Finding ways to connect with patients and get inside their heads can be difficult. While we physician assistants (PAs) and nurse practitioners (NPs) are not detectives, we want to be able to connect with our patients and find out what’s going on in their lives so we can provide them help, guidance, coaching, and assistance — and that can be tough.
I’ve been in practice since 2000, and over that time I’ve found a few ways to engage with patients. One of the main ways I try to connect with my patients is through talking about food.
I work in an opioid treatment program (OTP), and I regularly take extensive histories for patients when they’re being admitted to our program and during annual medical updates, where we catch up with patients about what’s going on in general.
We work through a common yet flexible template, and one of the areas that we are charged to discuss is nutrition. Typically, the discussion starts with a question about how they are doing with nutrition and food. Often, I will ask patients about how they are doing regarding their diet and, if left unprobed, end up with responses like “oh, pretty good.”
If I ask them “Do you eat a balanced diet?” They will usually reply with a response similar to “Yeah, I guess so.” Frequently that’s the end of the road, as many patients don’t really know what else to say to such questions, and don’t really appreciate prying about personal information.
Something that I have found to be helpful, when asked artfully, is moving from “I want to ask you a few things about your nutrition” to “what did you have to eat yesterday?” It’s always interesting to see their response. Many patients adopt a quizzical look for a few moments, but then move to a thoughtful look of recollection, and then to telling me what they recall eating yesterday.
It will go something like this: “Let’s see… I had a bowl of cereal with milk, then, let’s see, then I had some chicken with rice for dinner.” I might then ask if they ever have a chance to eat fruits or vegetables, and they’ll usually be open about yes or no. This often leads into a brief discussion about fiber, food preferences, food preparation options and practices, and food availability. This discussion is almost always met with acceptance, or even appreciation. I never belabor this part of the visit, and if the patient is not open to this discussion, I move on.
I do find that most patients are open and even energized by talking about food, even if they have very little access to it. Many of my patients are homeless and without income, and I often speak with them about what specifically they eat, attempting to adopt a nonjudgmental approach. I find that patients are usually very honest, often thirsting for input about how to deal with their situation.
For patients who find food at gas stations, convenience stores, or even from waste receptacles, sometimes we talk about what they like. If they have the luxury of at least going to gas stations or convenience stores, we’ll explore which places they go to, and I share with them my tastes in gas station/convenience store food. Maybe it’s a place that has good hot dogs, maybe they have a decent burrito selection, or perhaps they like bananas. Many have found, like I have, that 7-Eleven stores in the Seattle area have a predictable supply of ripe and inexpensive bananas.
Patients usually are pleased to learn that I have eaten plenty of gas station/convenience store food in my time, and we often will exchange stories or information about specific foods we have learned to appreciate in such settings, including comparing gas station food as far as quality, price, and service.
For patients with no access to gas station/convenience store/fast food options, we’ll also talk about other options for food access, particularly church/shelter meals, of which they may not be aware. If they already have access to church/shelter meals, we’ll talk about how the food is, what they like, what they don’t, how they are treated, and if they know of other options.
I have found that these discussions are a wonderful way to promote awareness and discussion about lower fat and higher fiber foods. I also find that talking about food is an excellent way to energize patients in history-gathering settings who may start the appointment feeling fatigued and disengaged. We’ll frequently share stories about positive food experiences we’ve had in the past, revealing the extremely evocative nature of food memories.
My patients range widely in income as well as food literacy. Some of them are cooks, chefs, or food service workers, many with vast experience in food preparation and cooking. With these patients, I almost always find them most interested in talking about what they do with food, what they like to eat and prepare, and how food impacts them as well as their family’s lives, both as consumers and as workers.
I always look forward to bringing up food and am consistently pleased about the response my patients have to such a discussion, whether they are homeless and eat from waste receptacles, or whether they are highly trained chefs. It’s a reliable way to connect, and in the end, we both positively remark that our discussion has made us hungry, usually said with a shared smile.
Jim Anderson, PA-C, MPAS, DFAAPA, is a physician assistant working in addiction medicine in Seattle.