Instructing patients on dietary changes

When a patient needs a dietary change, the provider will give the order to the medical assistant. The provider will tell the medical assistant what type of diet the patient needs to be on. If the diet is only for a short period of time, the provider will indicate the time period. Sometimes the dietary change is related to a procedure. The provider will order the diagnostic procedure, and the medical assistant should be knowledgeable about the dietary changes required for that procedure.

Scope of practice: Deciding what type of diet a patient needs is a medical decision made by the provider, not the medical assistant. The medical assistant’s role is to explain and reinforce the order the provider has already given - not to prescribe, modify, or independently determine a patient’s diet.

Before meeting with the patient for coaching, it is important for the medical assistant to gather any brochures or information needed. Remember, it is a good idea to send the patient home with written instructions on dietary changes. If the patient does not understand English, use an interpreter service, and make sure brochures are in the patient’s primary language.

Lastly, before meeting with the patient, the medical assistant should look over the brochure. It is important to be knowledgeable about the content you are explaining to the patient. Reading the brochure aloud as a way of instructing the patient is not professional. The patient may feel you do not know what you are talking about.

When a medical assistant instructs a patient on a dietary change, it is important to know why people eat what they do and to understand how cultural dietary traditions relate to illness, as described in the following section. The following section also reviews the communication techniques and nonverbal behaviors that can show awareness of a patient’s concerns.

Showing awareness of a patient’s concerns

Being aware means being alert and understanding what you are perceiving. When working with patients, identify the patient’s concerns. After you become aware of the patient’s concerns, you can show that you are aware. It is important to be accurate in your perception of the patient’s concerns. If your perceptions are incorrect, you could speak or behave in a way that is insensitive to the patient.

Let’s review a few ways a medical assistant can show awareness of the patient’s concerns:

• Reflection: The medical assistant puts words to the patient’s emotional reaction, which acknowledges the person’s feelings; for example, “It sounds like you are unsure of this new way of eating.”
• Restatement or paraphrasing: The medical assistant rewords or rephrases a patient’s statement to check the meaning and interpretation. This shows you are listening and understanding the patient. You might say, for example, “What I am hearing is that you really like your family traditions for holiday meals.”
• Summarizing: This allows the medical assistant to recap and review what was said; for example, “If I understand how you feel about this new eating plan…”

A medical assistant can also show awareness by using positive and open nonverbal behaviors. These nonverbal behaviors could be used when working with a patient on a dietary change:

• Position: The medical assistant should be at the level of the other person and angled toward the patient. For example, if the patient is sitting, then the medical assistant should be sitting also.
• Arms and posture: The medical assistant should be poised with their arms to the side. This is an open, positive nonverbal behavior that shows interest in the other person.
• Facial expression: The medical assistant should be smiling. Refrain from rolling your eyes, yawning, or frowning. These can be perceived as being bored or rude.
• Gestures and touch: The medical assistant should use small gestures and an appropriately light touch on the hand of the patient, depending on the situation.
• Mannerisms: The medical assistant should focus on the patient. It is not appropriate to look at your watch, phone, or the clock. This gives the patient the feeling you are bored or impatient.

Factors that can affect a person’s diet

When you work with patients regarding a dietary change, it is important to understand the factors that can affect what they eat:

• Cost: How much money we have affects what foods we purchase. It can be expensive to purchase fresh fruits and vegetables, fish, and lean cuts of meat. Less expensive options are available, but they may not have the same taste or appeal.
• Convenience: With busy lifestyles, people sometimes choose what is easiest and quickest. This usually includes eating out or take-home meals.
• Background: Our background can influence the foods we eat. Some cultures have healthier diets than others. It can be helpful for people to modify cultural dishes by cutting the salt, fat, and sugar without giving up the taste.
• Emotional comfort: Some people may eat when they are happy or when they are sad. Usually, under these conditions, the food choices are not the healthiest. Some people stop eating when they are emotional.
• Routine: People eat what they always eat out of habit, personal preference, and availability. People may also eat with certain activities, like viewing a sports event, driving, or watching television. These habits are difficult to break.

It is important for the medical assistant to get to know what the patient is eating and why. This helps when coaching a patient on a dietary change. For example, suppose a patient tells you fresh produce is too expensive for their new low-sodium diet. Instead of just repeating the provider’s instructions, you might suggest canned or frozen vegetables labeled “no salt added” - they cost less and still meet the sodium restriction.

Cultural diets

Medical assistants should be familiar with the diets of the various cultural groups in the area where they are practicing. This information can be helpful when coaching patients on specific diets ordered by the provider. Here is some general cultural diet information:

• Asian diets include whole grains (e.g., millet and rice), fruits, vegetables, legumes, nuts, and seeds. Fats are derived largely from vegetable oils (peanut or sesame oils). Dairy products are not traditionally eaten. Protein sources include broiled or stir-fried fish and seafood, egg whites, tofu, and nuts.
• Latin American diets include food from plant sources at each meal. This can include maize (corn), potatoes, fruits, vegetables, whole grains, beans, and nuts. Poultry, fish, and dairy are typically consumed daily. Meat and eggs are eaten weekly.
• Mediterranean diets include whole grains, fresh fruits and vegetables, and all types of legumes (e.g., beans, lentils, and peas) daily. Olive oil is used. Fish, poultry, and eggs are consumed weekly and meat monthly.
• Mexican diets include corn or flour tortillas, cabbage, legumes, squash, tomatoes, corn, and potatoes daily. Cheeses are eaten, but milk is not regularly consumed. Protein sources typically are fish, beef, poultry, lamb, and many types of beans.

Patient coaching

Good nutrition is important for a person’s health and well-being. For many people, changing their diet can be difficult and uncomfortable. It is important for the medical assistant to be sensitive to the change that the patient is asking about. Educating the patient about the benefits of making a dietary change may make the transition easier. Compliance with the diet increases if the person meets certain conditions:

• Can modify special foods and not give them up completely
• Has support from family and friends
• Can slowly transition to the new diet, though this might not always be possible

The medical assistant is an important team member when there is a need to help patients transition to a new diet. It is important for the medical assistant to be familiar with the dietary changes required for common procedures and diagnoses.

Legal and ethical issues

After the medical assistant coaches a patient on a dietary change, it is important to document the teaching in the health record. The documentation should reflect the provider ordering the teaching, the general topics taught, and how the patient’s learning was evaluated. If the medical assistant provided the patient with written materials, this should also be noted in the documentation.

Patient-centered care and professional behaviors

As medical assistants work with patients from various cultures, it is important for them to know more about those cultures. Many cultures have dietary traditions that influence how they respond to illness. In some cultures, food is considered a cure for illness. For instance, in the Mexican culture, when people are sick, they are out of balance in that they have too much heat or cold. To correct this balance, the person needs to eat foods of the opposite quality. It is important to be sensitive to these cultural practices.

When you work with patients who are making dietary changes, it is also important to be respectful of the patient. It is easy to tell a patient what to eat and what not to eat, but that might not be the best way to approach the situation. A medical assistant may want to start by finding out the patient’s favorite foods. What foods does the patient typically eat at meals? Are any health beliefs related to that food? Learning about the patient’s diet can help the medical assistant coach the patient.

If the dietary change conflicts with a cultural practice, or if the patient needs additional dietary support, talk with the provider. A referral to a registered dietitian may provide the patient with extra support and information.