ ​practitioners​ ​see​ ​themselves​ ​as​ ​specialising​ ​in​ ​care​ ​of​ ​the​ ​whole​ ​person​ ​rather 
than​ ​defining​ ​their​ ​practice​ ​by​ ​care​ ​of​ ​a​ ​particular​ ​organ​ ​system,​ ​time​ ​of​ ​life​ ​or​ ​context.​ ​The 
relationship​ ​which​ ​general​ ​practitioners​ ​build​ ​with​ ​individuals​ ​and​ ​families​ ​over​ ​time​ ​is​ ​a 
feature​ ​of​ ​the​ ​role.​ ​General​ ​practice​ ​seeks​ ​to​ ​be​ ​patient-centred,​ ​taking​ ​into​ ​account​ ​the 
individual​ ​patient’s​ ​agenda​ ​and​ ​reason​ ​for​ ​seeking​ ​medical​ ​care. 

 
General​ ​practice​ ​seeks​ ​to​ ​provide​ ​accessible,​ ​comprehensive,​ ​coordinated​ ​and 
whole-person​ ​care​ ​across​ ​the​ ​lifespan.​ ​This​ ​involves​ ​health​ ​promotion,​ ​prevention,​ ​acute 
illness​ ​care,​ ​chronic​ ​disease​ ​care,​ ​mental​ ​health​ ​care,​ ​rehabilitation,​ ​and​ ​palliative​ ​care.​ ​In 
the​ ​Australian​ ​health​ ​system,​ ​general​ ​practice​ ​is​ ​the​ ​gatekeeper​ ​for​ ​access​ ​to​ ​many​ ​other 
services,​ ​in​ ​particular​ ​specialist​ ​medical​ ​services​ ​subsidised​ ​by​ ​Medicare. 

http://www.who.int/gho/health_workforce/physicians_density/en/

 
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http://apo.org.au/files/Resource/nphc-supp.pdf

Globally,​ ​Australia​ ​has​ ​a​ ​high​ ​number​ ​of​ ​GPs​ ​per​ ​citizen​ ​and​ ​for​ ​selected​ ​countries,​ ​a 
relatively​ ​similar​ ​ratio​ ​of​ ​GPs​ ​to​ ​other​ ​key​ ​health​ ​professionals 

General​ ​practitioners​ ​are​ ​the​ ​front​ ​line​ ​for​ ​primary​ ​health​ ​care.​ ​They​ ​are​ ​the​ ​first​ ​contact 
for​ ​the​ ​community​ ​and​ ​provide​ ​health​ ​prevention,​ ​treatment,​ ​episodic​ ​and​ ​long​ ​term​ ​care. 
General​ ​practitioner​ ​services​ ​are​ ​easily​ ​accessible​ ​for​ ​all​ ​of​ ​the​ ​community,​ ​and​ ​general 
practitioners​ ​are​ ​able​ ​to​ ​address​ ​a​ ​wide​ ​range​ ​of​ ​health​ ​issues.​ ​More​ ​than​ ​80%​ ​of​ ​the 
Australian​ ​population​ ​access​ ​general​ ​practitioner​ ​services​ ​each​ ​year. 
 
General​ ​practitioners​ ​normally​ ​work​ ​independently​ ​from​ ​other​ ​services​ ​and​ ​other​ ​primary 
health​ ​care​ ​professionals.​ ​If​ ​they​ ​are​ ​not​ ​able​ ​to​ ​deal​ ​with​ ​a​ ​certain​ ​health​ ​problem,​ ​general 
practitioners​ ​have​ ​easy​ ​avenues​ ​for​ ​referral​ ​to​ ​external​ ​specialist​ ​services.​ ​These​ ​referrals 
give​ ​general​ ​practitioners​ ​a​ ​‘gatekeeper’​ ​role,​ ​providing​ ​access​ ​to​ ​the​ ​rest​ ​of​ ​the​ ​health​ ​care 
system.​ ​Referrals​ ​also​ ​allow​ ​some​ ​services​ ​to​ ​be​ ​covered​ ​or​ ​partly​ ​covered​ ​by​ ​Medicare. 
Most​ ​general​ ​practitioner​ ​specific​ ​services​ ​are​ ​covered​ ​by​ ​Medicare,​ ​and​ ​allow​ ​citizens​ ​to 
receive​ ​sickness​ ​benefits​ ​if​ ​they​ ​need​ ​them. 
 
However,​ ​most​ ​general​ ​practitioners​ ​are​ ​primarily​ ​focussed​ ​on​ ​the​ ​individual​ ​health​ ​of 
people​ ​and​ ​not​ ​the​ ​overall​ ​health​ ​of​ ​the​ ​community​ ​they​ ​are​ ​a​ ​part​ ​of.​ ​There​ ​is​ ​less​ ​of​ ​a 
focus​ ​on​ ​the​ ​social​ ​determinants​ ​of​ ​health,​ ​which​ ​are​ ​addressed​ ​more​ ​often​ ​in​ ​other​ ​parts 

 
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of​ ​the​ ​Australian​ ​health​ ​care​ ​system.​ ​Therefore,​ ​most​ ​general​ ​practices​ ​work​ ​under​ ​the 
primary​ ​health​ ​care​ ​model​ ​rather​ ​than​ ​a​ ​primary​ ​care​ ​model. 

 
http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=6442458110 
 
 
This​ ​flow-chart​ ​indicates​ ​that​ ​Australian​ ​citizens’​ ​first​ ​contact​ ​with​ ​the​ ​Australian​ ​Healthcare 
system​ ​is​ ​either​ ​a​ ​primary​ ​care​ ​professional​ ​or​ ​a​ ​general​ ​hospital​ ​emergency​ ​department. 
GPs​ ​are​ ​central​ ​to​ ​primary​ ​health​ ​care,​ ​with​ ​the​ ​vast​ ​majority​ ​of​ ​citizens​ ​first​ ​presenting​ ​at​ ​a 
GP​ ​[overall,​ ​74.8%].​ ​A​ ​further​ ​10%​ ​of​ ​patients​ ​have​ ​first​ ​contact​ ​at​ ​a​ ​hospital​ ​emergency 
department. 
 

2. The​ ​patient-centred​ ​approach 

The​ ​patient-centred​ ​approach​ ​(also​ ​commonly​ ​referred​ ​to​ ​as​ ​client-centred​ ​practice)​ ​takes 
into​ ​account​ ​the​ ​individual’s​ ​needs​ ​and​ ​opinions​ ​in​ ​their​ ​treatment​ ​and​ ​makes​ ​the​ ​patient 
actively​ ​involved​ ​in​ ​their​ ​health​ ​care.​ ​This​ ​enhances​ ​the​ ​doctor-patient​ ​relationship​ ​by 
including​ ​everyone​ ​in​ ​the​ ​decision​ ​making​ ​processes​ ​surrounding​ ​the​ ​patient’s​ ​care,​ ​as​ ​well 
as​ ​giving​ ​doctors​ ​and​ ​patients​ ​a​ ​realistic​ ​view​ ​of​ ​the​ ​expected​ ​outcomes​ ​of​ ​treatment. 
 
The​ ​patient-centred​ ​approach​ ​means​ ​viewing​ ​the​ ​person​ ​as​ ​a​ ​whole​ ​and​ ​not​ ​just​ ​focussing 
on​ ​one​ ​part​ ​of​ ​their​ ​body​ ​that​ ​is​ ​malfunctioning​ ​(such​ ​as​ ​the​ ​circulatory​ ​system 
[cardiologist​ ​ ​or​ ​the​ ​feet​ ​[podiatrist]).​ ​Patient-centred​ ​care​ ​encourages​ ​people​ ​to​ ​create​ ​a 

 
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strong​ ​enough​ ​bond​ ​with​ ​their​ ​doctor​ ​to​ ​continue​ ​to​ ​see​ ​them​ ​throughout​ ​their​ ​lives​ ​[that 
is​ ​to​ ​act​ ​as​ ​a​ ​family​ ​doctor].​ ​General​ ​practice​ ​aims​ ​to​ ​provide​ ​accessible​ ​and​ ​comprehensive 
lifelong​ ​care​ ​from​ ​paediatrics​ ​to​ ​geriatrics. 
 
General​ ​practice​ ​currently​ ​treats​ ​illness​ ​reactively,​ ​that​ ​is,​ ​once​ ​an​ ​illness​ ​is​ ​already​ ​present. 
The​ ​symptoms​ ​are​ ​treated​ ​instead​ ​of​ ​trying​ ​to​ ​stop​ ​the​ ​illness​ ​from​ ​occurring​ ​with 
preventative​ ​methods.​ ​ ​However,​ ​general​ ​practice​ ​has​ ​continually​ ​been​ ​encouraged​ ​by​ ​the 
general​ ​public,​ ​policy​ ​makers​ ​and​ ​allied​ ​health​ ​professionals​ ​to​ ​change​ ​their​ ​approach​ ​to​ ​a 
more​ ​proactive​ ​one. 
 
In​ ​the​ ​late​ ​1990’s,​ ​changes​ ​to​ ​Medicare​ ​benefits​ ​occurred,​ ​altering​ ​the​ ​role​ ​general 
practitioners​ ​play​ ​in​ ​health​ ​care.​ ​This​ ​change​ ​in​ ​role​ ​allowed​ ​general​ ​practitioners​ ​to 
become​ ​the​ ​first​ ​contact​ ​“gate​ ​keepers”​ ​for​ ​the​ ​health​ ​care​ ​system.​ ​To​ ​help​ ​support​ ​general 
practitioners​ ​with​ ​chronic​ ​disease​ ​management​ ​the​ ​Enhanced​ ​Primary​ ​Care​ ​Package​ ​(EPC) 
was​ ​introduced​ ​by​ ​the​ ​Department​ ​of​ ​Health​ ​and​ ​Aging.​ ​This​ ​increased​ ​the​ ​benefit 
amounts​ ​for​ ​people​ ​who​ ​had​ ​a​ ​chronic​ ​disease​ ​and​ ​required​ ​a​ ​care​ ​plan​ ​developed​ ​by​ ​a 
GP.​ ​In​ ​2005,​ ​this​ ​was​ ​revised​ ​to​ ​increase​ ​the​ ​benefits​ ​further,​ ​allowing​ ​people​ ​with​ ​a​ ​chronic 
disease​ ​to​ ​receive​ ​Medicare​ ​rebates​ ​for​ ​up​ ​to​ ​five​ ​allied​ ​health​ ​services​ ​per​ ​year.​ ​However, 
this​ ​blurred​ ​the​ ​lines​ ​of​ ​eligibility​ ​to​ ​patients​ ​and​ ​put​ ​general​ ​practitioners​ ​in​ ​a​ ​difficult 
situation.​ ​It​ ​also​ ​increased​ ​and​ ​defined​ ​the​ ​role​ ​of​ ​general​ ​practice​ ​nurses,​ ​as​ ​they 
managed​ ​and​ ​coordinated​ ​most​ ​or​ ​all​ ​of​ ​the​ ​care​ ​plans​ ​in​ ​the​ ​practice. 
 
General​ ​practitioners​ ​are​ ​one​ ​of​ ​the​ ​larger​ ​providers​ ​of​ ​childhood​ ​and​ ​adult 
immunisations.​ ​In​ ​rural​ ​and​ ​remote​ ​areas,​ ​general​ ​practitioners​ ​have​ ​an​ ​ever​ ​bigger​ ​role 
due​ ​to​ ​the​ ​reduced​ ​amount​ ​of​ ​other​ ​services. 
 

3.​ ​Complementary​ ​and​ ​Alternative​ ​Medicine​ ​(1) 

According​ ​to​ ​the​ ​National​ ​Centre​ ​for​ ​Complementary​ ​and​ ​Integrative​ ​Health​ ​at​ ​the​ ​US 
National​ ​Institutes​ ​of​ ​Health,​ ​CAMs​ ​are​ ​divided​ ​into​ ​five​ ​categories:​ ​alternative​ ​medical 
systems,​ ​mind-body​ ​interventions,​ ​biologically​ ​based​ ​therapies,​ ​manipulative​ ​and 
body-based​ ​methods,​ ​and​ ​energy​ ​therapies. 
 

 
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In​ ​Australia,​ ​Complementary​ ​and​ ​Alternative​ ​Medicine​ ​(CAM)​ ​refers​ ​to​ ​a​ ​range​ ​of​ ​popular 
but​ ​diverse​ ​health​ ​care​ ​practices​ ​and​ ​products​ ​which​ ​exist​ ​parallel​ ​with,​ ​but​ ​not​ ​regarded 
as​ ​part​ ​of,​ ​the​ ​mainstream​ ​biomedical​ ​system​ ​(McCabe​ ​2005). 

Internationally,​ ​the​ ​most​ ​commonly​ ​used​ ​CAM​ ​practices​ ​are​ ​usually​ ​considered​ ​to​ ​be 
acupuncture,​ ​homoeopathy,​ ​herbal​ ​medicine,​ ​nutritional​ ​medicine​ ​and​ ​manipulative 
medicine​ ​(osteopathy​ ​and​ ​chiropractic)​ ​(Foundation​ ​for​ ​Integrated​ ​Medicine​ ​1997).​ ​Since 
the​ ​1960s,​ ​there​ ​has​ ​been​ ​a​ ​considerable​ ​resurgence​ ​in​ ​the​ ​popularity​ ​of​ ​CAM.​ ​This​ ​has 
resulted​ ​in​ ​an​ ​increasing​ ​number​ ​of​ ​public​ ​institutions​ ​developing​ ​policies​ ​around 
recognition​ ​as​ ​well​ ​as​ ​regulation​ ​of​ ​and​ ​registration​ ​of​ ​CAM​ ​practitioners. 

https://nccih.nih.gov/health/integrative-health 
Complementary​ ​and​ ​Alternative​ ​Medicine​ ​[CAM]​ ​refers​ ​to​ ​a​ ​diverse​ ​range​ ​of​ ​various​ ​health 
care​ ​approaches,​ ​each​ ​with​ ​their​ ​own​ ​strong,​ ​unique​ ​philosophical​ ​explanation​ ​of​ ​health. 

 
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These​ ​approaches​ ​have​ ​never​ ​been​ ​considered​ ​mainstream​ ​and​ ​have​ ​co-existed​ ​with​ ​the 
mainstream​ ​biomedical​ ​approach​ ​to​ ​health​ ​care.​ ​The​ ​most​ ​common​ ​types​ ​of​ ​CAMs​ ​are 
acupuncture,​ ​herbal​ ​medicine,​ ​homeopathy,​ ​nutritional​ ​medicine,​ ​osteopathy​ ​and 
chiropractic​ ​services. 
 
Currently,​ ​some​ ​of​ ​these​ ​alternative​ ​services​ ​are​ ​eligible​ ​for​ ​Medicare​ ​rebates.​ ​Having 
Medicare​ ​reimbursement​ ​for​ ​alternative​ ​medicine​ ​has​ ​increased​ ​its​ ​popularity​ ​and 
accessibility​ ​to​ ​the​ ​general​ ​public.​ ​Popularity​ ​is​ ​also​ ​dependent​ ​on​ ​a​ ​patient’s​ ​culture​ ​and 
past​ ​experiences​ ​with​ ​health​ ​services. 
 
CAM​ ​services​ ​are​ ​very​ ​diverse​ ​in​ ​nature.​ ​However,​ ​there​ ​are​ ​some​ ​common​ ​aspects.  
CAMs​ ​view​ ​the​ ​person​ ​holistically​ ​and​ ​all​ ​believe​ ​there​ ​is​ ​interconnectedness​ ​between 
body,​ ​spirit​ ​and​ ​mind.​ ​Therefore,​ ​all​ ​of​ ​these​ ​approaches​ ​focus​ ​on​ ​all​ ​aspects​ ​of​ ​health 
[including​ ​emotional,​ ​psychological​ ​and​ ​behavioural​ ​wellbeing].​ ​All​ ​CAM​ ​services​ ​provide 
individualised​ ​treatment​ ​for​ ​each​ ​patient.​ ​No​ ​two​ ​patients​ ​are​ ​treated​ ​the​ ​same,​ ​even​ ​if 
their​ ​condition​ ​is​ ​the​ ​same,​ ​as​ ​CAM​ ​practitioners​ ​believe​ ​everyone​ ​experiences​ ​their 
conditions​ ​differently​ ​and​ ​therefore​ ​require​ ​their​ ​own​ ​personalised​ ​treatment​ ​methods 
and​ ​goals. 

CAM​ ​services​ ​also​ ​do​ ​not​ ​create​ ​a​ ​formal​ ​treatment​ ​relationship,​ ​but​ ​instead​ ​create​ ​a 
partnership​ ​with​ ​the​ ​patient.​ ​This​ ​empowers​ ​individuals​ ​to​ ​become​ ​part​ ​of​ ​their​ ​healing 
process,​ ​involved​ ​in​ ​decision​ ​making​ ​and​ ​also​ ​removes​ ​some​ ​of​ ​the​ ​burden​ ​of​ ​care​ ​from 
the​ ​practitioner.​ ​Many​ ​of​ ​CAM​ ​services​ ​believe​ ​that​ ​with​ ​the​ ​right​ ​guidance​ ​and​ ​support, 
patient’s​ ​bodies​ ​can​ ​heal​ ​themselves.​ ​CAM​ ​practitioners​ ​believe​ ​that​ ​ill​ ​health​ ​is​ ​due​ ​to​ ​an 
imbalance​ ​of​ ​harmony​ ​within​ ​one’s​ ​self​ ​and​ ​that​ ​restoring​ ​this​ ​balance​ ​of​ ​their​ ​life​ ​force 
can​ ​reduce​ ​or​ ​replace​ ​the​ ​need​ ​for​ ​any​ ​biomedical​ ​interventions. 

While​ ​there​ ​appears​ ​to​ ​be​ ​face​ ​validity​ ​between​ ​chiropractic/osteopathic​ ​manipulation​ ​and 
treatment​ ​of​ ​pain​ ​for​ ​example,​ ​there​ ​is​ ​less​ ​apparent​ ​synergy​ ​between​ ​physical​ ​therapies 
and​ ​the​ ​management​ ​of​ ​anxiety/stress,​ ​insomnia​ ​and​ ​ADHD​ ​(attention​ ​deficit​ ​hyperactivity 
disorder). 
 

4.​ ​CAMs​ ​(2) 

 
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CAMs​ ​have​ ​increased​ ​in​ ​popularity​ ​since​ ​the​ ​1960’s.​ ​It​ ​is​ ​most​ ​common​ ​for​ ​wealthy, 
well-educated​ ​individuals​ ​from​ ​well-developed​ ​communities​ ​to​ ​seek​ ​out​ ​CAM​ ​services.​ ​In 
2002,​ ​CAM​ ​services​ ​were​ ​used​ ​by​ ​52.2%​ ​of​ ​the​ ​Australian​ ​population.​ ​Ages​ ​varied,​ ​but​ ​were 
most​ ​common​ ​in​ ​ages​ ​25-34.​ ​Many​ ​CAM​ ​users​ ​do​ ​not​ ​tell​ ​their​ ​general​ ​practitioner​ ​or 
family​ ​doctor​ ​that​ ​they​ ​are​ ​using​ ​CAM​ ​services.​ ​Many​ ​people​ ​reported​ ​using​ ​CAM​ ​services 
for​ ​maintenance​ ​of​ ​their​ ​general​ ​health. 

A​ ​common​ ​group​ ​of​ ​the​ ​population​ ​that​ ​use​ ​CAM​ ​services​ ​are​ ​people​ ​with​ ​cancer.​ ​This​ ​is 
not​ ​only​ ​to​ ​aid​ ​in​ ​the​ ​treatment​ ​of​ ​disease,​ ​but​ ​also​ ​to​ ​manage​ ​the​ ​negative​ ​side​ ​effects​ ​of 
biomedical​ ​treatment​ ​of​ ​cancer,​ ​such​ ​as​ ​chemotherapy​ ​and​ ​radiotherapy.​ ​CAM​ ​therapies 
are​ ​often​ ​used​ ​by​ ​people​ ​in​ ​the​ ​later​ ​stages​ ​of​ ​cancer,​ ​as​ ​a​ ​last​ ​resort​ ​method. 

There​ ​has​ ​been​ ​an​ ​increasing​ ​number​ ​of​ ​CAM​ ​services​ ​recognised​ ​by​ ​formal​ ​institutions 
such​ ​as​ ​the​ ​Royal​ ​Australian​ ​College​ ​of​ ​General​ ​Practitioners.​ ​The​ ​Therapeutic​ ​Goods 
Association​ ​(TGA)​ ​regulates​ ​CAM​ ​medications,​ ​to​ ​ensure​ ​patient​ ​safety​ ​and​ ​increase 
accountability​ ​for​ ​CAM​ ​professionals. 
Degrees​ ​are​ ​now​ ​available​ ​for​ ​CAM​ ​practitioners​ ​in​ ​fields​ ​such​ ​as​ ​Chiropractic​ ​and 
Osteopathy​ ​and​ ​these​ ​services​ ​can​ ​be​ ​partially​ ​rebated​ ​by​ ​Medicare​ ​if​ ​referred​ ​to​ ​by​ ​a 
general​ ​practitioner.​ ​Most​ ​private​ ​health​ ​insurers​ ​offer​ ​rebates​ ​on​ ​some​ ​or​ ​all​ ​of​ ​CAM 
services​ ​used. 
 
Over​ ​the​ ​last​ ​10​ ​years,​ ​an​ ​increase​ ​in​ ​regulation​ ​and​ ​registration​ ​of​ ​CAM​ ​practitioners​ ​has 
occurred,​ ​in​ ​areas​ ​such​ ​as​ ​Chinese​ ​Medicine,​ ​Chiropractic​ ​and​ ​Osteopathy.​ ​This​ ​increases 
the​ ​health​ ​professional’s​ ​ability​ ​to​ ​apply​ ​techniques​ ​and​ ​procedures​ ​they​ ​learned​ ​through 
the​ ​appropriate​ ​training.​ ​These​ ​are​ ​all​ ​regulated​ ​under​ ​the​ ​Australian​ ​Health​ ​Practitioners 
Registration​ ​Agency​ ​(AHPRA). 

5.​ ​Evidence-based​ ​medicine 

Evidence-based​ ​medicine​ ​(EBM)​ ​and​ ​evidence-based​ ​practice​ ​(EBP)​ ​refers​ ​to​ ​the​ ​use​ ​of​ ​best 
available​ ​research​ ​to​ ​guide​ ​practice​ ​in​ ​health​ ​care.​ ​These​ ​studies​ ​guide​ ​the​ ​treatment​ ​on​ ​an 
individual​ ​basis​ ​and​ ​are​ ​commonly​ ​used​ ​in​ ​all​ ​areas​ ​of​ ​medicine​ ​such​ ​as​ ​nursing,​ ​allied 
health​ ​and​ ​general​ ​practice.​ ​The​ ​practice​ ​of​ ​EBM​ ​is​ ​a​ ​complicated​ ​process,​ ​reviewing, 
interpreting​ ​and​ ​applying​ ​finding​ ​from​ ​studies​ ​to​ ​everyday​ ​practice​ ​with​ ​patients.​ ​The​ ​focus 

 
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of​ ​EBM​ ​is​ ​less​ ​on​ ​how​ ​a​ ​treatment​ ​works,​ ​but​ ​rather​ ​how​ ​effective​ ​a​ ​treatment​ ​is.​ ​The 
favourite​ ​method​ ​of​ ​conducting​ ​EBM​ ​studies​ ​is​ ​through​ ​randomised​ ​control​ ​trials​ ​(RCTs) 
and​ ​these​ ​are​ ​hard​ ​to​ ​apply​ ​to​ ​CAM​ ​therapies​ ​that​ ​are​ ​practiced​ ​by​ ​practitioner​ ​owned 
private​ ​establishments.​ ​This​ ​is​ ​added​ ​to​ ​the​ ​philosophical​ ​clash​ ​that​ ​therapies​ ​should​ ​be 
individualized​ ​to​ ​each​ ​particular​ ​patient/client 
 
Fundamental​ ​aspects​ ​of​ ​evidence​ ​based​ ​practice 

 
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6.​ ​The​ ​development​ ​of​ ​nutrition​ ​&​ ​dietetics 

Broadly​ ​speaking,​ ​dietitians​ ​are​ ​allied​ ​health​ ​professionals​ ​who​ ​assess​ ​and​ ​address​ ​issues 
people​ ​have​ ​with​ ​food.​ ​Dietitians​ ​use​ ​medical​ ​nutrition​ ​therapy​ ​in​ ​clinical​ ​management​ ​of 
conditions.​ ​Dietitians​ ​aim​ ​to​ ​enhance​ ​the​ ​nutritional​ ​health​ ​of​ ​people​ ​in​ ​the​ ​community,​ ​at 
a​ ​person,​ ​group​ ​and​ ​population​ ​level.​ ​They​ ​do​ ​this​ ​through​ ​health​ ​promotion​ ​strategies; 
change​ ​to​ ​food​ ​practice​ ​and​ ​to​ ​the​ ​food​ ​environment.​ ​Health​ ​promotion​ ​initiatives​ ​created 
in​ ​conjunction​ ​with​ ​dietitians​ ​include​ ​the​ ​Healthy​ ​Tick​ ​initiative​ ​and​ ​the​ ​Food​ ​Pyramid. 
dietitians​ ​also​ ​assist​ ​in​ ​the​ ​management​ ​of​ ​diseases​ ​that​ ​are​ ​affected​ ​by​ ​food​ ​intake,​ ​such 
as​ ​Diabetes​ ​Mellitus​ ​and​ ​Anorexia​ ​Nervosa.​ ​They​ ​treat​ ​these​ ​conditions​ ​by​ ​providing 
nutrient​ ​information​ ​to​ ​patients​ ​and​ ​promoting​ ​healthy​ ​eating​ ​practices. 
 
Dietetics​ ​in​ ​Australia​ ​was​ ​first​ ​developed​ ​in​ ​the​ ​1930’s.​ ​The​ ​first​ ​professional​ ​body​ ​for 
dietitians​ ​in​ ​Australia​ ​was​ ​the​ ​Dietetic​ ​Association​ ​in​ ​Victoria​ ​in​ ​1935.​ ​It​ ​had​ ​13​ ​members.​ ​In 
2005,​ ​there​ ​were​ ​approximate​ ​3000​ ​dietitians​ ​practicing​ ​and​ ​approximately​ ​450​ ​students 
studying​ ​dietetics.​ ​Dietetics​ ​is​ ​currently​ ​a​ ​female​ ​dominated​ ​profession,​ ​with​ ​only​ ​8.5%​ ​of 
makes​ ​graduating​ ​into​ ​the​ ​workforce​ ​in​ ​2007. 

 
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All​ ​nutrition​ ​and​ ​dietetics​ ​courses​ ​provide​ ​a​ ​strong​ ​knowledge​ ​base​ ​of​ ​basic​ ​sciences​ ​such 
as​ ​biochemistry​ ​and​ ​physiology.​ ​There​ ​are​ ​also​ ​specialised​ ​subject​ ​areas​ ​such​ ​as​ ​food​ ​and 
nutritional​ ​science,​ ​public​ ​health​ ​nutrition​ ​practice,​ ​medical​ ​nutrition,​ ​research​ ​skills, 
communication​ ​skills,​ ​food​ ​service​ ​and​ ​sociology​ ​of​ ​food​ ​and​ ​nutrition. 
 
Dietitians​ ​and​ ​nutritionists​ ​are​ ​not​ ​the​ ​same.​ ​In​ ​2007,​ ​a​ ​category​ ​for​ ​“Accredited 
Nutritionists”​ ​was​ ​created​ ​by​ ​the​ ​dietitians​ ​Association​ ​of​ ​Australia​ ​(DAA).​ ​This​ ​qualification 
is​ ​for​ ​people​ ​that​ ​have​ ​completed​ ​a​ ​nutrition​ ​program​ ​and​ ​have​ ​extensive​ ​training​ ​in 
human​ ​nutrition,​ ​but​ ​do​ ​not​ ​have​ ​a​ ​clinical​ ​dietetic​ ​qualification.​ ​Nutritionists​ ​are​ ​most 
commonly​ ​employed​ ​in​ ​health​ ​promotion​ ​roles​ ​and​ ​community​ ​education​ ​roles.​ ​Dietitians 
in​ ​community​ ​based​ ​roles​ ​are​ ​able​ ​to​ ​describe​ ​themselves​ ​as​ ​nutritionists;​ ​however, 
nutritionists​ ​are​ ​not​ ​able​ ​to​ ​describe​ ​themselves​ ​as​ ​dietitians. 
The​ ​DAA​ ​is​ ​the​ ​most​ ​prominent​ ​body​ ​for​ ​the​ ​regulation​ ​of​ ​standards​ ​for​ ​dietetics​ ​and 
nutrition.​ ​However,​ ​you​ ​do​ ​not​ ​have​ ​to​ ​be​ ​a​ ​registered​ ​member​ ​to​ ​be​ ​a​ ​dietitian.​ ​The​ ​DAA 
does​ ​provide​ ​mechanisms​ ​for​ ​quality​ ​accreditation​ ​of​ ​dietetic​ ​services​ ​and​ ​management​ ​of 
safety. 

7.​ ​Role​ ​of​ ​the​ ​dietitian  

Dietitians​ ​are​ ​health​ ​professionals​ ​who​ ​are​ ​trained​ ​to​ ​understand​ ​the​ ​myriad​ ​of​ ​functions 
and​ ​roles​ ​played​ ​by​ ​food​ ​in​ ​our​ ​lives​ ​and​ ​in​ ​our​ ​communities.​ ​Dietitians​ ​use​ ​this 
understanding​ ​to​ ​enhance​ ​the​ ​nutritional​ ​health​ ​of​ ​individuals,​ ​groups​ ​and​ ​entire 
populations​ ​through​ ​promoting​ ​health-enhancing​ ​changes​ ​to​ ​food​ ​practices​ ​and​ ​to​ ​the 
food​ ​environment.​ ​Nutrition​ ​and​ ​dietetic​ ​services​ ​are​ ​delivered​ ​across​ ​the​ ​continuum​ ​of 
health​ ​care,​ ​from​ ​primary​ ​prevention​ ​and​ ​early​ ​intervention​ ​to​ ​illness​ ​management​ ​of 
disease. 
 
Dietitians​ ​have​ ​the​ ​ability​ ​to​ ​work​ ​in​ ​a​ ​variety​ ​of​ ​different​ ​clinical​ ​settings.​ ​Around​ ​60%​ ​of 
the​ ​dietitians​ ​work​ ​in​ ​the​ ​government​ ​or​ ​within​ ​public​ ​health​ ​services.​ ​The​ ​rest​ ​are 
employed​ ​in​ ​a​ ​variety​ ​of​ ​private​ ​sector​ ​settings.​ ​Almost​ ​50%​ ​of​ ​dietitians​ ​are​ ​employed​ ​in 
primarily​ ​clinical​ ​or​ ​acute​ ​settings:​ ​either​ ​in​ ​a​ ​hospital​ ​or​ ​an​ ​aged​ ​care​ ​facility.​ ​These 
dietitians​ ​usually​ ​manage​ ​and​ ​treat​ ​diseases​ ​and​ ​disorders​ ​such​ ​as​ ​Diabetes​ ​Mellitus,​ ​renal 
disease,​ ​liver​ ​disease,​ ​cardiac​ ​diseases​ ​and​ ​other​ ​disorders​ ​that​ ​require​ ​medical​ ​nutrition 

 
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therapy​ ​such​ ​as​ ​Anorexia​ ​Nervosa.​ ​Medical​ ​nutrition​ ​therapy​ ​falls​ ​under​ ​the​ ​biomedical 
model​ ​of​ ​care. 
 
Dietitians​ ​work​ ​within​ ​the​ ​multidisciplinary​ ​team​ ​alongside​ ​doctors,​ ​nurses,​ ​occupational 
therapists,​ ​physiotherapists,​ ​speech​ ​pathologists,​ ​psychologists​ ​and​ ​others.​ ​Their​ ​role​ ​in 
the​ ​team​ ​is​ ​to​ ​provide​ ​specific​ ​and​ ​individualized​ ​dietary​ ​regimes​ ​for​ ​each​ ​patient​ ​on​ ​their 
caseload.​ ​If​ ​it​ ​is​ ​required,​ ​dietitians​ ​can​ ​prescribe​ ​dietary​ ​supplements​ ​to​ ​aid​ ​in​ ​weight​ ​gain 
or​ ​loss,​ ​and​ ​to​ ​ensure​ ​that​ ​their​ ​patients​ ​are​ ​not​ ​deficient​ ​in​ ​any​ ​nutrients.​ ​Dietitians​ ​can 
also​ ​specialise​ ​to​ ​ensure​ ​quality​ ​and​ ​efficient​ ​food​ ​services​ ​in​ ​health​ ​services,​ ​for​ ​both 
normal​ ​and​ ​therapeutic​ ​diets. 
 
Approximately​ ​20%​ ​of​ ​dietitians​ ​work​ ​in​ ​community​ ​settings.​ ​Community​ ​setting​ ​dietitians 
can​ ​be​ ​involved​ ​in​ ​group​ ​education​ ​sessions,​ ​one-on-one​ ​therapy,​ ​policy​ ​development​ ​and 
other​ ​campaigns​ ​that​ ​can​ ​be​ ​local,​ ​state​ ​or​ ​national​ ​wide.​ ​Community​ ​dietitians​ ​work​ ​under 
a​ ​social​ ​model​ ​of​ ​health.​ ​They​ ​can​ ​also​ ​aid​ ​people​ ​transferring​ ​from​ ​acute​ ​settings​ ​back 
into​ ​the​ ​community​ ​with​ ​their​ ​transition​ ​home.​ ​Community​ ​dietitians​ ​often​ ​have​ ​a​ ​strong 
focus​ ​on​ ​obesity​ ​and​ ​public​ ​health. 
 

http://www.deakin.edu.au/exercise-nutrition-sciences/careers/dietetics 

 
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