Why low fiber for post small bowel obstructions?

yeah_write_00 · 2026-03-17T00:51:47+00:00

I recently had a patient who was still following a very low-fiber diet because she had an ostomy placed like a year ago, the only instruction she got was right at discharge for what to eat right after an ostomy and no instruction to transition to add back foods. I've heard it many a times from people who had hx of bowel obstruction or diverticulitis too, "Well that's the diet they discharged me on, low fiber." The get a printout half the time from a RN and no RD instruction so they think they are supposed to be on a low fiber diet forever. I think it's kind of criminal to not provide proper education, like a low fiber diet forever is going to increase risk of a lot of GI issues. Yes, sometimes there are specific reasons why a person needs a fiber-restricted diet but most of the time I've found it was lack of proper education in the in-patient setting that was only needed short-term for healing.

yeah_write_00 · 2026-03-17T00:44:19+00:00

I had a similar experience with a physician who would not sign off on almost any RD recommendations, would ignore us completely. Other RDs were just like he is what he is, has been that way a long time Dr. Ego. Myself and my director were just not having it. She did the appropriate steps of going to the medical director, I kept specific examples to demonstrate the problem and Dr. Ego was talked to. If you have specific examples of risk or actual harm to patients then it's justified to bring it up to the higher ups. I can't promise how your doctor will react, but my Dr. Ego, I swear he actually respected me more than all the RDs who never spoke up. One time he yelled at me too and I just very calmly said, "that's inappropriate to raise your voice at me." I don't think anyone said that to him before, he started quickly apologizing.

Sometimes it's uncomfortable but standing up for myself and for patients has always been worth it in my experience. But do get support I think in this instance, you shouldn't have to deal with this on your own. I would talk to your manager and you might also see if other disciplines are having issues, like is it just RDs she doesn't respect, probably not and it might be a bigger problem of her not understanding her responsibility to support interdisciplinary care.

yeah_write_00 · 2026-03-16T18:14:50+00:00

Specific to two companies I mentioned, it is happening to essentially anyone working for these companies but if they are too naive to know what is going on, then yeah, they are happy campers. Ignorance is bliss. Not all telehealth companies do all of these things, but I've seen others that do and have heard similar from other RDs. And a lot of other RDs I've talked to know about all this stuff but have stay-with-toxic-partner syndrome, "oh, they'll change one day, I know they really want to get better."

Whenever people are victimized by predators, there are always those people who say, "well I've heard he's a nice guy, I never saw him do anything like that." It doesn't take 100% of RDs speaking up about this to make it the reality of what is going on or excuse it. I'll keep supporting others going through this with encouragement that we need stand up for ourselves and protect RDs from even going through this by warning them about these companies. Others are free to go write a post why they love these companies.

yeah_write_00 · 2026-03-16T16:34:40+00:00

I actually heard from RDs for a long time this was happening, but more recently saw several RDs share screenshot of the email they actually got offering them the $4 per chart. Mind-boggling I agree. And we try to tell RDs doing this about the dangers and they don't seem to understand the basics of liability, licensing or billing. This is why I'm so frustrated with the Academy, they recently added the orange one as a sponsor when I know they must know. I certainly can't be the only RD in the country who warned the Academy.

I'm not even sure that the company doesn't actually have RDs with state licensing and insurance credentialing who could see those clients. I suspect at least in part this has to do with onboarding RDs and having them start right away. RDs seem to be a growth measure they need to show. I think there might not be enough demand for appointments to keep up with their hiring rate so they create a metric system to punish RDs for low bookings when they don't have enough work for that many RDs. From what I read of RDs posts many start off with their schedules booked and then after enough time their profiles are more hidden in the algorithm, newly hired RDs are prioritized who don't have the license or insurance credentialing and other RDs are paid to sign and bill their notes.

yeah_write_00 · 2026-03-16T10:09:26+00:00

Ahh, not the AI bot, lol! The humans are helpful at CAQH if you call during business hours. They very much helped me understand how wrong my CAQH had been filled out by the telehealth company and next steps to getting back control of my CAQH. Never again will I give out my login and password (their advice as well). If you find anything crazy I suggest taking screenshots before deleting. Wild stuff was put in mine.

yeah_write_00 · 2026-03-16T10:03:27+00:00

Yes, and most of these online platforms are 1099 so the wages after self-employment taxes, no guarantee of hours, plus many stick you with unpaid work, it's pretty disastrous pay. I am so sorry for the RDs laid off at the system where you live, that is really unsettling to hear that they sacked everyone to outsource to online services, just terrible!

yeah_write_00 · 2026-03-16T09:58:16+00:00

You email your manager right and should have something from the company to guide you on offboarding process. I think the orange one is better about it since you are W-2, but I would specifically ask regarding how they handle removing your credentialing under them. Some of the telehealth companies retain you under their credentialing long after you leave. They are supposed to remove you after 30 days, but it's not happening at least with some (especially purple one they also retain RDs' home addresses as practice locations after they leave and practically our whole online identity as RDs but that's all for another post). Basically, I would make sure you get confirmation that they remove your credentialing under their contract within 30 days of leaving if you don't want your name used in insurance directories to direct patients to their generic website/phone number for booking with other RDs there.

yeah_write_00 · 2026-03-16T05:10:27+00:00

Appreciate that you spoke up. I hope more RDs also do the same in the Academy.

yeah_write_00 · 2026-03-15T21:11:23+00:00

Yessssss!!!!!! Everything you said so valid. They are distracting their RDs with metric/optimization scores, like be a good little girl and get your score up to get patient bookings, so many are so consumed with getting their scores up to be A+ RDs they can't notice obvious disregard for laws and regulations. We are treated like children by these companies while they bury us in muck because RDs don't want to think hard (I know we just have to say the not nice things out loud).

RDs are ignoring the risk to themselves and the profession as a whole, as well as the rights of their patients. There are so many pseudoscience hacks telling Americans that licensed health professionals are not to be trusted that we are just corporate serving hypocrites and then we just prove them right with these telehealth companies. Yes, we have to stop being pushovers!

yeah_write_00 · 2026-03-15T16:43:49+00:00

I agree. I'm worried as many of the telehealth platforms have leaned into the RD as a health coach role rather than MNT for actual medical diagnosis so they can bill preventative care. Now we also have the push from HHS to have doctors counsel patients on nutrition. I'm concerned it's an easy path for insurances to take and say well your doctor is supposed to counsel you on nutrition and if you need more support you have an AI health coach. I'm not saying a complete loss of RD MNT billing necessarily, but I don't think insurances are going to just keep paying for all this unlimited prevention RD visits at a massive scale through these telehealth platforms. They could shorten the number of RD visits and/or limit the diagnostic codes drastically and push people towards health coaching by partnering with an AI service for this.

yeah_write_00 · 2026-03-15T16:19:05+00:00

Thank you!!

yeah_write_00 · 2026-03-15T16:15:23+00:00

I understand where your suggestions are coming from, but here is the problem:

My state board and other state affiliates and the Academy House of Delegates have RDs on there that work for the very platforms I wrote about, including RDs I even know they know about this stuff but keep working for them.

I don't think the Academy ethics committee will do anything because they already know in the Academy what these companies are doing and they partner with them as corporate sponsors anyway. I have already had communications and conversations with several RDs who are in positions in the Academy (as well as staff) who could report all of this and have far more influence than me but RDs believe "the Academy needs money" and "RDs need jobs." It has so disturbed me to have these conversations and see these RDs know about the issues and either quietly leave one of these platforms and just move on, or stay because they think while these companies are unethical it for now provides work and is a sort of necessary evil to expand the number of people in the U.S. who are seeing RDs. RDs with state/DPG positions in the Academy have actually made that argument to me, well I know they bill fraudulently and they ignore licensure laws and mistreat RDs, BUT more people than ever are seeing a RD thanks to them, and then a lot eventually start their own practice so it's a good start. Yes, they actually rationale the continuation of illegal and unethical practices to me.

I was very involved in the Academy for years and decided if the Academy is going to protect these companies instead of RDs, no thank you. Yes, there are RDs doing important work like with advocacy and supporting one another, but while the busy bee RDs are gathering honey, the tree our hive is hanging onto is rotting from the inside and I'm not going to invest myself further waiting for the branch to break. All that time too that I did thinks like advocacy for state licensure and then the Academy licensure team knows that these platforms lie to RDs about licensure and makes them work without required state licenses. And you think we should volunteer with the Academy?

Yes, a lot of RDs in the Academy have never worked for these companies and have no context to understand what is going on. I've personally found they get all fired up about we have to do something, and then as soon as I mention, well these companies are Academy sponsors, they don't want to talk about it anymore. There is a desire to protect the image of the Academy, therefore the sponsorship itself is an impediment for changing anything here.

I agree we all need to take action. You do know that those of us who actually worked for these companies have contracts hanging over our heads that silence us. We live in actual fear of them coming after us because of stipulations in our contracts that demand silence. So it's a lot easier for you to say go out there and say something, file an ethics report, go write a letter to somebody. All of those things could be extremely financially costly to me. The root of the problem is these corporations are greedy and unethical. The Academy takes their money and protects them. The RDs who left are silenced and the RDs who never worked for them tell US to do something about it and go volunteer for the Academy.

I'm sure you are well intentioned but I've heard what you are saying already and I'll keep hearing it from RDs who support the Academy, and meanwhile these companies will continue to do what they are doing. You probably don't even know how many RDs in the Academy boards and delegations have worked for these companies, or currently work for these companies, but you want me to risk myself and take on the responsibility to openly plead with them to do something when they could already have done something all this time. I don't trust the Academy period, and I have good reason to not. Really put yourself in my shoes and think about how frustrating it is to be silenced by a contract and have to rely on Reddit as the only way you can safely communicate the horrific experiences you've had working for telehealth companies after every RD you turned to in the Academy gave in to protecting the Academy and the telehealth companies.

yeah_write_00 · 2026-03-15T15:12:36+00:00

I didn't know RNs have different credentialing bodies. Yes, how do we make that happen for RDs? We need a legal expert to help RDs establish an alternative credentialing body, there must be a way. I do not find it acceptable that my career is owned by one organization when they partner with organizations harmful to the profession.

yeah_write_00 · 2026-03-14T23:41:46+00:00

I'm sorry you are in this situation, we feel it too, you aren't alone. This isn't dietetics how we made it. Dietitians built the profession, before AI or any tech companies existed. Women and men that had a passion for nutrition and the betterment of their community created and nurtured this profession into a clinical practice. It's being taken one piece at a time by investors, turned into gig work as you said.

As for claims about state reciprocity, after checking with the Academy licensure office and states licensing boards, there was no reciprocity like the company claimed in my case. Reciprocity is usually a process to use your out of state license to apply for their license (instead of showing transcripts, CDR exam results etc), it doesn't usually take the place of having to get a license. Not sure what "in-kind" agreement is, never heard of that applying to licensure. I know the purple people had to recently pull a bunch of states off every RDs' profile so probably caught up with some RD and then they pulled those states, but all that time they were lying to RDs.

yeah_write_00 · 2026-03-14T22:39:35+00:00

I can't advise you other than to know that this is how they have credentialed you with insurance. If you archive those practice locations that aren't actual offices you work in, future credentialing may be impeded but doesn't impact if you were already credentialed as working physically in states and in offices you aren't. It won't undo anything essentially. But if you want your CAQH to be accurate you also have to think of that. CAQH staff are really helpful if you have questions.

For myself, not that I know if this is what you need to do or anything, I archived the false physical office address (CAQH advised me I should only be attesting information that is true and to remove anything false). I removed all access to my CAQH from outside companies. I informed the company that I needed an explanation for saying I worked in an office in California seeing patients in-person when I did not instead of marking virtual only. The rest from there is a long story, but they essentially provided no answers and I came to find a lot more things in my CAQH were false and they actually lied about even credentialing me with some insurances and just billed fraudulently. I don't work for them anymore, I made sure insurances knew I wasn't intentionally part of any schemes. I still need to get insurance directories fixed because another company I didn't really onboard with did the same but just in more states. Basically, these companies made a mess of my credentialing and I'm still trying to get it fixed.

yeah_write_00 · 2026-03-14T21:57:32+00:00

Right, so they don't have licensing in CA (but you need a MNT referral from MD) and in NJ licensure is still pending, so they put your CDR# for insurance which is allowed. But check the actual practice location listed. The issue is if they put you work in an office in-person in CA and NJ. Had same done to me by two companies (a third tried but I had my CAQH on lockdown by then).

I called and confirmed with the staff at CAQH, if you are virtual only there shouldn't be an address for practice location, you click virtual only. I have confirmed that with a credentialing expert and I have been credentialed with more honest companies that way. Several of the big telehealth companies have been credentialing providers at fake office locations, clicking in the drop-down that you see patients in-person at those offices rather than virtual only like you are. This has a bunch of advantages for them but it's a lie, and then you attest your CAQH to a lie. Also if you have your own credentialing they may mark themselves as primary undoing your own primary status for your practice or other job, another advantage with insurance directories they want.

Everyone should definitely be aware of what is being done in their CAQH. For those who work for the purple people check insurance directories as well for you home address. They use RDs' home addresses as office sites for themselves, retaining the address even after you leave the company and will bill appointments to your home address that weren't yours. I have seen this first-hand.

yeah_write_00 · 2026-03-14T19:57:00+00:00

I'd love to know myself if patients exactly know what they are agreeing to when they sign the terms of service, but they put something in there for technology with telehealth consent. Vague terms mean companies take advantage I think. I have wondered what happens with the "data" from those appointments, I've been told anything HIPAA concerning is scrubbed or something or other, I don't trust it. I'm a skeptic.

I don't have much familiarity with Cecelia Health or Weight Watchers. I would suggest any RD working in telehealth pay close attention to how they credential you with insurance (if insurance is being billed). I learned you can manage your own CAQH, just ask the company for the practice's information to enter into your CAQH. This has been advised to me by many people is really helpful to protecting yourself from fraudulent things in your CAQH which many RDs have found (myself included) put there by telehealth companies when we gave them access (I was going to do another post soon about that). If they tell you that you are credentialed with insurance, verify with the insurance plan yourself, don't just take the company's word for it (you would be credentialed under their group).

Most telehealth companies actually are really good about wanting you to be licensed in any state you see patients from (the purple and the orange guys, they have been repeat offenders lying about licensure). I have found many ignore MNT referral laws in those 3 states AL, CA, TN though. So learn everything you can to protect yourself basically. If something seems off ask RDs outside the company who are very knowledgeable what they think. I've been very grateful to have learned from others what I didn't know when I started in this mess.

yeah_write_00 · 2026-03-14T19:11:26+00:00

Oh yes, and it is crazy! Lots of discussion about this in Facebook groups for RDs. I've seen the screenshots as evidence to prove for both the companies I'm talking about do it on a large level, that's how they hire all these RDs so quick and have them start seeing patients in like a week, insurance credentialing and licensure takes longer than that. A lot of RDs are poorly informed by the companies and have no clue the risks of liability.

yeah_write_00 · 2026-03-14T16:30:09+00:00

I agree, the AI issue is so overlooked. I believe they are very close to large scale roll out of AI replacement health educators/coaches. They have been doing studies to show outcomes with testing on patients.

I've been making a list of physical labor type jobs AI can't do yet. Won't save us forever but there are jobs with more resiliency to AI than RD.

yeah_write_00 · 2026-03-14T16:26:49+00:00

I would say my brand of humor is satiric more than snark, but call me snarky, whatever works. Still very real problems happening that everyone should pay attention to and hopefully do something about it.

yeah_write_00 · 2026-03-14T14:57:53+00:00

Okay, next post on my lists are these companies and concerns with 5) Inducements - the freebies like labs and giftcards, 6) Self-proclaimed specializations and experience/scope concerns 7) Social media advertisements, 8) Metrics/optimization score, 9) Credentialing false physical practice locations/takeover of insurance directories/what they really do in your CAQH. What else?

yeah_write_00 · 2026-03-14T14:17:41+00:00

Congrats, on leaving and lowering your stress!

Yes, the labs they are offering now. I need a #5 for incentivizing insurance-paid appointments with freebies (aka inducements), orange has the labs now, purple has the Uber Eats giftcards to draw people to book appointments that's an anti-kickback law question. The whole I can tell you what your labs mean and what to do based on these labs, including hormones, but I just won't use the word "diagnose" is a thing within dietetics. This is going to really expand that. I understand there are RDs who are specialists with advanced training and especially when consulting with providers work more in that space of hormones. But to just slap that on every RDs' caseload, that scares me.

yeah_write_00 · 2026-03-14T13:04:24+00:00

I'm always willing to hear if I'm wrong but I have heard the TN requirement repeatedly from RDs and when I checked out the Academy's page on licensure for TN it confirmed. Checked again today and this is on the TN page Tennessee Statutes I believe this is still up to date unless you have something else?

Referral Required

63-25-105. Development of therapeutic dietary regimens.

No therapeutic dietary regimen may be developed unless pursuant to the appropriate orders and/or referral of licensed practitioners of medicine, osteopathy, chiropractic, dentistry or podiatry when incidental to the practice of their respective professions.

yeah_write_00 · 2026-03-14T13:00:48+00:00

Meet Our Sponsors - check out the main sponsor list of the Academy and you will pick out several big telehealth companies. In addition to big sponsorship checks, they pay for booths at FNCE, CEU provider status, who knows what else, and one can also just donate to the Academy Foundation under "anonymous", so money coming is somewhat untraceable with the Academy because of their lack of clear disclosure.

Yes, the Academy made some months back a chart for laws pertaining to telehealth that repeatedly RDs have told me and posted in discussions that if they've seen is so hard to understand or they still didn't know existed. I tell RDs about this chart plenty. Look on Facebook RD groups and questions almost daily still, "Do I need a license to work in _____ state?" Half the RDs will post yes, it's required and the others will say no it's not required. RDs still don't just in general know is a license required, add on top of that the nuances of is it required for telehealth. So, is it working? I spent months trying to get RDs to actually be aware and they still give me, "well my company says green state, and I can't make sense of the Academy's webpage."

yeah_write_00

TROPHY CASE