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The substitute teacher wrote in the note sent home on Tuesday that a cafeteria employee said that her lunch consisted of four chocolate bars, a bag of marshmallows, Ritz crackers and a pickle.

\"Please see that she packs a proper lunch tomorrow,\" the teacher wrote. An attempt to reach the teacher for comment wasn't immediately successful.

Puckett told ABC News that, since the note was addressed to \"Dr. and Mrs. Puckett,\" it was clear that the teacher knew he was a physician which he said \"just adds to the irony of it all.\"

What the cafeteria worker and the substitute missed, however, was that the 8-year-old also had four pieces of ham and a low fat string cheese rather than a sandwich, since \"we don't eat a lot of bread,\" said Puckett, who is double board certified in osteopathic family medicine and obesity medicine.

\"We leave it up to her and she looks at the school menu and she packs her own lunch and she's a very independent second grader,\" he told ABC News.

\"Sure, I'd liked her to pack a few more veggies and maybe a piece of fruit, but we compromise on pickles occasionally,\" he wrote in his original Facebook post.

Kirksville, Missouri, school superintendent Damon Kizzire has apologized for the incident and said that the way it's \"being blown out of proportion is way out of line with how it was intended. It was all meant with the best of intentions.\"

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