On our flight back from Columbus, I was catching up with my Today’s Dietitian (are you seeing a trend with my reading on flights?). In May’s issue there was an interesting article entitled, “Keys to Clear Communication”. I found this article not only relevant to a conversation Gina and I had on Thursday, but also because it’s pertinent to my current role as an out-patient dietitian. Plus, an old professor of mine from the University of Illinois, Karen Chapman-Novakofski, was quoted in the article. Neat!
In my day-to-day work, I see patients of varying ethnic background, varying education levels, varying health concerns, and various other potential barriers to communicating a healthy message. With over half of the leading causes of death linked to poor nutrition, dietitians have an important task of tailoring nutrition messages in a way which they can not only understand, but put to use in their lives.
It’s fair to say that if you’ve made it this far, you are not illiterate. However, the National Adult Literacy Survey from 1993 indicated that approximately 25% of US adults may lack the literacy skills to function at an “average” level in today’s modern society. Sad, isn’t it? I have encountered several patients who could not read or write, making it a challenge to teach concepts of nutrition and disease management. And to make the dietitian’s task even more challenging, up to 80% of patients forget everything their doctor told them by the time they leave the office. It has happened more than once that a patient comes in with some “concerning lab work”. Was it the cholesterol? Blood pressure? Blood sugar? My guess is as good as the patient’s. Good thing for medical records, huh?
When I was talking with Gina , she shared how much she enjoys speaking to large groups about nutrition and that she’s able to breakdown complex concepts to an easy to understand message. When speaking to groups, I do the opposite – assume that I’m over-simplifying concepts that people are already familiar with. And sadly, that has never been the case. I shared with Gina that I am more comfortable in a one-on-one setting because I like to “feel out” a patient and individualize the session based on the patient’s needs.
The Today’s Dietitian article lists several tips for counseling patients, particularly those with limited literacy:
- Limit the number of concepts you teach. As the practitioner, it is up to you to decide what change will make the most impact on the patient’s health and nutrition status. Hone in on that topic.
- Use simple jargon. A patient will much more likely understand “average blood sugar” than “HbA1c” or “weight for height” than “BMI”.
- Organize your message to highlight your most important message(s). For example, don’t relay an important message at the beginning of your 60-minute session and not address it in the remaining 50 minutes.
- Ask patients to summarize or teach back important messages. Ask leading questions such as, “So what are some of your favorite foods that you now know contain too much saturated fat? What might be a healthier alternative?”
- Listen. Truly listen. Patients know whether or not you’re listening. You can chart during your session, but remember to make good eye contact and non-verbal cues that you’re paying attention – nodding your head, smiling, etc.
- Use demonstrations and hands-on teaching tools. In my job, food models, nutrition labels, and empty food boxes and containers are essential to have on hand. I use my food models and food labels on a daily basis, all day long.
In addition to handouts to review with patients, I am sure to add my own personal notes, asterisks, and highlighting. I also encourage literate patients to take notes of anything they find important or wish to record. And I typically end counseling sessions with goal-setting and send the patient home with a copy of goals they set.
I believe individuals all learn in different ways and it’s imperative to relay a message in the appropriate way for it to be most beneficial and apt to drive change. In the past year, I’ve noticed a profound growth in my ability to relay complex messages and empower patients to make healthy changes in their lives. Just as my old professor was quoted in saying, I too find it most rewarding when a patient says to me, “I’ve been a diabetic for so many years, and this is the first time any of this has made any sense to me.”
Talk about rewarding.
Question: Have you ever left a medical appointment or counseling session of any sort feeling as though you gained nothing? Or that it was a waste of your time? When you think of your doctor, why or why not do you like he or she?
Here’s to a great week,