As an RD who works with patients, providing patient-centered care is so important to your patient’s success. Today, we’re talking about how to manage your implicit biases as dietitians while also providing patient-centered care in your clinical nutrition work.
Providing Patient-Centered Care as an RD
Let’s start with why you’re here. Your purpose as a dietitian.
If you’re patient or client-facing, there’s only one person you’re responsible for in your work. And that person is your patient.
And this is despite what the medical nutrition therapy directs you towards, or even what the facility you’re working with recommends. Ultimately the only thing that matters is what your patient wants to do and what they don’t want to do.
Being able to recognize this and honor it is the core of providing patient-centered care.
And one of the hardest parts of providing patient-centered care is limiting how much you lean on your implicit biases, meaning the assumptions you might have based on who your patient is and what behaviors you then expect from them.
Today, we’re talking about how to manage those implicit biases as dietitians while also providing patient-centered care in your clinical nutrition work.
We’re talking about:
- What exactly is patient-centered care and how to provide it
- What is implicit bias and how to manage it
- Three skills you can use to use patient-centered care more, and limit your implicit biases
What is Patient-Centered Care?
Patient-centered care is the time and direct attention you as a healthcare provider give to your patients. And in doing this, you put your own ideas of what should happen or needs to happen to the side.
Instead, space is given to your patient to allow them to decide the course of their own treatment.
No matter what your professional judgment tells you is best for them or what your personal affiliations about treatment or diet plans tell you is right, you allow your patient to decide what type of change they want to see happen. And how they want to make that a reality.
And as straightforward as it is to imagine giving your patient total control over their own treatment course, it’s the doing it part that gets a lot harder.
Providing Patient-Centered Care
For many people, food is a central part of their lifestyle. What they eat, how they eat it. When they eat, the people they share meals with. At their core, these are all lifestyle decisions.
Which means being a dietitian revolves around supporting and helping your patients manage lifestyle changes.
Because you know what the science says and you understand the impact of making specific choices, it’s so easy to want to help your patient cut down on time and just give them the answer.
IE: You have a heart issue. You need to limit salt. Do this starting now.
But patient-centered care works differently.
It helps us lead our patients to a goal they feel best about setting. Rather than pushing them into a goal we believe is best for them to accomplish.
And research tells us that when our patients set their own goals with patient-centered care, they’re more likely to reach them.
How can you start doing this?
With each new patient or client, the aim should be to provide them care dictated, not only by their health care needs, but their own preferences and personal wants.
It’s easy to fall into the trap of believing that because a person might benefit from specific medical nutrition therapy, it’s your responsibility to make sure they get it.
Doing things differently is hard.
Especially when you bump up against resistance to do anything from your patient.
But just because a person might benefit from a specific type of medical nutrition therapy, it’s not your responsibility to PROVIDE it.
It’s your responsibility to OFFER it.
This key difference puts your patient in the driver’s seat and gives them the opportunity to make their own decisions about their health care and the kind of support they want you to provide.
To do this you’ve got to spend time figuring out what your patients want for themselves and prioritize that over everything else.
Just because we SHOULD be providing patient-centered care, doesn’t mean it’s something actually do or feel like we have the capacity for.
Many times our implicit biases step in and take over, often when we least expect it.
Implicit Biases of RDs
What is Implicit Bias? Definition
Implicit bias is a negative attitude, one that you might not be consciously aware of having, against a specific social group of people.
Although implicit bias is usually used in conversations around gender or culture, it’s a useful way to think about the broader judgments you hold as a healthcare professional about people you encounter who choose to live fundamentally different lives as you.
Dietitians tend to be very passionate about the way we prefer to provide care to our clients and patients.
This often includes very specific thoughts about how nutrition or diets should show up in a healthy world.
Some dietitians provide more conservative support, following MNT guidelines with immense care. Other dietitians are more liberal with their practice, perhaps focusing on providing a no-diet method of support and encouraging healthy at every size (HAES).
However, your recommendations are only as good as what your patient wants to do.
Your personal ideas of what nutrition care should look like, the types of goals certain patients should have, the kinds of conversations we think our patients should hear are all secondary to what your patient wants.
The morality and the judgment that are part of those “they should” thoughts and the “you need to” conversations is where implicit biases come into direct conflict with the goal to provide patient-centered care.
And in order to show up and provide full support for your patients, you need to prioritize their goals over your own personal nutrition or lifestyle preferences.
Providing Patient-Centered Care and Managing Our Own Biases
This is hard work.
Remembering that you’ll come into the work you do with your own implicit biases is hard enough.
Practicing moving past them so you can provide patient-centered care is harder.
The responsibility of understanding who your patients are doesn’t just fall on them. It’s part of the work we’re tasked with to ask the kinds of questions that give them permission to share who they are with you.
Instead of providing support based on what we think is most valuable for our patients, providing care based on only what our patients are asking us to provide.
Three Skills to Practice Providing Patient-Centered Care
To get better at managing our implicit biases and providing patient-centered care, here’s a few motivational interviewing skills that can help encourage behavior change that starts with your patient.
Although each one can stand alone, these three skills often work sequentially. Begin at number one, practice number two, and then lean into number three.
Three Skills to Practice
#1: Manage the Righting-Reflex
The Righting-Reflex is our instinctive impulse to fix something we see our patients doing.
This easily happens when the focus of a nutrition education session shifts from being patient-centered to focused on the medical nutrition therapy needs you’re taught as a dietitian are supposed to be provided.
Instead of allowing a conversation with the patient to determine what they would like to change or manage, we immediately launch into providing guidance and trying to “fix their issue”.
This type of unsolicited advice runs directly counter to patient-centered care.
Rather than leaning into what we believe is best for our patient, refocus the conversation on what your patient is interested in doing, changing, or working on.
#2: Get Good at Acceptance
This is for us as much as it’s for our patients.
Acceptance for our patients might come in the form of understanding and coming to terms with the fact that some things happen slower than they’d like them to happen, take a little more work than they imagined they would take, or progress might be limited by other factors that are generally outside of their control.
For dietitians, there’s the need to remember that your patient’s outcomes are not our responsibility.
You are not here to force them into achieving the goals you set for them. You’re also not here to push them into achieving the goals they set for themselves.
You are a guide.
You’re here to provide the support, encouragement, and opportunities for reflection our patients might need in order to meet the health goals they set for themselves.
#3: Listen Better
After you’ve reigned in your own implicit biases and started to accept that guidance is your primary goal as an RD, it opens you up being able to listen to what your patients actually want.
Listening can be really hard.
And a lot of that is because we don’t have a lot of time to do it. Especially in acute care when we have a short amount of time to get a whole lot done.
Because of this, we tend to lean into what we know and rely on the MNT we’ve been taught instead of giving our patients an opportunity to tell us what they want.
Instead of using our limited time to share what we know, practice the cycle of: asking a question, responding to the answer, then asking a follow up question.
By listening to what your patient has to say, you open up space for them to really think about what they want and their capacity to make that thing happen.
Even if they come up with nothing, remember that it’s not our job to instruct our patients or tell them where they should go. Keep in mind your patient might not even be looking for the solution you feel strongly about providing.
At the end of the day, you’re there to share information that’s been requested. It’s your patient’s job to decide what they want to do that information.
And That’s It!
It’s so much easier to set a goal for our patients when we don’t have time to have long, drown out conversions to figure out what they want for themselves. Especially when we’re up against a laundry list of notes that need to be written and interventions that need to be provided.
But despite all of that our patients should be the ones setting their goals and deciding on the changes they’d like to see in their lives.
And providing that kind of patient-centered care is the ultimate goal of all the work you’ll do as an RD.
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