How to Structure Nutrition Counseling Sessions - My Dietitian Journey Podcast

0:00 hello and welcome to the my dietitian Journey podcast my name is Adam this is Felicia she owns the business she's The dietitian um her husband but I know how to make a podcast so I'm here too today we're going to talk about structuring a session your first session yes with a new patient we're using the word patient from now on we are because patient is the appropriate word for a provider giving care to that person that person is your patient okay so we're going to get into structuring your initial session with a new patient yes and uh what that looks like Felicia's strategy for it she's done it a million times so she's kind of an

0:45 expert just saying she has a lot of letters after her name alphabet soup yeah so let's just jump into it yeah what are we going to start with how do we uh how do we first approach uh the first session before you even meet with the patient so before you meet with patient just kind of my process um so every patient is sent an onboarding email and paperwork for the appointment and then they also have to include their insurance and their photo ID on file so I use Simple practice and there's a client portal that is embedded so the patient doesn't have to print anything also before the appointment so I required the paperwork is filled out 24 hours prior and that's to make sure that we can verify insurance benefits make sure that the appointment's going to

1:30 actually be covered and then also obtain any referrals so if the patient needs a specific referral from a primary care physician or if they need a specific diagnosis code for their insurance to cover we want to make sure that's on the file before the appointment so we know that again the service will be covered and then typically right before the session or a couple days before I'm going to look through the paperwork see if there's any red flags on like the intake form or areas of concern so this could be really helpful for starting the conversation with the patient during that first appointment so maybe they have diabetes that might be something that I want to talk to them about or I look for any red flags that might indicate a referral to another health care provider provider and then

2:17 also looking at testing needs so like if they have diabetes something I would think about for that first appointment is do they have any labs that they need to get done or have they gotten done and maybe I can request a copy of those ahead of time yeah we've we've hit some hurdles prior to the initial for patients I've spent a lot of time on hold with some insurance companies trying to figure things out just to be told that what's not covered but then the patient got a different story there's a lot of legwork prior to the first appointment yeah and there's mixed information and mixed views on this but I recommend calling to verify benefits but also encouraging your patient to call and verify benefits and you can give them a script to call and verify those benefits so they know exactly what

3:04 to ask for but it's a good habit for you to get into as well so you understand what things to ask and then also that you are documenting that information as well yeah that's probably a new area for you as a provider you the listener but also your patient is also maybe new to the world of health insurance or not very knowledgeable maybe they've had a plan and they don't use it that much or they don't have to interact with the insurance company very often so if they call to try to verify benefits having a script is great because there's a really good chance they're not going to know what to even ask yeah or like how to formulate what to ask they don't know what they don't know so it's probably a brand new world for them if they're asking about their coverage yeah

3:49 especially especially for Medical Nutrition benefits and like do they have coverage and do they have a copay do they not have a copay do they have a deductible to be met like all those kinds of things sometimes the insurance will just say like oh it's a covered benefit but then do they need to have a certain diagnosis like there's other questions that you'd want to ask to make sure that's actually is covered that's that's one of the things that you wouldn't expect a patient to know what what diagnosis codes are required for Medical Nutrition Therapy to be a billable service yeah for 97802 and three to be billable what diagnosis codes are required if any sometimes there aren't any sometimes there are sometimes you can just bill for BMI sometimes you need hypertension or diabetes or something you know

4:34 so do you want to talk about how you start your sessions yeah so my sessions have kind of a structure to them but they're very flexible so I usually always start the appointment with you know welcome thanks for filling out the paperwork ask them if they had any initial questions that they wanted to get started with I will say 95 of the time when I say that someone just jumps right into a story about here's my problem yes I like cheese here's why I'm here my heart's gonna stop exactly so they they just kind of like jump right into it um some of the questions that I might use would be like what are you hoping to get from today's session or what made you interested in scheduling with me or you know what is your your top priority in terms of the conversation so those

5:20 can help but again like 95 of the time people are just kind of jumping right into it um sometimes people are a little hesitant when they first start the appointment because they're not really sure what to expect and how this is supposed to go so sometimes I'll start with kind of like a summary so I'll note the time you know give kind of an overview of the appointment so today is just a time for us to kind of get to know each other meet up better understand where you are with your nutrition and your wellness and we can kind of see what questions you might have if there's any information that might be helpful you know and go from there in terms of like goal setting so it gives them just kind of like a loose overview but also knowing that it's you know very flexible one thing I do try to avoid in the very beginning part of a session is to just

6:05 start like rapid fire q a so like ask a question they give an answer ask a question give an answer like interviewing them yes it feels like an interview and it feels very impersonal and so sometimes that can happen with like closed questions like when you say do you exercise do you track your intake and it's like yes no answers and that doesn't really it just sets a tone for the appointment of like the patients in like the passenger seat and you're just driving the session and they may not feel comfortable like jumping in and sharing things well you want do you want the appointment to be more of a conversation than an interview that's the idea right yeah definitely more of a conversation and I once people get into it too they start to share more and I

6:51 find that even if there's questions that I really need to clarify and and ask in terms of information most of the time if the patient if I get the patient talking they really share that stuff anyway so I don't need to be asking all of these you know 15 other questions I can ask like one or two and get the information that I would need to you know clarify or help best so you're trying to create a conversational environment that encourages the patient to share the information that you would need to ask questions about and it tends to be the case they just sort of naturally reveal the information you need given that you're asking the right conversational questions do you have any examples of those questions yeah so one of the things I'll say is like tell me more about and and then which it's not a question but it's like a tell me more

7:37 about your your food intake or tell me more about your history with exercise or tell me more about your routine and again those kinds of questions versus like do you exercise I find the patients just kind of like open up and share you know well I start my day with this this you know and they kind of go off and it's really easy to then be able to pull information from that um and that's something that you know those those kinds of questions like tell me more about or you know when you think about your nutrition what's an area that you feel like you really want to focus it on again I feel like ninety percent of the time people have an area that they're like this is a problem for me or this is why I'm here if someone really isn't giving you much to work with this is where I fall back

8:23 on that like new patient intake form you know I saw on your paperwork that you had noted that you have type 2 diabetes um so tell me a little bit about that where you recently diagnosed is this a diagnosis that you've had for a while and again even though that sounds like a closed question most the time patients I find really open up and say oh I've had it for a while but it's not really managed well or that's really what I'm hoping to get from these appointments is just to better understand my numbers and again it gives you lots of information to work with do you ever find yourself in a situation where because tell me about is a request for information and you know people people like talking about themselves yeah so do you ever find yourself in a situation where you're having to yank the patient back on track or sort of direct the

9:09 conversation back toward a an area of value to the like the whole point of the appointment because they're you know they can go off and start telling you about their cat and their sister's cousin or something yeah I would say that's probably pretty rare that that happens where it's too much in terms of dominating the session and I will say a lot of people ask like how long are your sessions anywhere from 45 minutes to an hour so there's lots of time to be flexible for an initial usually for an initial usually um and so there is time where if someone is talking about their cat you know that it's something that we could spend a few minutes and it also makes them feel more comfortable and more relaxed so I find that it's valuable if they share a little bit of personal details um because then I find that they just they get more relaxed um and sometimes that could be something we can be like oh you have a dog I also

9:55 have a dog You're Building Rapport yes Rapport exactly um so sometimes I do find people go off a little bit on a tangent in those cases again I really find that sometimes people they say a lot of things but it's also important information for me to know so for example someone might kind of be going off about their day and their work and how they're stressed about this and that that tells me that they have a lot mentally going on in terms of juggling workplace home life how nutrition fits into all of that they've got lots of stress on their plate and I start to think about okay they need really realistic strategies and it gives me insight as to like where they're starting from so even if it doesn't feel directly related to

10:40 nutrition it's still something that can impact their eating habits their exercise routine so even if they're seemingly going off topic I kind of think about how does this relate to how they might be eating or exercising and most of the time it gives me a lot of insight into their routine and who they are as a person as to maybe tailoring my recommendations based on that yeah so if you think about it the appointment is for Medical Nutrition Therapy and you're treating the patient by taking them through a therapy session the word therapy is in your service it is therapy the target factor that you're trying to influence is their nutritional habits their eating their lifestyle habits that affect whatever their ailment is but ultimately

11:27 it's a therapy session you're not like it's not cognitive behavioral therapy yeah but approaching it like it's a therapy session and not just directing do this do this don't do that having that conversation building that rapport is part of therapy remember that you're a provider of therapy with a nutritional Focus yes Medical Nutrition Therapy that's the whole point yeah so if they want to talk about their cat and you can derive some influence on their nutritional habits or their lifestyle habits from that Conversation Piece it is valuable I could just you know if someone's going on for like a half hour maybe you know rope them back in I don't know yeah and sometimes there is points where it's like my gosh they've talked for a while at night and I usually try to like jot

12:12 down like keywords they're saying to kind of struggle back to but sometimes I'll be like you know I don't mean to cut you off but I just want to make sure you mentioned a few things in what you shared with me and I'll highlight the things that are more relevant to the equipment and so I'll highlight those things and then say you know can you tell me more about and then you know a specific point that again relates more to nutrition or and that gives me a little bit more direction to the session itself um I do find when patients are really talkative that tends to be the first appointment and that kind of there's still a talkative person sometimes you know throughout the rest of the appointments but the first appointment it's like they want to really share with me a lot so I can get kind of caught up to speed um and again sometimes it's also people unload I feel like that first

12:58 appointment because they've maybe been around a lot of providers and they're just frustrated they're almost like if I can just tell you everything that's going on then we can you know get started and you can really help me and so it's kind of like sometimes when they're sharing a lot it's because they just want to put it all out there so I know exactly where they are and they'll often say like I knew that was a lot but I just feel like it was important information for you to know and so you know do you ever set the stage such that the patient understands that you'll see them for multiple sessions and that like you don't have to do everything up front do you ever do you establish that in any capacity yeah and I kind of when I start if I like a little bit more of a session summary um I'll say you know we have about an hour for today's appointment and you

13:44 know today's appointment we need to get to know you you to get to know me but also we can kind of get an understanding of what your history looks like and you know how we're going to best work together um and then I'll let them know you know today's appointment may or may not involve you know nutrition education or things like that but at Future sessions or today's session depending on the flow and what makes the most sense you know we might be talking about those things and I let them know that partially because I don't want them to feel like I'm just going to keep throwing all these things at them too and I think that that sometimes relaxes people like knowing that they don't have to do all these things in the appointment with me that it's a little bit more of like a relaxed session sometimes I do give nutrition education and sometimes it's it's really not about me telling them anything in that first

14:29 appointment but us again me getting more information from them and then also them being able to share with me and catch me up to speed on where they are in terms of the nutrition their Wellness so you're you're tailoring the session to them specifically every person's different every person's at a different place in their journey of nutrition as you would say maybe I don't know yeah no that's the word Journey right we do like the Lord Jordan but that's exactly it raised in a different place and I will say it's pretty rare but it has happened and I've had a few patients this way where they they come into the appointment and they're like okay I need to know XYZ or they come with like rapid fire questions okay we'll start there you know so that's sometimes that's how the appointment goes and they're kind of directing the session and that's totally fine too

15:15 um I would just say that most people are not like that when they come into the appointment at least that I work with anyway well I I would imagine most people don't know what they need to know right away yeah it's it tends to be more of my younger clients that are like my younger patients who are like in their 20s or 30s um versus like my most of my patients are in like the 50 to 60 range I would say that's like the bulk of my patients and if someone's in like that 20 to 30 range a lot of times that's where they come with you know I have questions about protein and exercise so someone who might be informed about nutrition already but they're kind of wanting to make sure that what they're doing is you know optimal for them and that's where I find that they kind of come more prepared in terms of questions to ask me to make use of the time so so what if a what if a patient isn't very

16:01 talkative so definitely um I do rely on the paperwork a little bit so like tell me more about your you know you mentioned in your paperwork you have this condition or that condition um have you had any education on this or you know have you seen any recent doctors so that's kind of like clarifying their medical history but also getting an understanding of what testing they've had if they need any help with nutrition education in that space there's a lot of times where I'll just kind of then jump into a 24-hour Recall now if anyone remembers like doing a 24-hour recall from like undergrad if you're a diet dietitian it is pretty structured I don't do it like that so I just asked them you know I want to get a better understanding of your food nutrition habits so why don't you take me through

16:48 you know a typical day of eating or if it's easier for you how about we talk about what you had to eat yesterday or today depending on the time of the appointment and I'll say like starting with breakfast so I'll have them start some people will literally just run through their entire day without me saying anything and some people I'll kind of you know be directing them into the next step so they'll say well for breakfast I usually have pancakes and a cup of coffee um and then that's usually before I get to work and then I'll say okay and then what's your next meal or snack so I kind of you know prompt them along the way with doing that I often find people will share what they're eating and then they get to the end of the day and they're like and at night this is my worst time actually this is probably the

17:33 worst time snacks I just I lose control and so they they usually say something along this recall where it's like here's where my root issue is or if let's say they skip a lot of meals they'll be like I know I don't eat well I really want to get into a better routine and in that case again it's like a pinpoint where I could say like okay this is a topic we can explore either today or at a future session so I don't like stop a recall to address that but I just kind of make a note so then that way we can kind of circle back to it but that actually helps to get people talking too and it's again me providing a little bit more direction to the appointment but it also allows them to really explain to me like what their day looks like and an opportunity for them to share what their eating habits look like and how we can

18:19 kind of address them if anyone hears any weird background noise it's we have a five-month-old puppy he's just kind of romping around a little bit trying to get him to settle down but it's not working out so good he's doing puppy business yeah yeah if you're watching on YouTube I'll throw a picture up um so do you chart during your sessions I do now so if you've listened to any of the previous podcasts um I think the last one was on um the contract that I did with dietitians on demand and I learned very quickly how to chart while also running a session and in doing that um now I chart all the time during my appointments before I was like oh it takes away from the session you know I'm not paying attention but that's not the case so my note flow I have changed to

19:05 be more representative of how I might go through an actual session so it makes it easier for me to take notes at the end of the appointment I still have to usually go back and make some minor adjustments but most of the time I'm just you know making tweaks and I'm not writing a full-on note afterwards so to clarify you used to not chart during your sessions you thought it's attracted from the session and then you had a stint with dietitians on demand where you worked in bariatric surgery pre and post care right and you had 15 minute rapid fire sessions all day for whole eight hours at a time and learned that you had to in order to keep up in that environment you learned you had to chart while you were going through those

19:50 appointments which were more of an interview style not as talkative and conversational yeah because you just unfortunately didn't really have too much time but I learned how to multitask a lot better and not detract from the session while still being able to pull the information um and so that definitely helped and my being able to like type and not look at the same time my skills I guess so to to any newer dietitians who maybe don't have that experience and maybe haven't had the challenge of having to chart or even that are new to this do you recommend that they chart during the session yeah I would I would maybe just practice with it and what I used to do when I started was I didn't necessarily not do anything I would take like shorthand notes on like a piece of paper

20:37 it was just like the typing and looking at the same time that was what I like couldn't get the flow of but I would still take like paper notes and then be able to and then I would trans like put those into the actual note format I was spending a lot of time that was the thing and I wasn't really thinking about it but now I only have a few minutes so I would say like try to practice doing it even if you don't do an entire note during the appointment and also see if you need to adjust the way that your appointment is structured in your in your practice management system if you use one because sometimes you need to adjust you know the flow of what your your template looks like to better align with how you run an actual session so do you think um it's okay to not chart during an appointment or is it vital that they do

21:25 you think this is an essential skill to like practice and learn like was it transformative for you when you started doing it during your sessions I don't think it's absolutely necessary I think it is helpful if you are running a busy practice where you have patience blocked you know in a day or you have other things going on like when I first started I didn't have a huge patient load so it kind of didn't matter like I could spend the extra time charting after an appointment or you know billing extra you know I didn't really need to worry about it too much and I was yeah time is money but I was like I'm just starting and it's just you know it didn't really matter as much now or my time is you know not as flexible and some days I'm seeing patients you know back to pack or like having a small gap between that I I need to be more optimized about how I have you know the

22:10 appointment in the time and I was just I was just spending way too much time like 15 20 minutes after for each patient writing the note and like doing all those things and it just sometimes I'd be like wait what was this and I'd have to like look at my notes it was just I was spending more time and I feel like it was actually less representative of the session too so in terms of accurately recording notes and time management it's more effective to chart during the session yeah and it's a good skill to invest time in and practice Yeah right okay yeah and you just happen to have a lot of rapid fire practice but if you're new to your practice and and you're starting getting patients rolling in it's a good thing to build a skill for over time yeah I think but is that

22:57 yeah yeah it's absolutely so what are some key things you review with a patient during the first session so definitely their medical history and this is like Beyond beyond what is in their paperwork because paperwork they might say like I have diabetes gerd IBS that you know in some cases they've had IBS for their entire life they know how to manage it they know what the triggers are they don't need to like have any education on that so I want to identify what of those conditions are they actively seeking assistance on in terms of managing with nutrition and then also like if they have diabetes and I'm reviewing their medical history I want to know do they test their blood sugar regularly you know making sure I have the accurate medications on file if they had recent Medicaid recent labs done did they have

23:45 any past education on Diabetes what their biggest concerns are you know if they have GI issues you know are they working with a gastroenterologist you know do they know what foods are causing symptoms so really getting a clear understanding of their medical history and then also again what are their kind of like active chronic conditions and what things are are already well managed that they are dealing with um other big things would be like recent doctor's appointments and you know making sure if there was a recent appointment did they have any specific recommendations from their provider that I need to also be aware of a lot of times I will find patients get Labs on and they're Physicians like labs are good don't really go over too much

24:31 else with them so one thing I find is that I'm often helping a patient to kind of navigate what their results are you know here's your A1C this is what it was before here's what the A1C actually means you know here's your fasting blood glucose level and so again reviewing with them if they had recent labs and then actually talking to them about it that also helps the patient but also for me to understand kind of where they are in terms of managing whatever condition they have obviously their food nutrition history so understanding the foods the beverages what they're consuming their meal timing their physical activity what they've done previously what they're doing now and then just overall goals you know what why are they seeing me what are they hoping to get out of the appointment but also long term what are

25:16 they looking for and working together a physical history activity physical activity history rather physical activity history and then if they have goals you review the goals with them too their goals yeah sometimes people come in like and I'll say like 90 a good percentage of people say I want to lose weight but it's something that they are like always wanting to lose weight but really they're coming to see me because their blood sugar is elevated you know or their blood pressure is elevated or you know they had a recent change in like their GI symptoms and so weight loss is kind of always on their radar but it's not the priority in terms of us to address it's focusing on like something else that's going on do you often find yourself helping a patient interpret

26:02 their Labs is that something you've done frequently or like often more frequently lately than before which I think is just interesting and I think part of it has been with covid and maybe some of the virtual appointments that are going on that they're a lot more they're a lot quicker and sometimes it doesn't mean that they're not provided a good session or or care from their provider it's just the big thing is like your Labs look good or watch your watch your blood sugar warm I'm happy you don't need to change your medications and like that's kind of it and then they're like well what is what does good mean like what do these numbers mean what does total cholesterol versus LDL like which one am I supposed to be looking like that kind of thing where I'm like telling them like here's what LDL is here's HDL is

26:48 the one you want to be and so like kind of walking them through that um and that's a big thing and again I just find sometimes the provider just doesn't have the time to sit and talk to them and if their labs are good they'll often just say that or oh your A1C went up make sure you're watching what you're eating and then kind of leave it at that do you find that patients derive value from having those labs interpreted for them or going into greater detail on what the numbers mean to patients typically enjoy that or do they engage with you on that yeah most of the time I um when I start that conversation and I if they have labs they share it with me or they've send them to me ahead of time I'll say you know I have your recent labs and I just wanted to know if you had any questions about anything that was on there and like a patient recently was like well I'm not really sure what

27:34 I'm looking at like can you walk me through like what you're seeing and so I'll look at them and I'll say okay so your A1C was 5.7 and it went down to 5.4 you know and all I did A1C is an average blood sugar we're three months okay great we move on to the next so I'll kind of like highlight key things um for one patient it was they their labs in terms of their cholesterol their lipid panel was good and their doctor said it was good and they were like but my LDL is still high like is that a good number or a bad number and so we talked about like how their total cholesterol had come down their HDL went up so like overall risk had greatly been reduced which is why the physician was happy but here's where the targets were and here's how close

28:20 they were to like the Target so I usually ask before I just start like spitting all this information at them in terms of if it would be helpful but most the time it's like the patient is asking me to go over something with them or when I asked them if you have any questions about your Labs it's like the first thing they're like well I don't know what I'm looking at or is the only all the good cholesterol or the bad one I heard you know what affects that and that also brings up a lot of really good nutrition education points too where like someone will say well HDL my HDL went down like how do I increase that and that's an opportunity for me to provide some education in that space do you set goals for every session with the patient it depends on

29:06 depends only that my goals now are much different than what they used to be when I first started I used to have everybody set like a formal smart goal like exercise three times a week for 20 minutes and I've kind of moved away from that because my style and how I run a session is a lot different now and more focused in on like motivational interviewing and really identifying where the patient is in terms of their stage of change and most people are not ready to set goals and stage of change referring to the theoretical or what's it what's the transtheoretical model yes which we did I think a series on three podcasts yeah I'll link uh I'll link the playlist for that yeah and some I'd say most people are in this like contemplation where they're like weighing the pros and cons of change or

29:52 Preparation stage where they're like thinking about and ready for Change and making it uh you know an action step in the next 30 days but they're not ready to like actually take action like go to the gym yet and so if we set goals like that most of the time they're not going to be accomplished between the appointments so I kind of take a step back and use that first to second appointment as a time to gather more information about their routine their lifestyle their food habits their exercise habits you know having them track GI symptoms so there's some kind of action item but it's not like a you need to go and do this it's like go out to the gym or start eating more vegetables it's like let's just get a really clear picture of where you are right now and not to have them start

30:38 making changes to their life just yet and that usually I think is a lot more receptive for the patients than to just jump into all these really clear action items that they need to start addressing how do you typically close a session so usually I give a little bit of a summary about what happens we talked and an example could be so we talked a little bit about your nutrition your exercise we talked a little bit about managing IBS are there any additional questions you have before we close out for today's session some most the time people will say no sometimes people will say like actually I do have a really quick question usually I try to do this at like the 10 or 5 minute Mark before the hour only because I find sometimes if people

31:25 do have a question then it gives them that space to be able to talk and then I ask them if they were interested in scheduling a follow-up session or if they wanted to touch base with me why I do that is sometimes people maybe we're not a good fit sometimes people will need to kind of think about it and so I usually give them an out you know or you know you can reach out to me and let me know and it takes the pressure off and I find that that helps with cancellations and if someone really isn't interested in scheduling that second appointment they don't feel obligated at the end of the appointment so usually a summary and then like next steps in terms of scheduling so just some random questions that you've gotten for um this sort of thing we're gonna rapid fire through a few of these so if a patient's uncomfortable talking about their weight but you need

32:11 that number for a chart or Insurance how do you navigate that so every intake form for patients has a section where they fill in their height and their weight part of this is to calculate things like BMI if that's something that I need to bill for one thing I bring up with patients and this is something that depending on how the appointment goes I either bring it up in the beginning or towards the middle is I let them know that you know in certain cases I need to have an accurate weight on file I understand that one weight is not a comfortable topic for a lot of people and I also am not weight centered myself as a practitioner I let them know that if they are looking to track their weight that's absolutely something that we can do but if they're also not looking to track their weight and

32:56 they're going to look at other metrics for Success that you know we can they can either send me the weight through email or you know we can share that in the beginning part of the appointment and just kind of move on and not be like a conversation topic I find that pretty much all of my patients are okay with that that they understand why it's necessary to be in there but the fact that I'm not pushing them to have this big conversation about weight and the fact that in order for them to make any changes to their weight there needs to be something else done like they need to exercise or you know eat a different way or sometimes it's Stress Management or relating to a medication or something like that and so I'm taking the pressure off of that conversation for them and

33:43 most of them are just okay with being able to have to talk about weight or you know send it over to me in some fashion so have you ever had a patient refuse to give you their weight no or put up a fight no never had someone so framing it that way has always been successful for you yes you have a 100 success rate with that yes oh that's good not many things have a 100 success rate I know yeah what are some things to avoid in the first session definitely lecturing so like starting the appointment and just like telling people what to do or um you know overburdening with information I I did this when I first started I used to come I used to do face-to-face appointments and I do virtual primary all virtual at this point I would come into an appointment with a folder and like handouts and like

34:28 all of the stuff and so when I my appointments were much different back then too but I would just start like giving information and then I probably gave everybody like five or ten handouts like it was really ridiculous I remember these handouts I remember your folders she was really into it like my sticker for like bras nutrition and my business card wasn't I was like very proud of these but um some people really liked them because they're like oh this is lots of really great information if I had coupons I stuck them in there but sometimes it was just like straight up overwhelming for people and I also found that they just became like a hub and Dumping Ground for all the stuff that I would give them every appointment because then I would come with more hand I had a binder that I would travel with with handouts in it and I'm like oh we talked about whole grains I have a hint you know handout

35:14 fatigue yes so don't do that um one it's just also I find that people weren't really utilizing it much either and so it ended up being like a little bit of a waste in terms of like paper but just really overwhelming for the patient um directing too much in the session so like this kind of goes along with like lecturing and also just telling the patient too much of what to do it just again you I find that I don't get a lot from the patient in those cases and I don't get to know them enough and that also don't build that Rapport and that connection with them and I found that people weren't scheduling as often that actually happened a lot when I first started where I'm like why aren't people scheduling follow-ups because I was just kind of talking MMO over the head with

36:00 stuff here's a folder takes his hand out on Broccoli oh yes I have a stick band sticker and so some of it was like I just I felt like oh if I gave them all this information they're gonna get a lot out of it people get a lot out of being able to have a connection with me than and having someone listen and understand than they do with 15 hand knots so yeah the long game is more effective than information dumping yeah who to thunk it while you were new you don't know you developed the skill over time figuring this out it's therapy you know it's not education it's therapy yeah it can be education too but primarily therapy yes Medical Nutrition Medical Nutrition Therapy do you do meal plans for patients not anymore so that in my time of just sharing things uh when I first

36:47 started I thought like okay everybody keeps asking for meal plans I need to create meal plans if anyone's actually created a meal plan from scratch it takes forever and I would tailor them to the patient so like it wasn't just me creating like this standardized plan I gave to to 15 patients it was like I created a meal plan specific to that patient to the calories the carbs all of that without software either so Hand doing everything what I started to find one Beyond being time consuming they were getting these meal plans and like I had one patient who was adamant I need a meal plan I know this will help me and then I like went and saw her like two weeks later and asked her how the meal plan went and she's like oh it was on the table with my folder she's oh I meant to get around

37:32 to it but then I I don't know I used the one day and then I just felt like it wasn't the day that I usually would eat and it was just like this whole big thing of like why I shouldn't use the bill plan and I was just like I spend like all of these hours on this meal plan but I found that people want meal plans but they really want ideas and they also want something that could be realistic for them so now my Approach has changed when we talk about meal plans in a session one of the key things that I do is that I get an understanding of where they are in terms of their nutrition and then we talk about like specific tweaks to make and then I also have like a meal plan template where it's more of like options and then ideas for how to build a meal so it's less about like

38:19 it's less about like key you know like this structured plan and more about flexibility and tailoring it towards them it also takes the pressure off of me to be able to create this like full-on structure all right what do we think about uh wrapping this one up any final thoughts your first appointment will probably not go in the exact way that you would like it to so um take the pressure off yourself spend time just listening to your patient and asking questions that give your patient space to talk understand that you don't need to fit in everything to that appointment and you have more appointments to work with to be able to fill any gaps that are in

39:04 that session the other thing to think about too is that you are human and so you may not always say things that maybe will be the best thing to say and you'll find your footing along the way as to how to really navigate a session it's not in it's not always that intuitive but it's also something that we don't get a lot of time in undergrad and the internship to really really practice these skills and so I think that just the more you do it the better you'll get at it as cheesy as that is but then also just know that you know you will find your faux flow in terms of the session and how that's going to work best for you and also the patience that you want to work with too yeah don't beat yourself up if it goes

39:50 poorly the first 10 times whatever there's a few bumps along the way you'll learn you know reflect and move on yeah right Felicia's first 50 sessions probably didn't go as well as her following 50. yeah and then now you know hundreds of sessions later I don't know even the thousands yet maybe yeah probably you know they are that much more tailored to the experience that she's going for and then you know you as a provider find your own Rhythm and your own style too you you have to develop that and figure out what that's going to be yeah you need sessions to do that too right that's absolutely like you find the style that's going to work for you and also the patience that you want to attract like and a lot of the patients

40:36 that I work with now have besides having like diabetes heart disease they also have depression and anxiety and things like that and so a lot of times going into the session there's a lot more of like nervousness or not sure what to say or like there's just a lot more there and so being able to kind of create this like warm inviting environment that's not super clinical I feel like helps patients relate to feel more relaxed and then share more with you and you get this better partnership that is more conducive to helping them with reaching their goals all right I think that's going to do it for us here at the my dietitian Journey podcast join us next time when we talk about something different relating to Private Practice we're not there yet we should probably schedule these out at some point a few in advance so we can

41:22 say what's coming next but uh check the description for links to some relevant stuff that we talked about during this podcast and uh we wish you well thanks so much for being with us