By Amy Sun
Quiet. Shy. Introverted. These are only some of the words people have used in the past when describing me. Hearing this, I decided that I would strengthen my communication skills. I have made progress and continue to seek out ways to work on my skills. As an undergraduate student, I took public speaking classes. As a dietetics student, I got a job as a menu technician working in a hospital. As a dietetic intern, I know that communication is key to reaching patients, getting the information I need, educating patients, advocating for dietitians, and, above all, providing the best patient care possible. Communication is a skill that can only be learned through practice. At my past clinical rotation site, I learned five important elements to effective communication as a dietitian. These elements are: address, ask, advise, answer and advocate.
The Five Elements of Communication
The first aspect of communication covered in my clinical rotation was to address the patient and explain the reason for my visit. These two items allow me to make a connection with the patient and move towards establishing rapport.
“Hello, my name is Amy and I am the student dietitian.”
In order to be respectful to the patient, I learned that I must always knock and ask for permission to enter the room. Sometimes patients are with doctors or other medical professionals. Other times, patients may not be in the correct mental or physical state for my visit. In addressing patients, it is important to use gender neutral and inclusive language when initially talking with all patients and to use patients’ choice of language for describing themselves (pronouns or preferred name) going forward. To respect the patient’s privacy, I always ask if it is alright to talk to the patient with another person in the room.
The second thing I need to address is the reason for the visit. Through watching the other clinical dietitians, I noticed that they always introduced themselves by name and title and would often introduce me as their student (asking permission if it was ok for me to be in the room as well). They would then mention their reason for the visit, whether that be for education or because a nutrition consultation was requested.
In order to get the information I need to conduct an assessment, I learned not only to ask the right questions, but also to ask the questions in the right way. When asking patients questions, I learned to always ask open-ended questions in order to get more information. Allowing the patient to talk provides more information than a “yes” or “no” answer. Open ended questions also help to facilitate more conversation, which continues to build rapport and provides a fuller picture of the patient’s health.
I also learned many strategies on how to reword questions if the patient is not answering the question in the way I want. For example, instead of asking if they have gained or lost any weight, I asked the patient if their clothes are feeling looser or tighter. Instead of asking a patient how their diet was at home, I asked for more of a diet recall to properly assess their intake. Instead of asking if patients have any problems swallowing, I asked them if they experience any chewing issues, dental issues or if they experienced gagging or choking. Just simple changes in the way I ask questions can alter the information the patient provides.
At times, a patient may not be completely transparent about or aware of the answers to some questions. When the patient is unable to offer answers, sometimes asking a family member or a friend in the room is appropriate. I have also learned that I can ask others on the patient’s healthcare team to get accurate information. I encountered many situations where patients had altered mental status or were not receptive to questions. In those instances, I would speak with nurses to find out information such as how much a patient ate or consult a speech language pathologist to better understand if the plan was to switch the patient from an oral diet to tube feeding.
The bottom line is: to get the information you need to treat a patient, ask questions in the right way and ask the right people.
Oftentimes, when a nutrition consult is requested, the reason is listed as patient education. The reason for our visit is to advise the patients on what to eat to improve their health. Some patients have very little nutrition knowledge. Dietitians are the experts on nutrition. Nutrition information that might seem obvious to us may not be to everyone. Education is an important part of our job. Education and offering strategies for patients to improve their nutrition is one of the most challenging tasks that I encountered while in the hospital.
I would often go into the patient’s room with visual aids such as the MyPlate diagram or diet outlines from the Nutrition Care Manual. I would review the information at a level the patient could understand. Sometimes, I learned I needed to speak louder and slower. Other times, the patient expressed some knowledge towards a subject so I knew I could go more in depth. Sometimes, I would spend my time correcting nutrition misconceptions. Every patient was different, so each education had to be tailored to the patient.
Sample educational diagram used to explain a balanced diet to patients.
Each preceptor I was with used a different set of educational materials and had a different teaching style. I learned something from each of them. I consistently heard the message to meet each patient where he or she is. Use simple language and avoid using scientific jargon. Even the most simple concepts like eating one cup of a food could be described using your hand (a fist size, a palm size) to explain portion size. Instead of saying, “With a high sodium diet your body will retain water, causing edema,” you can simply say, “Salt and water like to hang out together. The more salt you eat, the more your body will hold onto water. This causes swelling in your legs.” Learning how to communicate knowledge and tailor my response differently to each patient was a constant learning opportunity and a dynamic experience every time.
The next communication component is simple: answer the patient’s questions. If the patient has any concerns about their diet or nutrition, address these concerns as professionally as possible. I heard over and over again from the clinical dietitians that we are the experts on nutrition. Most patients do not have the same degree of knowledge that we have.Thus, just like I do when educating patients, I answer their questions using easy to understand words and avoiding jargon.
More importantly, I learned that if I don’t have the answers, there is nothing wrong with letting the patient know. I can excuse myself to look up the answer to properly address a patient’s questions. As a dietetic intern, there were many instances where I had to ask my preceptors for information or research more about a topic to thoroughly answer my patient’s question. If the question is out of the scope of a dietitian, I learned that I can refer them to the proper individual who can help.
Before working with dietitians, I did not understand the need for advocacy within our profession. In a clinical setting, an individual might not understand the importance of the role of a clinical dietitian. From listening to my preceptors, I learned that we often need to establish ourselves as an important player on the interprofessional healthcare team. From advocating for our profession to advocating for the best interests of the patient, we need to communicate the importance of our role and use our nutrition knowledge to best treat our patients.
But in order to effectively advocate, we need the support of the rest of the healthcare team. I see the benefit of creating strong relationships with doctors, pharmacists, nurses, and everyone else on the team. One of the dietitians I worked with made it a point to attend rounds, not only to learn about the current states of the patients in the Intensive Care Unit but also to build a relationship with other members of the team. I learned more about the interdisciplinary team when I spent time with a pharmacist, a speech language pathologist, and a wound nurse. It really opened my eyes to how relationships with other professionals play a part in establishing us as professionals ourselves.
Although when people first meet me, they may still say I am quiet and shy, I am not offended by these comments; they are true to an extent. But I am also confident, knowledgeable and professional. I am now a confident communicator. I know how to communicate with patients and other professionals.This past rotation at my clinical site has strengthened both my clinical knowledge and communication skills. And I know that with each rotation, I will continue to learn and I will continue to grow.