Nutrition Counseling

Connecting With Resistant Patients

You can tell it’s going to be a rough session when a new patient sits down with their arms crossed and tells you the only reason they came is “because my doctor told me to.” As a diabetes educator and outpatient dietitian, I’ve seen quite a few patients who are angry about having to see a dietitian. You know which patients I’m talking about: They’re the ones who have a chip on their shoulder the size of Mt. Rushmore. Before you say a word, they already resent you.

These patients can present some difficult situations for dietitians, but helping them see you’re on their side can be very rewarding. In my practice, I use the following three strategies, based on motivational interviewing principles, to help win these patients over.

1. Listen to their stories. During appointments, I sometimes feel pressured to squeeze in as much nutrition and lifestyle change information as possible. However, I’ve found I can be much more effective when I take the time to connect with my patients and get to know them as people, in addition to their diet and health issues.

I recently had an angry patient with prediabetes who seemed very unmotivated. But as we worked together, his anger subsided; he started opening up about how he’d lost his job and his wife and explained that he’d stopped taking care of himself as a result. Listening to his story and acknowledging the hardships he faced helped build trust between us and made him more receptive to hearing what I had to say.

Try opening with these statements to help patients tell their story:

  • “Tell me about yourself.”
  • “Tell me about what’s important to you right now.”
  • “What concerns you the most about your diagnosis?”

2. Validate their feelings. In my experience, a patient’s anger isn’t usually about me; it’s about their diagnosis, fear of losing control over their diet, or a sense of helplessness and frustration. Acknowledging your patient’s feelings can help neutralize anger. Start by thanking them for coming to the appointment and then try validating their feelings. Here are some examples of affirming statements to try:

  • “I can see how this is hard for you.”
  • “I can understand hearing conflicting information is frustrating.”
  • “I appreciate that you took the time to meet with me today.”
  • “Changing your diet can be hard. My goal is to provide support for you as you learn how to manage your diabetes.”

3. Ask open-ended questions. Find out what your patients are ready and willing to work on. I’ve had some patients flat out tell me they aren’t going to do what I suggest. In these cases, I remind them that I’m just presenting information and tools, but they get to decide what to do with that information, which gives them a sense of control. The following are some questions I use to find out what my patients are willing to work on:

  • “Here are some topics we can discuss today. Which one would you like to start with?”
  • “We discussed a lot of information. What do you feel ready to start working on this month?”
  • “How could meeting this diet/exercise goal make your life better?”

Remember, it’s not about you. When faced with hostile patients, it’s easy to think you’re doing something wrong. However, a patient’s hostility towards nutrition counseling isn’t a reflection of your competence or compassion. It’s simply a reflection of where that patient is on his or her own journey. For more practical tips on how to apply motivational interviewing techniques to nutrition counseling, check out the book Motivational Interviewing in Nutrition and Fitness by Dawn Clifford and Laura Curtis.

— Joanna Eaton, MSPH, RD, CDE, is a registered dietitian and diabetes educator based in Frederick, Maryland. Joanna specializes in taking a patient-centered approach to nutrition counseling and diabetes education. She also provides consulting services for a local gastrointestinal practice, helping people who are newly diagnosed with celiac disease and other GI issues. Joanna can be found at or on her Facebook page.

3 Comment

  1. Great advice. Neutralizing resistance is possible. You may or may not see immediate change, but you are certainly more likely to have a follow-up appointment when you approach the patient as you suggest.

    1. Thanks David! I appreciate the feedback. Yes, sometimes just getting them to come back is the best you can hope for!

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