Dietitians tend to be great educators. Our training helps us remain steadfast in communicating messages that separate nutrition fads from science. If only everyone would listen. At times our patients are listening but they aren’t changing their behaviors. Sometimes they don’t seem to care at all. So what do we do? Some say, “Provide the education and then leave it up to them—if they don’t want to change, there’s nothing we can do.” But spewing recommendations to those who appear uninterested creates an even larger gap between them and us. We quickly take on the role of the food police, and our patients become guarded, defensive, and uncomfortable. We finish our sessions in a frustrated frenzy, thinking, “Why do I bother?”
But we are more than educators—we are guides. Unlike a book, a video, or a blog post, a good guide responds uniquely to each person. Many seemingly unmotivated patients can begin to change their perspective with the right types of interactions. Effective communication styles, such as motivational interviewing, can move patients in the direction of change. Granted, this method doesn’t come naturally for those of us in advice-giving professions. But shifting our communication style just a bit may make a huge difference. Here’s what you can do to begin this shift:
- Set the agenda together. No matter the reason for the visit, involve the patient in deciding what you will discuss. “It looks like Dr. Smith referred you for diet education related to your diabetes. I’ve got some ideas about what we can cover, but I’d really like to know what you hoped to get out of today’s session.”
- Let the client know you’re listening. When our patients feel “heard,” they engage. As educators, we often listen and then quickly follow-up with our recommendation. That’s unlikely to build rapport or motivate the person sitting across from us. Listening in order to understand our patients’ point of view strengthens our connection with them and can lead to collaborative problem solving. If you hear yourself say, “So you’re concerned about…”or “Let me see if I understand what you’re saying …” you’re on the right track.
- Elicit change talk. Let’s say your patient responds, “My wife is worried about my diet, but I’m not going to eat rabbit food like she does.” You might reply, “So you and your wife don’t care for some of the same foods (patient knows you are listening); why is she worried about your diet (guiding the conversation to concerns)?” You may then ask which of those concerns he shares with his wife. Now you’re talking about things he may want to change.
Focus and Planning
What happens if you set goals for an ambivalent patient? Nothing. That’s the problem. When we’re working with fence-sitters it’s important that they have the last say in what they want to do. Our instinct is to set goals that will fully correct our clients’ diets. It almost seems like it’s our duty to cover everything they should do. But our patients aren’t our platform to demonstrate that we understand the best practices in our area of expertise. If we want to suggest a goal, we should do so after asking for permission, but let patients decide. Some change is better than no change at all.
This type of counseling takes practice, but it can empower your patients and relieve much of your frustration. For more information, check out Motivational Interviewing in Health Care: Helping Patients Change Behavior by Rollnick, Miller, and Butler, 2008.
— David B. Creel, PhD, RD, HSPP, is a psychologist and ACSM-certified clinical exercise physiologist. He works as a clinician and researcher at the St. Vincent Carmel Bariatric Center of Excellence in Carmel, Indiana. Visit his blog at drdavidcreel.com.