UNDER Ontario law, communicating a diagnosis is a controlled act. This means that certain health professionals may only perform it. While dietitians routinely conduct nutrition assessments and communicate their findings, communicating diagnoses of diseases or disorders must be delegated.
This article applies to all dietitians practising in Ontario, regardless of practice setting. Its purpose is to clarify how dietitians can share assessment findings and obtain informed consent for treatment without crossing the legal boundary into diagnosing.
Communicating a diagnosis includes three parts
The Regulated Health Professions Act defines “communicating a diagnosis” as a controlled act only when all three parts below are present:
- Communication: A dietitian may form a clinical impression, but they must not tell a client about a new disease or disorder if the client is not already aware of that diagnosis from another authorized health professional.
- Content: Communication identifies a disease or disorder as the cause of the client’s symptoms. This does not include describing the symptoms alone.
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- Describing the symptoms, risk factors, trends, or abnormal findings alone is generally acceptable.
- Applying a formal medical label, ruling out diseases or disorders, or minimizing the likelihood of a serious condition may cross into diagnosis.
- Circumstances: It is reasonably foreseeable that the client will rely on the information to make healthcare decisions – decisions that can significantly affect health and wellbeing. For example, starting, stopping, or declining recommended treatments.
All three elements must be present for communication to be considered an unauthorized controlled act.
The fourth ‘C’: context
There is a fourth part to consider as well: context.
Even though dietitians are not authorized to communicate a diagnosis, they are required to obtain informed consent before providing care to a client. Informed consent includes explaining:
- The reason for treatment,
- The nature of the treatment, and
- The prospects of any proposed treatment.
To meet this obligation, dietitians may need to explain assessment findings, including symptoms, trends, and relevant lab results, before treatment begins. The key distinction is that dietitians may explain what was found and why nutrition treatment may help, without stating that the client has a specific disease or disorder.
Clear framing, careful language, and explicit referral for diagnosis are essential to threading this fine needle.
Case law guidance: Why language matters
Ontario courts have emphasized that intent does not determine whether a diagnosis was communicated — impact does.
In Spurrell v. College of Massage Therapists, a massage therapist told a client she likely had muscle spasm and not pneumothorax and discouraged her from seeking hospital care. The Divisional Court found this was communicating a diagnosis and posed a risk, even though no formal medical label was used.
Key lessons from the case law
- Minimizing symptoms or ruling out conditions can amount to communicating a diagnosis, especially if the client relies on it to make decisions.
- The use of a formal medical label is not required for the finding of diagnosis.
- What matters is whether the client is likely to rely on the information when making health decisions.
- Encouraging or reinforcing the need for medical assessment reduces risk.
- Language such as “this may suggest,” “this may be related to,” or “this needs further assessment by your physician” is safer than definitive statements.
What to say
Dietitians should feel confident discussing nutrition assessment findings and explaining why nutrition intervention is appropriate, while remaining clear about the limits of their role.
Communicating laboratory results
Communicating assessment findings, including laboratory values, is different from communicating a diagnosis.
Dietitians may:
- State whether a value is above, below, or within the reference range.
- Explain trends, patterns, and potential nutrition-related contributors.
- Discuss why the result is concerning and warrants further assessment.
Acceptable examples:
- “You have several symptoms and lab patterns that are consistent with high blood sugars, including x, y and z.”
- “These findings raise concern and I encourage you to talk to your family doctor.”
- “From a nutrition perspective, we can work on ideas to help your blood sugars while you follow up with your doctor on next steps.”
Not acceptable examples:
- “I think you have diabetes.”
- “These results rule out diabetes.”
- “You don’t need to see a doctor; this is just diet related.”
If a client asks directly, “Do I have ___?” an appropriate response is: “I can’t diagnose conditions, but I can explain what your results show from a nutrition perspective and why it’s important to follow up with your doctor.”
Dietitians must not: State that a lab result confirms a disease or disorder, unless delegated.
Some laboratory results are diagnostic (for example, labs that indicate a disease or disorder exist like a 2-hour plasma glucose value of ≥11.1 mmol/L for a 75 g oral glucose tolerance test). In these cases, it is appropriate to say: “The result requires follow-up with your physician.”
It is not appropriate to say, “This result means you have diabetes.”
What if you are delegated to communicate a diagnosis?
A dietitian can receive a delegation to communicate a diagnosis by an authorized provider, most commonly a physician.
Delegation must:
- Be clear, documented, and consistent with the CDO Delegation Standard.
- Specify whether the delegation is client-specific or directive-based.
- Be supported by the dietitian’s knowledge, skill, and judgment.
Dietitians must practise within the limits of the delegation and document accordingly.
Key takeaways
Dietitians should:
- Clearly communicate nutrition assessment findings and obtain informed consent.
- Avoid using formal medical labels unless delegated.
- Consider how the client might rely on the information shared.
- Explicitly refer clients for diagnosis when appropriate.
- Remember: how you say it matters as much as what you say.
References
- College of Dietitians of Ontario. (2020). Standard: Practising through the Delegation of Controlled Acts.
- Regulated Health Professions Act, S.O. 1991, c. 18.
- Spurrell v. College of Massage Therapists of Ontario, 2013 ONSC 4117 (CanLII).
This article is based on “Communicating a Diagnosis” by Richard Steinecke, LLB, which appeared in the Fall 2013 issue of Résumé, the former newsletter of the College of Dietitians of Ontario. It was updated by the College in January 2026.
