1 | Discussing Nutrition: 3 Things Every Clinician Must Do

Whether you're a seasoned physician or a healthcare student, this podcast is for you, so stick around and let's make our patients healthier. One exam room at a time. Welcome to the Exam Room Nutrition podcast. I'm your host, Colleen Sloan. I'm a Registered Dietitian and Pediatric PA for this first episode. I really wanted to make my goals for this podcast clear so you know exactly what you'll find here. and dig into how we actually start the nutrition discussion.

If you haven't already, go listen to my trailer because that goes into some more details about my goals and vision for this podcast. So let's get into what this podcast is all about. Each episode will be short and to the point to give you some practical tips that you can incorporate into your day I'll often be interviewing registered dietitians who can give us a fresh look at nutrition and how we can educate our patients appropriately.

I really wanna give you a toolbox, or better yet, a medical bag full of nutrition solutions and appropriate conversations that you can have with your patients that would completely transform their health and future. You'll learn to change the words that you use to foster trust and help our patients have a healthy relationship with food. You'll be equipped with conversation starters, appropriate questions to ask, and. Helpful nutrition tips but don't worry, this won't take any more time.

In your busy day, I already know you're overbooked and probably running late Sometimes the topic of nutrition and guiding your patients in their dietary patterns can be a bit overwhelming. Confusing, uninteresting. Do you sometimes find yourself giving vague recommendations like, drink more water or eat more fruits and vegetables? Our patients already know that, what they need are practical, tangible things that they can incorporate in order to do those things.

How do you talk about sensitive topics like obesity, diabetes, PCOS picky eating. We don't want to offend or damage our patient's relationship with food, but we do want to relay factual information and practical tips. And I know that although we want to do no harm, sometimes our words can cause more harm than good, especially when we talk about losing weight or eating healthier. And I'm fully aware of the barriers that we face as clinicians in providing nutrition information.

It's not only that sometimes our patients are disinterested or they really don't find value in eating healthier or losing weight, and they really don't care to lose any weight. There's also the issue of time constraints. I am aware that we are very busy, we're understaffed, we're overbooked. We're often running late, and sometimes there's not that time to have those deep, thoughtful conversations in nutrition.

A huge barrier to, sharing nutrition information with patients, I've realized is the lack of nutrition training that the majority of us as clinicians receive. I remember when I was in PA school, I think we had one nutrition class, which really I. Was not very helpful, at providing us with everyday solutions to common nutrition issues.

I'm not sure about what it's like for nurse practitioners because I can't speak on that, but I can imagine it's pretty similar to what the rest of us are receiving and it's very minimal. And I know sometimes dietary guidelines can be complex. medicine is an ever-changing field, and nutrition can feel that way too.

There's also a lot of voices that are not credentialed out there who are maybe providing you, or most often providing our patients with inaccurate or false information that it's really hard to stay on top of everything. So that's why I'm here. I want to stay on top of all that for you and relay that information. For you. so here's what you can expect from this podcast. Practical insights. We have so many expert interviews scheduled that I'm so excited for what's to come.

I really wanna give you two to three things that you can either say or recommend your patients do in each episode, whether you're in pediatrics, primary adult medicine, geriatric medicine, pulmonology, neurology, any field, any specialty, nutrition has an impact in the future health of our patients, and I really wanna help you get your patients on track.

Clear up any confusion about any diets or supplements and help your patients walk towards a healthy lifestyle and healthy relationship with food. I also hope for this, to be a community of support because practicing medicine is challenging. It's overwhelming, especially now trying to bring in the nutrition topics and nutrition education. That's why so often it's just not done. So many people just kind of glaze over it or give really vague responses.

So my goal here is to just be a community of support. An encouragement and a place where you can find those little golden nuggets of nutrition information that you can say, oh, that's perfect. I can do this, and I can say this with my patients today. let's dig into how we actually start the nutrition discussion. How do you even give your patient useful information? especially when you only have 10 minutes maybe for a well child check or a yearly physical, how do you fit it all together?

I wanna break this down for you in three simple steps. Number one, explain the visit. This sets the expectation and tone for what will be talked about, what they'll gain at the end of the visit, and allow an opportunity for the patient to ask any questions upfront. It also allows the patient maybe to accept or decline talking about a specific topic.

I will do this for patients, especially my teenagers, when we start to discuss their weight, because sometimes they either don't wanna know or they're struggling with an eating disorder or maybe. They are overweight and struggling with body complex issues, so I'll make sure that they are comfortable with that. So in pediatrics, this is how I will start and, explain the visit. we're doing your well check today.

we're gonna go over anything that's happened in the last year that might be important for me to know. I'll make sure that she's not on any new medication or seeing any specialists. then we'll move on to discuss her diet and the typical things that he or she eats. And if it's okay with you, I'd like to go over her growth chart. You will leave today with her school physical forms and vaccine records. How does that sound for you?

By explaining the visit, you are giving the patient and the family an opportunity to understand what's gonna happen in the next five, 10 minutes, and an opportunity to accept or decline. Number two, ask permission. So before jumping right into telling them how much weight they've gained or how much weight they've maybe lost, I like to phrase it like this. All right. So now we're moving into the nutrition portion of the section for today.

Would it be okay if I reviewed her growth chart with you or maybe something like this? Is it okay with you if we discuss your height and weight pattern over the last year or something like this? Are you comfortable telling me about the foods you typically eat in a day? This respects the patient's autonomy. It allows for an open, trusting environment, and it gives the patient control over the visit. Number three guide don't prescribe.

The classic medical approach is just if you do these three things, then all your problems will be fixed. as clinicians, we have a tendency to wanna be problem solvers.

We are trained to ask specific questions, to dig in and to get to the root cause, to create a diagnosis and a treatment, which is excellent in medicine, but not as helpful when you're discussing nutrition and weight instead of just making a list of everything that they've done wrong, have a two-way conversation to ask them if there are certain things that they think that they can improve on or would like to start to work towards.

I know this is hard guys, but when it comes to nutrition, try to step away from diagnosing and treating. Talk a little bit less, listen a little bit more. There was an article that came out a few years ago that showed that most doctors interrupted their patients on an average of 11 seconds. Which really doesn't give the patient much of an opportunity to have any kind of questions or discussion or explain what's been going on with them. And I know there are two sides to it.

I know we're all really, really busy, but when it comes to nutrition, it is really important to talk less and for you to just listen more. I like to start by just respecting their autonomy. You are not the patient. You do not know the ins and outs of their every day. You don't know what they're struggling with every day, and you also don't know what they are ready to change or ready to work towards.

so instead of just pushing your ideas on them and giving them a meal plan or saying you have to follow this, Because that just sets you up to be in opposition with your patient. And your patient can become very defensive when you're just telling them what they should do, what they need to eat, how to do it. I like avoiding you should or you must phrases because honestly, no one likes to be told what to do.

And as I'm listening to what they're describing as their typical meal pattern or maybe some things that they think that they need to work on, I will reflect back things that they've said to me. A phrase that I like to use often is, it sounds like you wanna try to eat more fruits and vegetables, or, it sounds like you've really struggled with drinking more water in the past, or it sounds like you're really concerned with your child's picky eating habits.

So, Now, instead of you saying your child is a picky eater. Now you're just reflecting back on things that they've told you that they are already processing and kind of wrestling with. So now that you can come alongside with them and collaborate and help them come up with some solutions. Another way I like to guide, not prescribe is by asking the patient or the parent, what sorts of things would you like to work on?

Or what sorts of things would you like to change about how you eat or how much physical activity you're getting? What sorts of things are you concerned about regarding your health or your weight today? I also like to bring it down on a human level, right? We're all human. Nobody eats a hundred percent of a perfect diet, so I like to relate to them, I like to say sometimes, Hey, everyone can eat healthier. Our goal is healthy behaviors. So which of these things would you like to focus on?

And I'll give them maybe two or three different things. So would you like to focus on eating, some more fruit during the day? Would you like to focus on smaller portions of carbohydrates? Would you like to focus on eating out less? Would you like to focus on drinking more water? Once they choose one or two things, then it makes that, Discussion much easier because now you're not trying to solve all of their nutrition challenges.

Now we're just working on one goal, and when they can follow up with you, they've tackled that one goal. They're not overwhelmed. They were probably successful because they weren't overwhelmed with 10 different things that they needed to change about habits over the last 10 years. And then you can work towards a new goal in the follow-up visit. So the next time you do a routine checkup or an annual physical exam, Remember these three things to lead your nutrition discussion.

Number one, explain the visit. Number two, ask permission. And number three, guide, don't prescribe. All right, guys. Now it's time for my nutrition notes in this section is where I'd like to leave you with a nutrition tip, an interesting quote, or a case that I think might add value to your day. Today, I'll leave you with a nutrition tip. Become a passive learner. As healthcare providers, we are supposed to be lifelong learners.

Staying up to date on the latest guidelines, management, diagnosis, and treatment. And a great way to take the burden off learning nutrition is to do it passively like this with a podcast. It's a great way to make use of your time, whether you're driving to or from work, whether you're cooking dinner, or going on a walk. And you're able to take in the information passively without actively sitting there and studying or highlighting, or trying to memorize things.

But these conversations will hopefully remain in the back of your mind so that when you do have a case similar to the topic that we discussed in an episode. You can say, oh, I remember what that dietitian said that I should ask, or I remember the solution that she suggested for this picky eater. And you can try it and see how much of an impact it will have on your patients. Well, that's all for today. Thank you so much for joining me. I hope you found value in today's episode.

If you'd like to follow me on Instagram, you can find me at exam room nutrition. I would love for you to share any questions that you might have that you would like our experts to tackle. So until next time guys, let's continue to make our patients healthier. One exam room at a time.