Monday, 4 April 2011

Being patient-centred

Sculpture of the head of a giraffe made from cutlery
It's been a relatively good week. I did some good consultations and some not so good, a couple without supervision and quite a lot on the stroke ward. Very little diabetes this week - just a gestational diabetes clinic. I compiled a list of low fat/low sugar yogurts, and a checklist to try and help me remember everything that needs to happen with any dietetic intervention on the ward. A patient (the patient's daughter actually) agreed to be my case study. I had quite a long meeting with the head of the department, who has given me some suggestions on how to develop the 'Activist' side of my personality, the bit that holds me back from being confident with new experiences in new situations.

One nugget of interest was a consultation at a GP clinic with a man who wanted to lose weight. The 'classic' way of running this type of consultation is to talk about the principles of healthy eating for weight loss, look specifically at the patient's diet and then agree where changes could be made. Then the patient either wants to come back, or doesn't.

I've been trying to be less directive and more 'patient-centred', so I've been giving the patient the opportunity to identify where changes could be made. In this scenario, the diet described had so many possibilities that it seemed a really good idea to let the patient choose - that way he would start with something he was probably going to be able to change, and therefore see some results and maintain motivation to continue. The choice he made was disappointing (for me) - he wanted some recipes for vegetables so that he could increase his intake of veg with main meals.

Of course, this wasn't all that we talked about, and I made it clear that increasing something without reducing something else wasn't going to result in weight loss, and we came up with a couple of other things. But when I talked it over with various other people, we decided that it was the right approach - if boring vegetables were stopping him from losing weight, then that would be a useful thing to tackle. Counter-intuitive, but perhaps correct.

1 comment:

Nicki said...

Baby steps, right? I am not a dietitian but I remember when I wanted to start losing weight. I added yummy recipes of veggies and yes, at first I gained but it made my palate start to want veggies more and more and other crap less and less. I also kept telling myself that if nothing else, I was at least adding some much needed vitamins that I was lacking without the veggies. Eventually, I cut down more on the junk and have lost 13 pounds so far. Lastly, being a psych major with a concentration in motivational psychology, I agree that by supporting his autonomy rather than being prescriptive (and therefore controlling), he stands a better chance at physical and psychological success. =)

It sounds like you have some very interesting work cut out for you! I wish you the very best!!!