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Nutrition counseling (when your patient isn't interested)
As a dietitian in any kind of clinical position, a large part of the work you do is nutrition counseling.
Helping your patient understand how to connect the dots between the health issues that landed them in the hospital (or sub-acute care, or even into your care as a private client) and the kind of healthy they want to be.
But what happens when the clinical nutrition you’re tasked to provide just isn’t being accepted by your patient?
This is a question that comes over and over.
And even though it’s not exclusive to new RDs, it’s one of the hardest for those just starting out when so much self-worth about how good you are as an RD is tied to patient outcomes.
We’re going to talk about how to handle it.
How to deal with the fallout of feeling pumped up and ready to have a quality conversation about the kinds shifts in nutrition that can change this person’s life…and your patient just doesn’t care.
To do this, we’re going to break this conversation down into four parts:
- Coming prepared
- Keeping things concise
- Knowing when to push
- Letting go
Let’s get started.
If you’re looking for more of how to spend time doing clinical nutrition counseling well, check out:
First a reminder: you're a dietitian, not a babysitter
Before we get into some actual practical advice about clinical nutrition counseling and how to manage this frustrating situation, this is your friendly reminder that it’s not your job to fix anyone.
You are not responsible for whether your patient follows your guidance or not.
It’s not your job to supervise them as if they were in kindergarten. It’s also not your job to restrict what they will or will not eat outside of your care or make sure they have the appropriate amount of exercise they will or will not have when they’re at home.
The most you can do is provide information to those who are interested in receiving it.
On the most simple level, this might be providing a diet order for someone while they’re in the hospital. You sign them up for the appropriate therapeutic tray of food, offer them nutrition education, and you’ve done a large part of your job.
Because the reality is not everyone wants to be told what to do. Not everyone is ready to explore a new lifestyle. Not everyone feels that a change is something that will benefit them.
Being able to accept when a patient’s interest level doesn’t align with your intentions or goals for them, is an essential part of doing nutrition counseling.
It’s not easy to do but it’s a skill that will save you a lot of time and help you avoid some of the stickier parts of imposter syndrome.
Nutrition Counseling Tip #1: Be prepared for anything
There’s only one thing you’re here to do as a registered dietitian. And that’s to support your patient.
To do that, you’ve got to be prepared.
What preparation in nutrition counseling looks like
Preparation is figuring out what information you know your patient needs and then doing a first round of basic research.
Research as in: collect the documents, handouts, resources and references you’d love to share with your patient.
Unless you’ve determined it’s your patient’s primary or most acute issue that you know needs to be discussed with your patient, this is not the time to commit an hour or two to digging into the archives of PubMed and ScienceDirect for the nuances of, for example, hypoglycemia in South East Asian men over the age of 70.
This is the time to collect some top level information on how to identify signs and symptoms of hypoglycemia for people who struggle controlling their glucose levels.
Have your handouts and resources ready to go
Having the fundamental resources and handouts in hand so you can walk into your patient’s room with the essentials is key to being well prepared for every nutrition counseling session you have.
You’ll choose these – at least in part – based on their therapeutic needs and the conversation you’d like to have with them.
And hopefully, you have a tight collection of handouts and resources you give to most of your patients who struggle with your patent’s specific issue and you can print them out quickly.
Be ready to ask the important questions
You want to spend as much time as you can with each patient because there will be some information that only they can give you. This means knowing what information you’re missing so you can ask specific questions and get a better sense of what matters to them the most.
With a little patience, a good amount of time, and a lot of listening there’s a good chance you’ll land on something that your patient actually wants to learn about.
There’s also a good chance they don’t have any questions for you and zero interest in the conversation. And that’s ok too.
Whether your patient is interested in what you have to share with them or not, it’s essential that you’re prepared to at least start the conversation.
This means succinct information that targets the most important nutritional issue(s) they’re dealing with and the ones you can support them in improving.
Nutrition Counseling Tip #2: Keep it concise
People love to talk, especially about themselves.
And for some reason the question of food brings up a lot of emotions, memories, and thoughts people suddenly feel compelled to share. Even if you’re talking to someone who’s not actually ready for change.
And as much as these conversations might be interesting to hear, be a temporary cure for loneliness for your patient, or make you feel guilty for not wanting to stick it out for the full hour…
…chatting with a patient for an hour is usually something you won’t have the privilege of indulging.
And this is even more true when your patient is not interested in the nutrition counseling part of a lengthy conversation.
This is where having concise nutrition counseling conversations is going to make a huge difference for both your sanity at work and how productive you are day to day.
There are two big reasons you’ll want to practice having concise nutrition counseling sessions.
One, your time is valuable. And two, it’s all about your patient’s interest level.
You don’t have a lot of time as a clinical dietitian.
The time you do have should be spent on essentials like:
- Reviewing the EMR
- Completing the assessment
- Talking to the rest of the health care team
- Preparing your patient’s therapeutic needs
And not on things like a complete meta analysis of current medical and nutritional considerations for each identifiable medical condition or a detailed review of all nutrient-medication interactions.
A good rule to follow is to start with what your patient needs (the basics), then give them what they ask for (some specifics).
Carve out time to do extra research when you know how invested and interested your patient is nuanced information you might not have in front of you.
Preparation goes a long way to help you make sure you’re focusing the conversation on some of the bigger topics that will provide the most support for your patients. Start with things like:
- Having a list of the questions you need answers to (think: UBW, daily eating habits)
- Handouts that address their most acute nutritional issue
- Being open to what your patient needs
It’s not likely that someone who isn’t interested generally will take the time to read specific and highly detailed information.
Instead of dropping off a thick packet of research that requires concentration, give them something that highlights a few key quick takeaways that can be referenced quickly and without much attention to detail.
Nutrition Counseling Tip #3: Figuring out when to push
No matter how prepared you are when you go see your patient, there are going to be times when they just aren’t ready to make a change. Any change.
Sometimes this means getting a clear “not interested” in the same amount of time it takes you to introduce yourself.
Sometimes you’ll burn through the seven short minutes you’ve got for each patient, listening to all the reasons why they aren’t ready. Or why now isn’t a good time. Or why your information isn’t going to help.
This is where a little prompting and some genuine curiosity comes can help.
Here’s an example of what a bit of resistance might sound like at the start of a conversation:
RD: Hi there! Your doctor asked me to come talk to you about following a renal diet…
Patient: I think I’m good right now, I don’t have any questions about that.
A lot of times, people don’t know they have permission to ask questions or make a request until they get permission. When you bump up against that first bit of resistance, try offering them a chance to think about what they actually do want to know about.
Something like:
RD: Ok, is there anything you DO have a question about? We can talk about anything you’d like…
If your patient perks up and starts to show a little interest when you give them this kind of permission, walk through that door. Giving your patient a chance to get the information they’re looking for right now, even if it isn’t the information you’ve prepared, can go a long way to building trust and then later sharing some of the more specific nutrition information you know will support their health.
But it doesn’t work all the time. If that type of question goes no where, try knocking on another door:
A lot of times, this is as simple as asking the same question in a different way.
The first time you offered nutrition education on a renal diet in a direct way. You were clear, to the point, and the emphasis was on the work that would go into making a change. For some people all that implied work that would have to happen to start this new diet might have felt overwhelming.
Instead of giving in to the first no you get, offer a chance to explore instead of learn. For example:
Patient: Nope I don’t really have any questions, but thanks.
RD: That’s ok. Well, I know you’ve just been started on dialysis and I know it can be scary. I wanted to leave you some information because on know the diet can be tricky. Can I show you what’s in it really quickly?
This time you’re not there to do the thing the doctor told you to do. You’re not even offering to teach. Now you’re asking permission to make sure they understand something that you’ve empathized with before you give them what they DID ask for, which was to be left alone.
You rounded a corner and knocked on the back door instead. Different question, different feeling, same goal.
These are some gentle pushes to help you gauge how resistant your patient actually is. Because it’s not always that they don’t care, or don’t want to know.
Many times it’s more because we didn’t ask the right question, didn’t tap into the feeling they’re going through, or even just didn’t listen closely enough.
When you do finally get shut down and hear that hard no, that’s when it’s time to wrap it up and walk away.
When that firm “no” show’s up after you’ve gently tested the waters — save your time, energy and breath. You only have a few valuable minutes with each patient you have to assess. Save most of them for the patients who are actually interested, have questions, and want to learn.
For those who don’t, drop off your concise resources and document your good efforts.
Another reminder: It’s not your fault
It’s not your responsibility to MAKE your patient ready to make a change. And there’s no shame in recognizing that someone doesn’t want to talk to you about their health.
If your patient decides they aren’t ready, it’s not your job to force them to receive nutrition education.
It’s not a reflection of you and your ability to succeed as a dietitian. It’s not your fault if a patient doesn’t follow your good advice.
You’re not bad at your job if you cannot provide education to someone who’s not interested in receiving it.
Why?
Because as long as you’re working with adults, your patient is their own boss. They’re a grownup and they can decide to make all the good and bad decisions they want to make.
You have a single job as a dietitian.
Your job is to be a guide to help your patients to get where they want to go. And if they don’t want to go anywhere right now, it’s not up to you to make them move.
On the most simple level, this might be providing a diet order for someone while they’re in the hospital. You sign them up for the appropriate therapeutic tray of food, give them a good nutrition education, and you’ve done a large part of your job.
But you are not responsible for whether they follow your guidance or not.
It’s not your job to supervise your patients as if they were in kindergarten. It’s also not your job to restrict what they will or will not eat outside of your care or make sure they have the appropriate amount of exercise they will or will not have when they’re at home.
The most you can do is provide information to those who are interested in receiving it.
And That’s It!
Looking for a complete system to learn clinical nutrition counseling with real life examples, daily reference handouts, and case studies? Check out Nutrition Quick Chats: Introduction to clinical nutrition counseling
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