Brief Summary
This podcast episode provides a comprehensive guide for dietitians on structuring their initial sessions with new patients. Felicia shares her strategies and experiences, emphasizing the importance of pre-session preparation, creating a conversational environment, and tailoring the session to the individual patient's needs and goals. Key takeaways include:
- Preparing for the session by reviewing paperwork and verifying insurance benefits.
- Starting the session with open-ended questions to encourage the patient to share their story.
- Creating a conversational environment rather than an interview-style session.
- Tailoring the session to the patient's specific needs and goals.
- Avoiding lecturing and information dumping.
- Focusing on building rapport and trust with the patient.
Pre-Session Preparation
Before meeting a new patient, it's important to send an onboarding email with necessary paperwork, including insurance information and photo ID, utilizing a secure client portal like Simple Practice to streamline the process. Require paperwork completion 24 hours prior to verify insurance benefits, obtain necessary referrals, and identify any red flags or areas of concern on the intake form. Reviewing the paperwork helps to identify potential topics for discussion, such as diabetes, or the need for referrals to other healthcare providers, as well as to determine if any lab tests need to be ordered or requested.
Verifying Insurance Benefits
It is recommended to verify insurance benefits by calling the insurance company and encouraging the patient to do the same, providing them with a script to ensure they ask the right questions. This is especially important for Medical Nutrition Therapy benefits, as coverage may depend on specific diagnosis codes. Dietitians should document all insurance information to avoid discrepancies and ensure services are billable under codes like 97802 and 97803.
Starting the Session
Begin the session by welcoming the patient, thanking them for completing the paperwork, and asking if they have any initial questions. Common opening questions include "What are you hoping to get from today's session?" or "What made you interested in scheduling with me?". If the patient is hesitant, provide a brief overview of the session's goals, emphasizing that it's a time to get to know each other and understand their nutrition and wellness. Avoid a rapid-fire Q&A format, as it can feel impersonal and discourage the patient from sharing openly.
Creating a Conversational Environment
Create a conversational environment by asking open-ended questions like "Tell me more about..." to encourage the patient to share information naturally. If the patient is not forthcoming, refer to their intake form and ask about specific conditions or concerns they noted. While it's important to guide the conversation, allow the patient to share personal details, as this can build rapport and provide valuable insights into their lifestyle and stressors. Remember that Medical Nutrition Therapy is a form of therapy, and building a connection with the patient is crucial for success.
Managing Tangents and Talkative Patients
While it's important to allow patients to share, it's also necessary to manage tangents and keep the session focused. Jot down keywords and gently guide the conversation back to relevant topics, highlighting key points the patient mentioned and asking for more details. Recognize that talkativeness in the first session may be due to the patient wanting to share their full history or feeling frustrated with previous providers. Setting the expectation that multiple sessions will be needed can also alleviate pressure.
Tailoring the Session to the Patient
Tailor each session to the individual patient's needs and stage of their nutrition journey. Some patients may come with specific questions, while others may need more guidance. For less talkative patients, rely on the paperwork and use a 24-hour recall to gather information about their eating habits. Chart during the session to improve time management and accurately record notes, adjusting the note template as needed to align with the session flow.
Charting During Sessions
Charting during sessions is a skill that can be developed over time. Start by taking shorthand notes on paper and gradually transition to typing directly into the electronic health record. Adjust the note template to align with the session flow. While not absolutely necessary, charting during sessions can improve time management and accuracy, especially in a busy practice.
Key Review Points in the First Session
Key things to review with the patient during the first session include their medical history, recent doctor's appointments, food and nutrition history, physical activity history, and goals. Clarify any conditions they are actively seeking assistance with and review recent lab results, helping them interpret the numbers and understand their implications. Pay attention to their overall goals, even if they are not the primary focus of the session.
Interpreting Lab Results and Goal Setting
Frequently, patients need help interpreting their lab results, especially in light of quick virtual appointments. Provide detailed explanations of key metrics like A1C, cholesterol levels, and LDL, and explain what those numbers mean. While many patients express a desire to lose weight, focus on addressing their primary health concerns, such as elevated blood sugar or GI symptoms. Avoid setting formal, rigid goals in the first session, and instead focus on gathering information and assessing the patient's stage of change.
Closing the Session
Close the session by summarizing what was discussed and asking if the patient has any additional questions. Offer the option to schedule a follow-up session, but avoid pressuring them to commit. This approach reduces cancellations and allows patients to make an informed decision about continuing therapy.
Addressing Sensitive Topics and Common Questions
Address sensitive topics like weight with empathy and transparency. Explain the need for accurate weight information for charting and insurance purposes, but emphasize that you are not weight-centered and are willing to focus on other metrics for success. Allow patients to share their weight privately if they are uncomfortable discussing it openly.
Things to Avoid in the First Session
Avoid lecturing, overburdening the patient with information, and directing the session too much. Refrain from giving too many handouts. Focus on building rapport and understanding the patient's perspective. Do not provide meal plans, instead, offer flexible templates and ideas for building meals that are tailored to their needs and preferences.
Final Thoughts and Advice
The first appointment may not go exactly as planned, so take the pressure off yourself and focus on listening to the patient. Understand that you don't need to fit everything into one session and that you have future appointments to fill any gaps. Remember that you are human and will find your flow over time. Don't beat yourself up if things don't go perfectly at first, and continue to reflect and learn from each experience.
