In clinical nutrition, it’s easy to fall into the habit of instruction rather than collaboration. Using inclusive language will only take you so far if you’re not asking your patient permission before you provide them advice. 

It doesn’t matter how badly we want to show our clients how much we know or what we can teach them. In motivational interviewing, our clients lead the discussion. 

Getting permission before launching into nutrition education, lets your patient to retain autonomy in the conversation.

• They get to decide if what you know is going to be useful to them
• They get a chance to choose what they want to learn or talk about 
• They tell you what part of the bigger picture is most important to them

As we remember to use Elicit-Provide-Elicit, we remain open to learning what our patient is most interested in learning about and move forward from there.

Here are some questions that can work at any point in a conversation:

• Do you want some ideas how to make that happen?
• I have some clients who’ve been working on this. I can tell you a little about their experiences, if you’d like.
• If you’re getting a little stuck with ideas, I have a few that might be helpful. 
• Those ideas sound really good. Can I give you a few more?
• I’m a little worried about XYZ / the doctor mentioned you just found out about XYZ. Would it be ok if we talked about that for a bit?

What does this look like in a conversation?

Some people will need to assert the fact that they already know what needs to be done. Here you might ask permission to share something they might not know.

• “Sounds like you’re pretty clear about why you want to stop drinking soda. What about fruit juice? Would you be interested in hearing about how even 100% fruit juice can be kind of like soda?”

Some patients want to be sure they aren’t going to be bossed around. This conversation might be best suited for permission to share some ideas that might help them reach their goal.

• “Yea, I get how overwhelming all these potential changes can be. Following something like a renal diet can be really hard. Do you want to talk about some ideas I have to help you ease into some of the bigger changes you said you were worried about making?”

Other patients don’t know where to start, or don’t believe there’s anything they should be concerned about in the first place. For them, presenting a fact and then asking permission to talk about it can be effective in opening up the conversation.

• “You know, potatoes can be really healthy. Lots of potassium that can help with blood pressure and a ton of fiber. How about we talk a little about how something like a baked potato can fit in your diet?”

Use these as a starting place, and then make up more as you go. 

Every conversation and every patient will require a different kind of permission request. When you find a few that work well with your style of conversation, make note of them to use them again and again.