A Whole New World: Outpatient Counseling

By: Kelsey Felter

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What does a University of Maryland intern do after completing a rotation that focuses on inpatient, clinical training? In my case, I did a second clinical rotation, but one that focused on outpatient counseling. I enjoyed my time in my primary clinical rotation and I was excited to observe and learn in a completely different setting. For my second clinical rotation, I had the amazing opportunity to learn about diabetes and pediatric failure to thrive counseling by shadowing dietitians in outpatient clinics and interacting with patients. I went into this experience with knowledge about these conditions but no experience actually counseling these patients one-on-one. After just two weeks, I learned so much about these conditions and their treatments. More importantly, I learned how to motivate and counsel patients.

My first outpatient experience was through the University of Maryland Medical Center (UMMC). I had the privilege of shadowing an outpatient dietitian as she counseled patients with Type 2 Diabetes Mellitus (T2DM) and taught classes about pre-diabetes, diabetes, and the management/treatment of diabetes. My favorite part about this experience was getting to see the importance of working around people’s schedules, lives, and comfort levels. For example, one patient had a very unconventional work schedule. He would work all night in a soda company warehouse and sleep until the late morning or early afternoon. His meal times were greatly affected by his work schedule. Dinners were either before he left for work at 5pm or after he got home from work at 2am. Eating during the day was variable for the patient due to his challenging sleeping pattern. Many times, he would eat high carbohydrate, nutrient-poor snacks, such as chips and candy because he could get and eat them quickly. This is not beneficial for patients with diabetes because foods high in carbohydrates cause more sugar to be in the blood. For people without diabetes, a hormone called insulin works to remove the sugar from the blood. However, for someone with diabetes, insulin does not work properly and the sugar stays at high levels in the blood. Most of this counseling session ended up focusing on a meal schedule, a medicine schedule, and a plan for healthy, quick snacks for when he is tired. Making the task of eating and preparing meals easier is something I think would help many people with and without diabetes. I am so grateful to have sat in on this and other counseling sessions at UMMC. I learned that problem solving is an extremely important tool in counseling, as most patient already understand the condition but need help overcoming specific barriers to their health.

In addition to observing counseling sessions, I also had the opportunity to help prepare for Heartbeat for Health. Heartbeat for Health is a day of health activities, education, music, health screenings, and refreshments for attendees. In preparation of this event, I was given the task to design a poster educating attendees about prediabetes, which would be displayed at this event. I made infographics focusing on defining blood glucose, eating tips to prevent diabetes, and advice on journaling to track sugar intake. I also constructed a matching game for kids and adults to learn more about food groups, exercise, and MyPlate.

Heartbeat For Health 1
Above, is the compilation of infographics that I designed for the Heartbeat for Health poster. 
Heartbeat For Health 2
Above is the matching game that I created for Heartbeat for Health attendees. The goal was to make a straightforward, visual game that could be played by users of all ages. 

My next experience with outpatient counseling took place in a Growth and Nutrition Clinic, where  a team of health professionals counselled parents of children with failure to thrive. This health team was composed of a registered dietitian, a phycologist, and a doctor. Each specialist would speak with the patient’s parent(s) for about an hour. The doctor would see the patient first to rule out any medical problems. The psychologist would see the patient next, acquire a full history of the patient’s behavioral patterns and food behaviors around mealtime from the parent. Usually, the psychologist counsels on how to manage mealtime and what behaviors should be addressed or changed. The dietitian would see the patient last, gather more diet history and finally counsel with mealtime tips and dietary recommendations. I loved getting to work so closely with each patient and their families to understand their issues by diving deeply into their behaviors. I also loved how every specialist came back with new information about the patient to build an even broader story. After meeting with the parents, each specialist would update the team about the information they gathered so the team could piece together the story, as one does a puzzle. What is making the child resistant towards food? What goes on at mealtime? How does the parent respond to the child? Who is in control, the child or the parent? After shadowing at this clinic two times, I learned that there is a common theme for families with children suffering from failure to thrive or picky eating. The most repetitive advice that was given to parents was: you are in charge of what is being served at the meal, what time you serve the meal and how much is provided at the meal. The child is in charge of whether they eat the food provided. Keeping the mealtime procedure as simple as this is extremely helpful to parents because they are being told their role, as well as their child’s role. I am extremely grateful to have shadowed at this clinic because I learned so much about children’s eating behaviors and how to help parents navigate ways they can regain control at mealtime.

My two weeks of outpatient were rewarding and eye-opening. I can see myself working in an outpatient practice. I enjoy connecting with patients by understanding what motivates them. I believe that one of the most important aspects of counseling is to piece together important parts of the patient’s history to really understand their issues and tailor their goals and eating plan to their unique needs. I learned how to counsel through educating, questioning, motivating, advising and supporting, and I hope to implement these skills in my future career!

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