Wow, I’ve almost finished with my coursework year of my Masters in Nutrition and Dietetics. What a whirlwind year it has been! I feel like it’s flown by but I also feel like I have learned so many things that I wasn’t expecting to have within the space of about 8 months!
(1) Listening is hard but important
I like to talk. A lot. And good thing, because my future career involves lots of talking and being able to talk to anybody! However, I have learned the importance of truly listening, not cutting someone off because I just had a thought. Instead, letting someone talk and repeating back to them what they said (without sounding like a parrot), is important for a patient to feel heard and to structure goals around what THEY want.
(2) It’s not about the perfect diet
It’s very easy to get somebody’s usual diet on a piece of paper and go “oh swap those fruit juices for a whole piece of fruit, get rid of those takeaways and lets try a sandwich instead”. This is second nature to me, I can pick out how many of each food group you’re having/not having, what nutrients are at risk or of concern and I know exactly what you gotta do to “fix” all that. But patients aren’t broken things to be “fixed”, they’re people and making a few changes at a time, and just being BETTER is an achievement when it comes to food and behaviour change. Go slowly!
(3) Meal plans aren’t a thing – don’t ask for one
Oh. My. God. This is my pet peeve – “can’t you just make me a meal plan?” Okay please tell me your cooking skills, shopping skills, cultural diet, amount of money you want to spend on food, how much time you have spend preparing food and what foods you do and don’t like – including every single fruit and vegetable. Yep, too much info! And even if I got all that info, it’ll get boring, it’ll probably be unrealistic and just because you have a plan doesn’t mean you can follow it no matter how determined you are. I can literally count on my one hand how many times we’ve been asked to write a meal plan, and it’s never any fun and leads to some weird meal/snack combos!
(4) There are truly no one-size-fits-all diet
And whoever tells you so, isn’t giving you the right advice. The best diet for you is dependent on so many things including your skills, food knowledge, your size, and what we’ve learned this semester – your medical condition, medications and so much more. These are all taken into account when diet recommendations are made by a dietitian. Keep that in mind next time you hear a celeb preaching their best diet tips.
(5) The right message is not very “sexy”
Eating a balanced diet takes hard work, losing weight takes hard work, exercising more than you are used to is hard work! It’s simply a law of the universe, we want to keep on doing what we’re already doing. For many that’s eating poorly (in whatever shape or form that is) and not moving a lot. Yes it’s slow (we are talking years to lose weight slowly), yes you will have set-backs, but it is a long-term process that will improve your health, it’s definitely worth it!
(6) Do not judge!
This is super hard. And I’m not afraid to admit it, I like to think I’m a very non-judgmental person when it comes to healthcare but your brain imposes these automatic biases and even stereotypes about a person. Really taking steps back and looking at these thought patterns, clearing them away and looking at the person in front of you (friends acting out scenarios so far!) and saying to yourself “this is a person who deserves health care, and they are a person no matter their background, medical condition, diet history or shape and they deserve my help”. Making this internal dialogue has really been important for me and helps in ensuring I do not pass judgement on a patient. We are trained not to judge you, don’t be afraid about being honest with a dietitian.
(7) Do not assume ANYTHING!
I learned to not assume the patient in front of me can cook basic meals, can open the pantry and have food there, has the ability to shop, understands what I mean when I say “breakfast, lunch, dinner” (some people still say breakfast, dinner and tea), don’t assume meals are cooked. Don’t assume someone knows what the meaning of “calories” is. Assume nothing, let the patient give you the insight into what language and strategies you can use to help them get the most from your services.
(8) Sometimes you are just going to lose
I feel like often this profession can be disheartening. Despite our absolute BEST efforts, the inevitable happens, people regain the weight, people can’t break the habit, people don’t come to see you, you can’t see the changes or improvements you want and sometimes NEED to see in your patients. And you start to question, “did I do a good enough job? Did I do this the right way?” Often the changes we are looking at are not immediate, and often not even visually observed and I think this may contribute to the reason why dietitians can be and feel undervalued by others. However, you are providing people with the guidance and opportunity to change, the changes are up to them, and it is often more effective than you’d think.
(9) It’s about the little things
Little wins! Oh my goodness, a year ago I would not have thought getting a patient to switch from regular cola to diet cola varieties would be considered a success in terms of diet quality, but for some patients that is a huge deal and make it a celebration. It truly gives them to confidence to move on and tackle the next thing. Going at everything at once is going to make any person feel overwhelmed, and it’ll feel so unrealistic they’ll think they can never do any of those things and not try at all. Starting small and getting them to come back so you can work on the next thing is really key to getting sustainable and long-term changes.
(10) Don’t tell people what to do, negotiate
I’m really still mastering this one, and it sounds easy but it’s truly not. Any patient in a hospital probably does NOT want to see a dietitian, they are not interested, they are getting poked and prodded all hours of the day and night, asked so many invasive questions and here I come waltzing into their room asking more questions than you could ever imagine and about something as so personal as food and weight (which can be sensitive for many people). Educating about WHY it’s important to make some changes before jumping into this is key. If you don’t give a good reason why it’s important to lose weight/control your blood sugars/eat more or less of XYZ, then why should they care? If you’re really drawing a blank try and offer some appropriate suggestions for them to choose from. But before that, make it all about the patient – what do they want to achieve? It allows them to feel heard and in charge of their own health, which is important in achieving their nutrition goals.
I’d like to say, I’m generally quite an empathetic person. But this takes on a whole new dimension, when you consider the fact you just asked a patient how they’re feeling today despite all their treatments, disease or illnesses, needles, tubes and the list goes on. You simply cannot say you understand how they feel, but it’s still important to ask. Acknowledge the patient is having a crappy time, it can help justify why you’re there asking them 101 questions when they’re feeling crumby.