Building on patient consultation/interview skills

Seeing a patient in clinic on a one-to-one consultation has always been one of my favourite parts of being a dietitian. You get some valuable time (time dependent on where you are working!) with the patient to develop a rapport, learn about them and construct a plan. I believe the more experience you have of conducting a patient consultation, the better you get at it, of which reflecting on your own practice is imperative. Considering what went well, what could’ve gone better, and what you will change for next time is all part of the journey. So I thought I’d compile a list of some skills I believe to be absolutely necessary to try and develop with each consultation or interview.

Recognising different patient types and attitudes
Obviously everyone will be different, and relating back to an earlier post of mine to do with the cycle of change, it is really important to try and assess at which stage your patient may be. Some will come in and be really ready for change and willing to try anything you suggest, but people at the opposite end of the spectrum may be very guarded and unwilling to trial anything. Considering this, within these different attitudes you will be faced with, you must try and develop the right strategy to work with each individual to their benefit. You will get answers to your questions, but whether or not they’re truthful is another story.

Be welcoming

This should go without saying, but will play a huge role in the relationship you will form with your patient. Go and collect them from the waiting room, shake hands, smile, open the door for them, and try to get their name right!

Be careful of your non-verbal communication

Eye-contact is essential to show that your are interested and listening to them, try not to keep typing things into the computer when they are talking, or make too many hand written notes. Open body language, face the patient, no crossed arms. And try not to sit directly behind the desk if possible, we were always told when training that you should sit without a big object between you and the patient to make them feel more welcomed.

Use clear language

Avoid jargon, make sure they understand what you are talking about. For example, don’t just say BMI without checking they know what it is. Our job as dietitians is to make the scientific evidence understandable to the general public, not to show off that we know all these long words!

Establish rapport

This starts right at the beginning when you first welcome the patient. Make some small talk “was your journey here ok today?”, “enjoying the weather?” etc. Show that you are listening, engage them in conversation, smile. And if it is a follow up appointment, make sure you remember something they mentioned the last time you saw them, like a holiday they were planning or something, and ask them about it (you don’t need to actually remember, just jot it down in your notes for next time!)

Assess motivation

Ask the patient what they believe their reason for attendance is. Even when you have a written referral from the GP/consultant/district nurse etc. This will not only assess what the patient has actually been told about the appointment and their condition, but also their understanding of it and their motivation to be attending.

Gather appropriate information

Dependent on the reason for attendance, consider other problems such as smoking, obesity, alcohol, diabetes, family history, drug history, patient’s medical history. As all of these factors can influence your plan.

Provide the information the patient wants

Involve the patient in management of their aims and plan at all times. Make sure they understand what you are talking about and agreeing on, and also make sure that it is what they want. Making changes that are completely unrealistic to a patient’s lifestyle are not going to be followed through, so your consultation will be a waste of time. It is always a good idea to provide some written information at the end of the consultation, so the patient can read through later on, not everything you have discussed will be remembered without written prompts!

Use time and resources appropriately

It can be hard to stick to appointment times, especially if you have a very chatty patient or a lot to cover. I find it useful to begin the clinic telling the patient that “we have X amount of time today” so they know how long the clinic will last. Some inevitably will run over, so just make sure you apologise to the next patient if their appointment is late, and make sure that you are keeping up with your record keeping too. You may not have time to document all of the information at the time, but as long as you have written enough to remind you you can finish this off later on.

Summarise

A very important technique in any interview situation is summarising. At regular intervals just repeat what has been discussed or what the patient has told you, such as the patients reason for attending, feelings, concerns and expectations and clarifying the agreed plan. This shows you have been listening, and makes sure that you have heard the information correctly.

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