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Communicating a Healthy Message

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:

  1. 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.
  2. Use simple jargon. A patient will much more likely understand “average blood sugar” than “HbA1c” or “weight for height” than “BMI”.
  3. 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.
  4. 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?”
  5. 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.
  6. 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,

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  1. June 14, 2010 / 5:47 am

    When the doc or anyone gives you a lot of info it can be hard to remember everything. I know I’ll bring paper and pen if I think that’ll happen so I don’t forget anything important.

    I don’t like my doctor because not once in 20 years did he bring up my weight. I think doc’s should practice preventative medicine as well.

  2. June 14, 2010 / 6:20 am

    These were some great tips! Thanks for sharing Nicole! I need to get that magazine asap!

  3. June 14, 2010 / 9:16 am

    I totally agree with the tip for using simple jargon. Sometimes when you get too technical all is lost!

  4. June 14, 2010 / 9:43 am

    I like when a doctor or medical professional gives me eye contact when they are asking me questions and when I am explaining my issues. It makes me feel like they are really listening. (there is nothing worse than feeling like a doctor doesn’t care about you)

    I also like when they ask me lots of questions because sometimes there are things that I may have experienced that I can’t remember to tell them or I may not think is important to tell them.

  5. June 14, 2010 / 9:54 am

    My work (the American Diabetes Assoc.) just had a meeting on this. They cited the same study about average Americans’ reading levels and how it can be really hard to get a disease under control when you don’t understand it. Blood glucose v. blood sugar was an example. But so was counting carbs. It’s really hard to do, and for people who have little math skills it’s almost impossible. An example was something like: If you have a bottle of juice with 42 grams of carbs per serving and each serving is 1/3 of the bottle, how much should you drink to get 15 grams of carbs? Many people will say, Forget that, I won’t drink it. But more might just drink and see how they do.

  6. June 14, 2010 / 12:09 pm

    really good points even for a teacher like me! very helpful for sure nicole ๐Ÿ™‚

  7. June 14, 2010 / 2:14 pm

    It’s really interesting to hear what you do day-to-day and who you may come in contact with. During my career in Human Resources, I’ve learned that communication is the absolute KEY to relaying any sort of message – important or not – it’s all in the WAY you say it. Especially in your role, when nothing makes sense to the average ‘bear’ it really is all about explaining something in terms people can understand. I’m sure you are a great communicator!!

  8. June 14, 2010 / 3:09 pm

    Nice post Nicole! When I have a doctor visit I usually have listed what I want to ask…since I am in the medical field I do not encounter many issues…but I totally see the problems that most of the people have….including my husband ๐Ÿ™‚

  9. June 14, 2010 / 3:11 pm

    It is very difficult to write appropriate handouts because of literacy. Many people in the US have a lower reading level because English is not their first language so they may only be at an elementary level as they are (hopefully) learning. As the outpatient RD at my old hospital I had to make multiple handouts for hospitalwide distribution. Of course you know these have to be at the 6th grade level, which is very tough. I think the new guidelines indicate that it should really be at the 4th grade level (I think because of the rise in ESL speakers living in the US and seeking medical care). I can see how it may be difficult to move in that direction, especially in a large group setting. It is harder to interpret the level of all those in attendance.

  10. June 14, 2010 / 3:51 pm

    This is very interesting stuff. I think it’s great that you work hard to try to communicate well with a diverse group of people, but I can appreciate the fact that it’s challenging.

    I love my primary care doctor because she truly listens. I never feel like she’s rushing me or not letting me speak. On the other hand, I once had a few appointments with a counselor who seemed to be talking down to me the entire time. It was a complete turn-off, and I felt like I got nothing from the experience.

  11. June 14, 2010 / 3:56 pm

    I read this article so slowly because I found it SO interesting! It’s definitely more difficult to generalize audiences that are big, which is why I stick to really simple concepts. In one on one sessions, however, I find that I provide way too much information. I actually put the recommendations to work today when I was doing a grocery tour with a client (not my new job, just private). At the end of our tour, and throughout, I kept asking him to repeat what I said and to show me that he understood. I realized he wasn’t understanding the concept of “starches” and “carbs” on labels….I never would have known had I not asked him to repeat what I told him!!

  12. June 14, 2010 / 4:10 pm

    I have had so many doctor appointments where I feel like I haven’t gained anything. Luckily, I found a fantastic doctor about a year ago! ๐Ÿ™‚

  13. June 14, 2010 / 4:12 pm

    Such a great, inspiring post! Working with at-risk 8th graders, many being ESL students, our curriculum has to be pretty darn simplistic and I find myself repeating, repeating, repeating ๐Ÿ™‚ It is really neat to see their ‘light bulb’ moment though, once they can accurately work through our worksheets and we see a significant improvement in their calcium/nutrition knowledge from pre to post. I’m hoping they will at least maintain that knowledge throughout their lives. I a different note, I may be working with prof level cyclists in the future and I’m hoping that I can remember all the in-depth, technical info! That will be a change of pace ๐Ÿ™‚ Have a great week Nicole, you rock!

  14. June 14, 2010 / 4:16 pm

    I like my DR I have now. We definitely talk about lots of things while in the office, I often go home and research them, then we are able to talk more when I come back. I think it’s always best to know why and what your doctor is prescribing you and the same would go for a dietitian. You would need to understand what you’re being told in order to get the right results.

  15. June 14, 2010 / 4:43 pm

    These are great tips. It’s crazy how 1 out of every 4 adults are illiterate. I was unaware of this. I often try to simplify jargon with my blog, by breaking down studies and relaying them in relatable and simpler terms. Although, the illiterate probably wouldn’t be able to even comprehend this. This just shows we need a better education movement…

  16. June 14, 2010 / 9:00 pm

    NICOLE YOU ARE SO SMART!! these are awesome tips girl- so much is put into communication with people.

  17. June 14, 2010 / 9:33 pm

    I do not like my doctor at all. Shes awful. First of all, I cant get disability insurance because she refused to clear me. And second, shes very judgemental. My mom dragged me there kicking and screaming once because of my ED, and my doctor refused to listen to me first and just made all kinds of assumptions. She also said things like “girls like you”. What exactly are girls like me?
    Ive never really forgiven her for that.

    • Nicole
      June 15, 2010 / 5:53 am

      That is horrible! I am so sorry ๐Ÿ™

  18. June 14, 2010 / 11:37 pm

    Good stuff Nicole. Sounds alot like teaching: never assume the student knows something, check for understanding, hands-on and involving= greater understanding…..
    I have high expectations for physicians–I will typically shop around until I find someone I feel I can “trust” and “cares”. Plus, I think so many medical professionals are scared of malpractice suits that they don’t tell you how it is and it is very frustrating. I read somewhere (Freakonomics, maybe?) that doctors that tend to get sued the most are the ones that aren’t personable with their patients. I can see how that would happen.

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