Learn to do clinical nutrition counseling and build confidence when you talk to your patients as a dietetic intern or new dietitian.
Clinical Nutrition Counseling: A new RD starer guide
Clinical nutrition is more than just being a dietitian who knows your medical nutrition therapy and can write a great diet order.
A major part of being a registered dietitian is your ability to translate the science and medical needs of your patient into information and advice that person can actually use.
But nutrition counseling in clinical nutrition isn’t something that’s taught enough in school. And for many dietetic interns and RDs new to clinical nutrition, having those first conversations can be extremely difficult.
Imposter syndrome can tear down your confidence and leave you unsure of how to talk to your patients about even basic nutrition topics.
In order to help you understand exactly how to do a nutrition counseling session, keep reading.
What’s the difference between nutrition counseling and medical nutrition therapy?
To start, let’s be clear that medical nutrition therapy and nutrition counseling are two different things.
This might seem obvious, but when you’re starting out in nutrition it’s easy to lose track of where one begins and the other ends.
Let’s do a fast review of the difference:
What is medical nutrition therapy?
Medical nutrition therapy is what you use to complete a nutrition assessment of your patient and their nutrition needs.
It’s all of the resources you use during your evaluation of a patient. Things like medical diagnoses, lab work, the outcomes of additional referrals – these all go into your nutrition note or care plan.
And when you write these notes, you reference specific conditions and use medical terms to illustrate your point.
What is nutrition counseling?
Nutrition counseling is the way you present that information to your patient.
You don’t just hand them your formal assessment or print out a copy of your nutrition note.
Instead during a nutrition counseling session or nutrition education, you present your patient with the specific dietary interventions that can directly impact their health outcomes.
And you do it in a way that your patient can understand, identify with, and then use.
What happens during nutrition counseling?
At its core, nutrition counseling is just an exchange of information. It’s your patient asking you a question and you providing an answer in return.
Clinical nutrition counseling happens anytime you’re providing answers to medical nutrition therapy related questions. This can be in a hospital when you’re working with patients or at the hospital health fair.
Wherever you are, when you’re providing health information to someone you’re doing nutrition counseling.
If that includes even a basic use of medical nutrition therapy, it’s clinical nutrition counseling.
How do you do a nutrition counseling session?
As a dietetic intern or even a brand new RD, it can be easy to forget how much you know.
Imposter syndrome and confidence plays a huge role in how well we’re able to take the information we know and then teach it to our patients.
Having a system to follow for clinical nutrition counseling can make building confidence as a new dietitian much easier.
So let’s get into it.
These 4 parts that will help you get better at talking to patients during each clinical nutrition counseling session you do. And as you practice and get better at talking to patients, you’ll build on these 4 and develop your own system.
But until then, start by working your way through each of the 4 steps to do solid clinical nutrition counseling each and every time.
PART 1: EVALUATE
Do not skip this part. Don’t make assumptions about anything your patient knows (or doesn’t know). And never present judgment over what they think they do know.
Your 3 goals here are to:
- Get a sense of what your patient already knows about the subject
- Be clear on what they think they know
- Identify any areas of interest they have about the topic
All of this is easier said than done.
You know more than you likely give yourself credit for. And there’s a good chance a lot of that knowledge you probably also consider “obvious” or “common sense”.
For many people, it’s not.
As you evaluate your patient, be sensitive to that fact. Respect this part of your counseling session and open yourself up to listening to what your patient has to say to you.
Here are 4 questions to encourage them to share their knowledge level with you:
- Can you tell me what you know about [this topic]?
- What would you say a health diet plan will look like or should look like?
- Can you tell me what you’ve been doing to help you manage [this topic]?
- Is there anything about [this topic] you’d like to know more about?
Getting a new patient to open up and tell you how much they know isn’t always easy. Many times people are hesitant to speak up about subjects they aren’t confident in.
As you work through the evaluation stage, being patient and respectful of the answers they give will encourage them to share even more.
PART 2: SIMPLIFY
Most of your patients will not have had any medical training. Many won’t have had the same level of education you have had. And some may not be native speakers of your language.
During clinical nutrition counseling sessions, it’s easy to fall back on the technical terms you were taught.
Those are probably also the same terms you use to write your nutrition assessment, PES statements and discuss patient care with the rest of the medical team.
But the reality is the simpler words you choose, the easier it is for everyone to understand what you’re saying.
This doesn’t mean dumb things down. You do not (and should not) be talking down to your patients at any point.
The more you can explain things using the same kind of language you’d use when you talk to your grandmother or your best friend, is the same language you should be using with your patients.
Keeping things simple has 2 primary parts:
- Use conversational words. Skip the medical jargon. Take out the technical terms.
- Regularly ask if you’re being clear. Offer many opportunities to explain things further.
You’re not going to use language that belongs in your nutrition assessment.
The goal of a clinical nutrition counseling is to provide nutrition education with a conversational tone that is easy for your patient to understand.
You’re also going to make sure that the words coming out of your mouth are being understood.
Just because you think you’re being extremely clear doesn’t mean your patient thinks you are. And it’s always going to be harder for them to ask you to explain something than it is to accept an opportunity for you to explain yourself.
We’ll talk about this more in part 4.
Having clarity builds confidence in your patient. And using simple language helps them realize that change is not just accessible but something they can accomplish.
And that is the ultimate goal of clinical nutrition counseling.
PART 3: EXPLAIN
Be able to say why the topic at hand is important. Be able to use simple words to explain the issue.
In short, be able to educate your patient on what they want to know. In a way they will understand.
After you’ve done a lot of nutrition education sessions and have done counseling for all kinds of people, you’ll have a system that comes naturally to you. You’ll have developed your own rhythm for clinical nutrition counseling.
Instead of having to carefully plan out each conversation with a new patient, you’ll have an automatic system in place with answers to common questions and a method of working through new ones.
But until you’ve come up with your own, start with these 3 steps to begin getting comfortable with standard nutrition counseling sessions:
- Start with why you’re there.
Provide a couple sentences about why you’re there to do this nutrition counseling session with them. You can reference things like their medical history, a current or recent diagnosis, concerning lab work, or anything else that is relevant. - Make sure they understand why it’s important.
You might briefly explain what’s happening in their body that makes a change in nutrition so useful or answer their question about a diagnosis or lab value you mentioned. - Give them realistic tips.
A lot of information or complete lifestyle overhauls can be intimidating. Focus on ways to meet their nutritional needs that fall in line with the lifestyle they are willing to lead.
These will help you start with a clear format or formula you can use every time to present the information in a clear and direct way that’s easy to understand.
PART 4: CONFIRM
You say something. Then you ask if you’ve been clear. Finally make a request for questions.
At each stage of your conversation, you’re going to follow this formula. Don’t underestimate the power of asking if your patient has questions.
It’s tempting to think that you either
A) Were clear about what you were saying the first time because it made sense to you or…
B) Were clear because your patient said they understood
Think about all the times someone has asked you if you understood something. And instead of saying no and feeling stupid or having that person judge you, you said you understood.
Now consider the fact that as the dietitian, your patient looks at you this way.
You’re the professional. You’re there to educate them. Which means you are also who might judge them if they sound dumb.
During a clinical nutrition counseling session, it’s your job to teach nutrition. And one of the best ways to teach something is to regularly confirm that your patient understands what you’re talking about.
When you do this well, you’ll also remind your patient that their understanding is your priority during their nutrition counseling session
How do you confirm your patient understands you during a clinical nutrition counseling session?
Ask these 3 questions, as often as you need to, throughout the entire conversation:
- Did that make sense?
- Any questions about that part?
- How do you feel about what we just talked about?
And then give your patient a chance to ask questions each time you move to a new topic or finish explaining something.
And That’s It!
When you start with these 4 steps, you’ll start doing clinical nutrition counseling that makes sense to your patients.
But this is just the tip of a very big iceberg.
Ready for a deep dive into clinical nutrition counseling? Check out Nutrition Quick Chats.
You get everything you need to — all the tools, resources, patient handouts — you’ll use every day to be confident in your nutrition educations and every time you talk to a patient.
Looking to get better at clinical nutrition? Check out Clinical Bootcamp.
Bootcamp makes sure you know exactly what you’re dealing with every time you get handed a new patient. You’ll know where to start, what to focus on, and what to do next.
Want even more to help in clinical?
Check out The Nutrition Cheat Sheets Shop for all the nutrition education and clinical resources that will make your life easier.
