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23 - Exam Room Nutrition: A PA's Journey to Compassionate Patient Education | Colleen Sloan, PA-C, RDN

• Ashley Love • Season 1 • Episode 23

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When a terrified 10-year-old boy walked into Colleen Sloan's pediatric practice in tears, she discovered he'd been monitoring his weight obsessively after another provider warned he'd "need needles in his stomach" if he didn't lose weight. This moment exemplifies everything wrong with how healthcare approaches nutrition conversations—and sparked a mission to change it.

As both a pediatric physician assistant and registered dietitian nutritionist, Colleen brings rare dual expertise to the critical intersection of medicine and nutrition. Her journey from clinical dietetics working with critically ill children to PA school while raising a child showcases her remarkable determination and passion for comprehensive patient care. What makes her approach revolutionary is her commitment to compassionate communication when discussing sensitive topics like weight, diet, and body image.

Most medical professionals receive merely 2% of their training in nutrition, despite its relevance to virtually every condition they treat. Through her platform Exam Room Nutrition, Colleen equips clinicians with practical tools to confidently navigate these conversations using techniques like "ask, offer, ask"—a framework that respects patient autonomy while providing expert guidance.

"Being curious is a really great characteristic of an excellent clinician," Colleen explains, advocating for questions like "What's making this hard for you?" rather than judgmental directives. This approach not only improves patient outcomes but also helps prevent provider burnout by fostering genuine connection instead of frustration.

Colleen's CME-approved course for healthcare providers fills a crucial education gap, covering everything from nutrition fundamentals to counseling skills for specific populations. By transforming how we discuss nutrition in the exam room, she's creating a future where medical care nourishes both body and spirit.

Looking to enhance your approach to nutrition conversations? Connect with Colleen on Instagram or LinkedIn @ExamRoomNutrition or through her podcast on Apple and Spotify. 

More at her website www.examroomnutrition.com

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Ashley:

Hello and welcome to Shadow Me Next, a podcast where I take you into and behind the scenes of the medical world to provide you with a deeper understanding of the human side of medicine. I'm Ashley, a physician assistant, medical editor, clinical preceptor and the creator of Shadow Me Next. It is my pleasure to introduce you to incredible members of the healthcare field and uncover their unique stories, the joys and challenges they face and what drives them in their careers. It's access you want and stories you need, whether you're a pre-health student or simply curious about the healthcare field. I invite you to join me as we take a conversational and personal look into the lives and minds of leaders in medicine. I don't want you to miss a single one of these conversations, so make sure that you subscribe to this podcast, which will automatically notify you when new episodes are dropped, and follow us on Instagram and Facebook at Shadow Me Next, where we will review highlights from this conversation and where I'll give you sneak previews of our upcoming guests. Today, we are joined by Colleen Sloan, a pediatric physician assistant and registered dietician nutritionist who has spent over a decade blending nutrition expertise with pediatric care. Colleen's journey began in clinical nutrition, where she worked with critically ill children, before realizing her desire to expand her scope of practice by becoming a PA. Since then, she's been making a lasting impact in pediatrics, seeing patients from infancy to adulthood. What's truly unique about Colleen's approach is her dedication to incorporating nutrition into every aspect of patient care. She's the creator of Exam Room Nutrition, a platform designed to help clinicians confidently discuss nutrition with their patients, emphasizing the importance of compassionate communication, especially when it comes to sensitive topics like weight management. In this episode, we'll dive into Colleen's journey from dietetics to becoming a PA, her commitment to lifelong learning and the tools she's developed to support fellow healthcare providers. She'll also share her insights on how clinicians can navigate difficult conversations with patients around weight, all while fostering trust and empowerment. Please keep in mind that the content of this podcast is intended for informational and entertainment purposes only and should not be considered as professional medical advice. The views and opinions expressed in this podcast are those of the host and guests and do not necessarily reflect the official policy or position of any other agency, organization, employer or company.

Ashley:

This is Shadow Me Next with Colleen Sloan. Hey, colleen, thank you so much for joining me on Shadow Me Next today. You have such an incredible story I cannot wait to hear about what you have to say. Thank you for joining us. Thank you so much, ashley, for having me on.

Ashley:

I think my journey is relatable for a lot of people, so I'm excited to just give some insights for any of your listeners. Absolutely so relatable, and there's so many of these conversations that I'm excited about all of them. There are certain elements of some that I know I am going to learn a lot about a certain element of medicine, and this is one of them. And I think when you and I initially met and started talking, I told you that I really did not have a great understanding of nutrition until I was a clinician, and it wasn't because of my practice, it was because of me as a person. I was just more interested in it, and the amount that I did not know as a clinician, as a PA, was really eye-opening. So thank you for what you do, thank you for the education you provide, thank you for what you're going to tell us today. I can't wait.

Ashley:

So tell us your titles, first of all, is this cool? And then a little bit about what drove you to pursue both of these titles. You're not alone in your feeling and your sentiment, and it's so true, whether you're an MD, do, np, pa, like any of the medical professionals we got, maybe 2% of all of our training had to do nutrition, and I think it's wild because really most of the conditions that we treat and we see in practice have something related to diet and nutrition, whether it's in weight management, which is everything, but even when you think about it migraines you can do some elimination diets and find out their trigger food anything in the gut, cardiac. So everything we do as practitioners does have some part of nutrition and I think having that education is so key. So you're not alone and that's really why I created my platform, which we'll get more into. But I want to bring it way back. My credentials are I'm a pediatric physician assistant and a registered dietitian, and what came first was becoming a registered dietitian. Oh, like you said way back, tell us a little bit about what the schooling, what that education process was for becoming a registered dietitian. And then maybe it was there. Did you have a light bulb moment? What did that look like for you? Yeah, I love sharing my journey on this because it's a lot of people are really curious about it because there's not a lot of RDPAs.

Ashley:

When I was in college, I knew I wanted to do something in medicine. I loved helping people, I love the science of medicine, but I did not want to major in biology, which is what most pre-med students major in. So I'm sitting at TGI Fridays with my dad one day and he's like you're so smart, you should absolutely become a doctor. And I'm like, yeah, I get, I think so, but I just don't know what to major in. So my mom at the time was a college textbook sales rep and she's like why don't you come down to FIU with me? I live in South Florida, so it's Florida International University. I have to call on a lot of the different colleges and nutrition happens to be one of them. Okay, so I walked the halls of the nutrition department, meet some of the professors, and that was the first time I actually even heard about a registered dietitian. I didn't even know what they were or that they existed, and I told my mom this is what I want to do. This sounds really cool. And it just so happened that all of the prerequisites, science classes and everything were exactly what I needed to apply to medical school, and so I completely changed my path.

Ashley:

I transferred over to FIU and in 2010, I graduated with my bachelor's in nutrition and dietetics. And you could have just I could have just stopped at that, but I was sold on nutrition. I was like I love this, I want more and I want to do this with my patients Plus. Now this is a little peek into my personal life, but I think it's. I like sharing this part of my story because I think it's relatable for a lot of people and I want to encourage people in that when you hit mishaps and things happen in your life that think are going to derail, you do not give up because you continue. I actually got pregnant in my last year of college and what probably could have completely stopped my career trajectory Honestly, I didn't skip a beat at all, and so I share that because just because you're a mom, just because you're divorced, just because you and put on a blank, don't let that be your crutch or your excuse to not do something that you are deeply passionate about, and I'm a firm believer in that.

Ashley:

So I continued on school. I completed without missing anything and it was great that I was a nutrition, because everyone was very pro breastfeeding and I was pumping on campus. It was hard, but I had such support with my colleagues and my student friends at the time, and so I became a registered dietitian. And so in order to become that, just because I have that bachelor's degree, you have to also do an internship and then sit for state boards. And so now it's a little bit different. You have to also get a master's degree, but back in the day you did not, but it's the same thing. So you can do a master's. You have to do an internship and then become board credentialed, board certified. And so I became a dietitian in 2011.

Ashley:

And I worked in clinical for about three years. I worked in the trauma ICU, so you do a lot of tube feeding and TBN calculations as a dietitian. I also worked some of the regular floor, so you do the cardiac education, dialysis education. Then I got a little bit bored of inpatient nutrition and so I started my own private practice. So I was doing diabetes education and weight management, and then I got bored with that.

Ashley:

A colleague and friend of mine, lucille Bessler, is a very well-known dietitian among the field. She ran the pediatric outpatient dietary services for big children's hospital down here in South Florida Joe DiMaggio Children's Hospital and she said hey, why don't you come on with me? I need a partner to run these clinics. I'm like, okay, but you need to teach me pediatrics because I've only ever done adult. And so we ran the cystic fibrosis clinic, the pediatric dialysis and the cleft and cranial facial clinic, and it was here that I was badly in love with two things One is pediatrics and two is medicine.

Ashley:

I reverted back to where I was in college, where I'm like I want to be caring for patients and I just had this deep desire to do more, to offer more, to even know more than just nutrition, because at that point I had done so many things in my career over the five-year span that I'm like I feel capped out and I feel like I still have gas in the tank that I want to pursue. And I thankfully, with all of these different areas that I worked in, I was able to talk to MDs and PAs and MPs, because I was at this crossroads what do I do? I'm a dietitian, but I don't know what to do next. And over and over again, it was like PA, pa. I met incredible PAs and every single one loved what they did and they're like yeah, absolutely do it.

Ashley:

The decision has to be very personal. So I have a lot of dietitian friends who asked me this question what made you decide PA versus MP or why not MD? It's a. It has to be a very personal decision, but for me it all worked out in favor of PA. I already had all of the prerequisites so I didn't have to retake any classes. I also had all of the clinical experience, so I really I didn't need to do any shadowing. Thankfully, because of my dietetics career.

Ashley:

And why I didn't want to become an MD is I was already a mom at this point. I really didn't want to be in school for six plus years to be an MD, and I also didn't want to be an NP because I also didn't want to go back to school to get my RN first. So it just all of that made sense and so I applied to one school here locally in South Florida. I got in. I do not recommend that for current applying PA students. It was competitive then and it is even more competitive now. It's one of the top careers to get into, so you've got to be on your game Now. It's one of the top careers to get into, so you've got to be on your game, but I got in to Nova South Eastern university in 2015 and graduated in 2017, of which are the two hardest years of my life.

Ashley:

Pa school is insane, and being a mom, right. So again, I'm like a firm believer and I will preach it from the mountains Do not let your age, your marital status, like any, your health, like none of that, hold you back. If you are committed to doing something, you can absolutely do it. And so now I've been a PA since 2017 and I stayed with my true love of pediatrics. I got my first job out of PA school in general pediatrics, and I have been with that company ever since, so about eight years now. First of all, it's amazing that you have been with the same company for eight years.

Ashley:

I think that alone, perhaps for those who are not as familiar with the PA profession especially, a lot of people do end up shifting after the first one, two or three years just because we're generalist trained. Usually, some of us enter specialty like dermatology, for example. I went into OBGYN first. It's a little bit more of a general specialty, but it's not very often that you hear of somebody sticking with the same job that they've had since the beginning, when they first started work as a PA.

Ashley:

I want to touch on that because burnout is not a hot topic right now, but I think that's a great word because it's prevalent. Any healthcare professional honestly, any career right now we're feeling burnout. We have less staff, so everyone is just doing more. We're getting paid less, and so it is real, and I know a lot of my colleagues, or a few of my colleagues, who are PAs coach people through burnout and I kind of chuckle to myself that I never felt that and I feel so blessed and proud of that. That I don't feel like that.

Ashley:

I actually, and to this day, can still say I love getting up and going to work and I really think it's because I pursued something that I'm deeply passionate about. I love kids and every patient. I pick them up, I kiss their cheeks. We just have so much fun because I respect that role as the general pediatrician in their life and I love the opportunity to watch that child grow from zero to 21. It is the coolest opportunity that you can get, and so I think for people trying to figure that out, you really do need to love your job. And that's not to say what I do is easy. I'm at a very high volume clinic. I see from eight to five, 40 kids in a day. So that's my template. So it has all the reasons to have burnout.

Ashley:

But because I'm so in love with what I'm actually doing, it feels easy to me, it's fun to me and I think that's important when you're choosing a job. It is absolutely because life and medicine really becomes your identity and there's nothing wrong with that and I don't hate saying that and I agree with you a hundred percent. I think that if you really investigate, know yourself, know what works for you, and you find that job that you can pour into but that at the same time also pours into you. I'm really glad you said that and I think it's a testament to how hard you have worked and how much thought you have put into where you're at. It's like you said, you really have to love it, but not only love it, but you really have to understand why you've chosen it.

Ashley:

When you were saying about that five-year mark, you get to this five-year mark and either you do start to feel that burnout. I think a lot of people switch or change or do things, and you were a dietitian for five years. I think there's something interesting about that five-year mark and if you think about it, as PAs we used to board certify every seven years, so around that five-year mark we're starting to think about our recertification. Then they bumped it out to 10 years. So it'd just be really interesting to gauge how much of us are able to actually sit down and look at what we're doing and evaluate these sorts of feelings that we're feeling at a five-year mark and say do I need to pivot? Do I need a big pivot? Do I want to pick up something extra? That I've been thinking about, I think pushing out our board certification 10 years. It's been really interesting for that. That's actually really. That's a really interesting point. I think you're right.

Ashley:

Most of my PA friends they are job switching and there's nothing wrong with that. I think that's the beauty and that's also. What drew me to being a PA is because as a diitian I switched every year or so. I either picked up something new or just completely switched gears, and so I wanted that flexibility. I was nervous if I became an MD and GI, like that's it, you're certified in that and you're stuck in that. That kind of scared me and I love that about being a PA, but I also think that if you're feeling that itch at that, whatever year it is really determined, is it the job itself or are you just itching for something new, like a new brain stimulant? And for me, what I actually did, looking back, is almost three years ago. I started a podcast and I started to talk about nutrition more and I wanted to teach clinicians more about talking about nutrition. And so I think that talk about nutrition more and I wanted to teach clinicians more about talking about nutrition, and so I think that having that creative outlet whether it is a side gig, maybe a side weekend job at an urgent care where you're getting a different pace in the clinic or, yes, a big pivot I think that's okay and I think there is beauty in that. And as PAs, we like to learn, we are lifelong learners and I think that's the key to a lot of prevention of burnout. Absolutely, and that is a perfect segue.

Ashley:

Colleen, you have Exam Room Nutrition, which is just turned into this incredible platform. Tell us a little bit more about what that looks like for you. We've talked about how it began, but are you enjoying doing this? Tell us about it. This lights me up. I'm so passionate about the mission behind examiner nutrition, which, yes, is a platform. Now it's a podcast, but it's also social media and we'll talk about eventually too.

Ashley:

It's a course and it really stemmed from one Saturday when I was in clinic, and it was just a day that stamped the approval of what I had been thinking that I want to do. I'm walking down the hall my first patient. I'm rushing because I'm known to be like 10 minutes late every morning and I look at the chart and it says rash is a sick visit, and anybody who's in pediatrics knows oh, thank God, like this is going to be quick, I'll get back on time at no time. But no, I walk in and the child was crying, and which is this is not abnormal in pediatrics. Most kids are crying and screaming. It's a lot of drama in the office, but it wasn't. He knew he wasn't here for a checkup and he was also about 10 years old. So I just sat down and I said oh, sweetheart, why are you crying? What is wrong?

Ashley:

The mom began to talk and she shared the story of how, six months ago, when he did his check, the clinician who I don't know if it was an MD, pa, mp, it doesn't really matter. Clinician had said you need to lose weight and if you don't lose weight by the next time you come in here you're going to be having to do needles in your stomach because you're going to have diabetes. A lot of fear, right. So this child mom told me had become obsessed with his weight. He began restricting his foods and they were of Asian descent, so they had a lot of cultural foods that he stopped eating. He weighed himself multiple times a day and that when he jumped, stepped on the scale and the office that morning, he had gained three pounds and in his mind he's a failure and now he's going to have to. You know he's got diabetes and he needs to take this shot in his stomach that he was threatened with and he was besides himself. And when I heard that story my heart dropped because it could have gone so differently.

Ashley:

This child actually was very age appropriate in his growth trajectory. He was not considered obese or overweight. He had gained some weight, but if you look at the stage that he was in in puberty, he's prepubescent. We expect boys and girls to put on weight during this time. This is natural. This is normal. We also know from science that all bodies come in different shapes and sizes, and so he might be settling into a larger body, which is fine. So I spent a few minutes telling him about what his body should be doing at this point, how food is nourishing to our bodies, and that we don't need to be weighing and restricting foods and we can be enjoying the foods and enjoying our bodies for what they can do.

Ashley:

And I left that visit and at the end of the day, I sat in my car and I started crying because I'm like there has to be a better way, because I'm sure the clinician meant no harm in that flippant comment. They probably really meant for it to be positive and to be motivating and encouraging and like we're supposed to do. We have to have hard conversations as providers. We have to have those. Hey, your weight might become a problem. We need to get this under control. That's probably what they meant to do, but they just didn't have the language in order to portray that. And so I'm like you know what? I have that knowledge. I, as a dietitian, know how to frame these conversations. I know how to discuss weight in a very compassionate, inclusive, sensitive way. I know how we can approach this and I want to share that with the community, and so that was really the birth of the podcast.

Ashley:

But I also, as a dietitian, really wanted to feature registered dietitians as the nutrition experts, because they are, and I feel they are not respected in the medical field as much as they should be, nor are they utilized as much as they should be. So I wanted to give them a microphone and really highlight them for looking at what they know, look at the time that they can spend with your patients. Let's use them, let's bring them alongside in our team so that we can better the health of our patients and a society at large. Well, colleen, my heart hurts. My heart hurts so bad for that child and I'm so glad that you were his follow-up.

Ashley:

I think we were put in very specific places for very specific purposes and to me your whole background was leading up to that one exact moment. But it's just such a reminder about how powerful our words are and our words matter and we need to be very intentional with what we're saying to certain people. And I think as clinicians, sometimes that can be hard, because I think a lot of times we are trying to communicate a concept to someone and we have to realize that the way we're communicating that concept is how the person sitting across from us is going to interpret that concept. Tell us a little bit about how clinicians and for pre-health students as well this is a great exercise, but tell us about how they can discuss the topic of weight period whether it's overweight, underweight, et cetera with compassion. Before we hear Colleen's response and the quality question that came from it, keep in mind that there's more interview prep, such as mock interviews and personal statement review over on shadowmenextcom. There you'll find amazing resources to help you as you prepare to answer your own quality questions.

Ashley:

Colleen just mentioned a powerful topic that's relevant for anyone working in patient care and one that makes an excellent quality question. Share a time when you had to navigate a difficult conversation with another person. What approach did you take to ensure it was compassionate and effective? As Colleen pointed out, these conversations can be incredibly tough, but the key is creating a compassionate environment, listening actively and ensuring the patient knows you're on their side and not judging them effectively and ensuring the patient knows you're on their side and not judging them. Approach these conversations with empathy, understanding the emotional layers involved and offering solutions that empower the patient rather than making them feel helpless.

Ashley:

Gosh, yeah, I have. Probably. Every day I have a story. That is like jarring to me that someone said this to a child. I posted a reel the other day that the parent came in and was like oh yeah, I'm really concerned about the weight, um, and she looks at her daughter, who was eight, and told her I know, honey, this upsets you, but you need to be on a diet Right. And she looks at me saying and I'm like no, we're not even using that word at all. And this actually came from school, because in schools, at least in Florida I cannot speak for other schools but the school system does height and weight screenings and if they are above a certain percentage then they get a note sent home and they have to come in and see the physician or the provider and get it signed off on. I sign one of those probably every single day. And I look at the parent. I say we're not even going to talk about this because I am not concerned. I know your child, I've been following their weight and she is fine and I just think we are in such a weight focused and obsessed culture that I'm hoping is switching and we're transitioning from that, but we really are still so focused on that that we can't seem to accept that just because a child is a little bit larger, it still means that they're fine, they're healthy.

Ashley:

And so I think the first place that we can start is, first of all, the very first thing that any clinician can do in this build rapport and shows that you deeply respect the patient is ask for permission before you talk about weight or before you even start talking about diet or nutrition, because sometimes the patient might not want to talk about their weight, and I've heard countless adults tell me that they came into the doctor because their ankle hurt and the first thing that the doctor said was like, oh, maybe you should lose some weight. And they're like well, can you help me with my ankle? I twisted it, I'm worried that it's broken. Like they weren't being heard for their chief complaint. And so it is so important that we ask permission, and the easiest way to do that is just to say hey, are you comfortable or is it okay If we talk about? And if it's a weight visit, if you're in primary care and that's what you need to talk about you're to wait today.

Ashley:

Or even if you're in a specialty. Let's say you're in pulmonology and you have a patient who has asthma and it seems to be uncontrolled. If you're on all these different medications, they're already on controller medications, they're on biologics, you've tried a lot of different medicines. This might be a great opportunity, especially if they are overweight or in a larger body, to maybe bring that up and say, hey, we've tried a lot of different medications. I'm just wondering if you think it would be okay if we talked about your diet a little bit to see if this might manage your asthma a little bit more. Framing it that way puts that decision in the patient's hands. They get to choose, if it's okay, if they're interested at all, before you just rattle off hey, you should lose some weight, why don't you eat some more fruits and vegetables? That's not going to stick with anyone at all. But if they choose, but it's okay, yeah, I'm open to that, I'm interested in that. That's a beautiful opportunity for you then to share a few options.

Ashley:

Now a strategy and motivational interviewing is called ask, offer, ask. The first ask is to ask permission. Then we have an offer and what we're doing is we are offering a menu of options. So, for example, you could say. For some of my patients, what has worked has been to eat an apple before lunch because that kind of helps them feel fuller. But I have other patients who really like to take a walk after dinner. This really helps with their digestion, helps them get some physical activity. And then I do have some patients that they've carried around a water bottle because their goal was to increase their hydration. Which one do you think sounds like something you could try? So we offered those three suggestions.

Ashley:

But that final question that's the second ask is another way that we're welcoming the patient and their life and their experience and their desires into the conversation. Which do you think would work for you? And it's easy as that. And they say oh, you know what? I don't want to do anything with my diet, I don't want to drink more water, but I think I could walk. Okay, that sounds great, let's work on that and that's it. So it's a beautiful way of respecting the patient, giving them autonomy but also bringing them into the plan, because it is a partnership.

Ashley:

You're not just dictating everything as the provider. No, there's so much goodness there and, as you're saying it, it's like this world is opening up in front of me Now I just want to go see a patient real quick to practice. But first of all, it's conversational. It does not feel like an attack, and I think so often, and probably most of us. It doesn't necessarily have to be weight-based, but I think a lot of us have had a question at least once in medicine where we felt like we were being scrutinized or attacked for something that our body was doing, which we can always help. But it is, it's conversational, it's disarming, it allows the clinician to continue to guide and lead the appointment, but also gives the patient options, which is great. I think that is so incredible, colleen.

Ashley:

How do you measure the success of these conversations you get to see your patients over and over that might look different from somebody perhaps that doesn't have that continuity of care. How do you measure success when it comes to nutrition and conversations like this? So it depends what you're trying to measure, if you're in weight management and if you're ultimately are measuring weight loss success, which I have my own opinions on that, because I think there's so many better things that we can measure that are non-scale victories. That would mean even more to a patient. But that's time for another podcast episode. Honestly, I measure the smiles that patients leave when they walk out the office. Probably the best thing that I can hear is when they're walking down the hallway after they leave my room and the kiddo says that was so much fun. I want to see her every time I've done my job. If they leave feeling like that and I think as adults even if you're an adult medicine you can leave your patients feeling like that too. They should leave feeling like man here. She was so cool, like she listened to me, she got me. I have a plan and I feel like I can do it, and I think that to me, is a measure of success, more than biomarkers, more than weight, more than any of that is, and that really comes from having that type of conversation.

Ashley:

Sometimes we have to be prescriptive. Yes, if they have pink eye, you need to give eye drops. If they have pneumonia, we need to give antibiotics. But when it comes to something so deeply personal as a person's relationship with food and their body, we have to be curious and that is probably the best approach to take. It is really just asking questions like what's been your, your dieting history? Where do you feel like you've struggled? Or one of my favorite questions with patients who we like to label non-compliant which I also hate that word. But those patients who you're like oh my goodness, they've come in four years, they're continuing to gain weight every single time, like what is happening? They're not listening to me.

Ashley:

I love to just pause and be curious, like some something's happening, we're missing the mark here and I love to just ask what is making this hard for you? And listen and just let them tell you because we have 10 minutes, maybe a peek into their lives. And they're living their lives 24 seven. I don't know what triggered them to eat Twinkies. Maybe they got super stressed out at work and that was their trigger. Maybe they are celebrating a raise and that was their trigger. Allow the patient to tell you, because I also find that's a great way to prevent burnout.

Ashley:

Asking the patient to problem solve is like what's making this hard for you? And they tell you like oh, for example, medication, if I can't swallow these pills, they're so big Like I can't get my vitamins in. I gag every time oh great, I've got gummies, we got powders, we got options. Whereas if you didn't know that piece of information, you would probably spend two to five minutes rattling off like your knowledge and things that maybe won't even help them in that situation. So being curious is a really great characteristic of an excellent clinician. It is, and that's one of the reasons we went into medicine in the first place is whether we were curious about the disease processes or curious about the biology or curious about how those things affect the person. Ultimately, we're just curious lifelong learners, like you mentioned earlier.

Ashley:

When you stop being curious with your patients, when you stop wondering, then it causes cynicism because then you quit asking why they're not doing what you asked them to try and do and then blame. The blame game begins. And I think if you invite those conversations with your curiosity, then you can figure out, like you said, you can get to the root of this and then you can be motivational because you know the root and I do gosh, I love being motivational with my patients. This also works, not if you're trying to get your patient on board with a plan, but this also works if you have a patient that's really defensive or very nervous or very scared. I had this conversation recently with another gal who said she had a patient she was trying to do a scary procedure but he had canceled and canceled multiple times, and so eventually she just called him and said come to the office, not for the procedure, we're just going to talk. I just want to know why you don't want to schedule this. And it turned out it was childhood trauma, and I think that I think we can get so much farther just by that tiny element of curiosity.

Ashley:

Hey, you seem really guarded today. Why you seemed really angry at check-in. Do you want to talk about it? You want to talk about it? And I think that that's a scary question to ask our patients, because, especially if you're like five, 10 minutes and then you're going to be like, okay, we just talked about this for 10 minutes, let me do your, let me do your exam real fast. But that is what, that's what they're going to remember. They're not going to remember that you felt their lymph nodes in their neck or that you looked in between their toes. They're going to remember how you made them feel better and motivated at the end of that appointment. Yeah, and I think it's also part of motivational interviewing.

Ashley:

Is that fixing reflex is we are very much used to? Here's the recommendation do this. And what ends up happening is we play ping pong with the patient and there's nothing more exhausting than doing that, and that, I think, is the number one way to burn out of. Okay, why don't you try to minimize your sweets? Oh I can't, I really love sweets. Okay, why don't you try to take a 10 minute walk every day? Oh I can't, because my knees hurt. Okay, why don't you try to drink more water? Oh, I don't like water.

Ashley:

Everyone listening has been there. When you just ask them what do you think out of these three options, two options would be something you could try. You're not going back and forth with the patient and you're not wasting precious time. And also, then the patient feel really equipped and capable. Colleen, you have so much good advice for everybody. These are great pieces of life advice, but especially for clinicians.

Ashley:

You created this CME-approved nutrition course for providers. Tell us a little bit about this. I'm so excited about this. This has been my project for about six months. I started the idea and exploring how to even get things CME-approved. As an individual, I'm not affiliated with a university or hospital, so that's in and of itself has been really exhausting, frustrating thing to figure out. But I am so proud of this and so excited to release this to the public and to clinicians, because there's nothing like it out there.

Ashley:

There are tons of webinars on GLP-1s and weight management and you get an hour and they're great. You've got tons of golden tips and advice, but there's nothing very comprehensive of like from the beginning nutrition education to nutrition counseling, like how do we do motivational interviews and intuitive eating, how do we bring and bridge the education with the counseling piece and then throwing in there the different populations. So what if I have a patient who's had bariatric surgery? Or what if I have a woman who's in midlife and she's going through menopause? We also need to know about those specific populations, and so this course is covering all of that. So it walks you through the nutrition basics, what you need to know how do you choose a diet for a patient all the way through some counseling skills and behavior change models, goal setting, all the way through those different populations and, additionally, you're not just stuck there in no man's land.

Ashley:

I've also created this to be very much in a strong community, because I find that webinars are great and courses are even great, but we're lacking that support from each other. Oh, I have a quick question. Or I had this patient. I know what to do, or having that forum and that community. So that is another really cool aspect of the course that when you are part of that, you're also joined into a membership, a Facebook group to, where we can just connect and meet each other and network. I'm hoping it will grow into something even bigger, that maybe we'll have live in-person events at some point down the road. But I'm really excited for this and I've brought in a lot of different speakers. It's not just me teaching, because I'm not an expert on menopause and I'm also not an intuitive eating expert, so I brought in dietitians, doctors and psychologists to really make this a very robust course for clinicians.

Ashley:

If you are listening and you are hopeful to go into medicine, what Colleen is describing, what she's doing, this is why we go into medicine. You're going to answer all these interview questions about why you love the team model or why you want to lead a team of medical innovators, but what you are doing that is why we do this. You are pulling together the best and the brightest, not for your edification although I'm sure you've learned a lot but not for you. It's for your patients and it's for my patients. So thank you because it's going to benefit so many people. This is not just for this is not just for primary care.

Ashley:

In dermatology, I do skin exams, and in order to see your skin, you have to disrobe is what we say in medicine. You have to take your clothes off, and for a lot of people who are very weight conscious, getting naked in front of me can be really traumatic. So we do end up talking about weight and a lot of times it's because a patient will make a statement and will say something to the tune of you know, insert negative comment about my own body here and it hurts my heart because I do. I every. Like you said, bodies are made different. Everybody is beautiful. The fact that she walked into my office smiling that day is what I'm going to remember. The fact that he cracked a hilarious joke while he was sitting there, I was doing a skin. That's what I'm going to remember. Your body and the shape of your body is not what determines my opinion on you, so let's not even bring it up. But those things happen in dermatology too, not just primary care. We have weight conversations all the time. So this is for every clinician who sees patients.

Ashley:

Yeah, I agree, and it's also like like it's not just dietitians, like I have a lot of people who are like I'm just going to refer to dietitians, which 100% yes and amen all the time. However, I actually talk so much more about nutrition, like hours wise, as a PA than I did as the dietitian. I know it sounds crazy, because you're a dietitian, that's all you talk about, but the volume of patients and the questions that they're coming to me for I as a dietician, I would never get referred. A patient who was like oh, oh, by the way, can my baby drink water? Now, like that's just a random question that they ask you at the end of the visit oh, I forgot to mention, I'm really constipated. What Forgot to mention? I'm really constipated. What foods can I eat? I don't want to take medication.

Ashley:

So those are like little simple things we've got to be equipped for as clinicians and as dietitians. This will even deepen your knowledge and nutrition counseling than you've even learned in school, because you're getting hands-on tips and tricks from clinicians who've been doing this for years. That's so true, and, colleen, that leads us to a perfect wrap-up question, and usually I ask if you have any advice for pre-health students that are interested in a career in medicine, generally speaking. But I want to tweak it a little bit and my question, my wrap-up question to you would be for someone interested in medicine if they want to start to include a nutritional element to their education, then talking college kids, postgraduate students, things like that where would they start? What would they do?

Ashley:

I think you've got to do two things. I think you have to do the education because you do need to know the basics. Like it is really important in today's environment that we live in that you understand what a fat is and the difference between saturated fat and unsaturated fat, and that news flash like seed oils are not going to kill you and create all these medical problems. Right, like fruit is not a sugar bomb. Like you need the basic nutrition science that the sugar and fruit is fructose it's not the same as sucrose as a simple sugar. Right, like that basic unfortunately right now is so misconstrued on social media so that you do need a very strong background in that firm understanding of nutrition science. Once you have that and you're confident in that, if you're going to work with patients, you've got to get some good counseling skills under your belt and that just means like how to ask good questions, how to be curious, but also practice listening.

Ashley:

We love to talk as clinicians. We love to preach and share all of this knowledge and the goodness that we know that we sometimes, a lot of the times, forget to listen, and I get it. We're very we're in a fast paced environment. We got to get to the points that we need to get to and complete our checklist, but sometimes it's okay not to do that checklist and it's also a skill that you'll learn as you go how you can truly and deeply listen to the patient, because they will tell you, they will tell you what's wrong, they will tell you what's bothering them, and it makes your job as a clinician so much easier to help them solve it. That is so good.

Ashley:

Thank you for the work that you're doing in nutrition. It's huge, it's so important and years from now, we're going to look back and say, look, she's a pioneer. She was one of the people that pioneered this in medicine. Thank you so much. Where can we find you Exam Room Nutrition on Instagram. Is that the best place? Okay, ashley, seriously, thank you so much for saying that, because this is a labor of love and I've poured blood, sweat and tears into it just because I'm so passionate about helping clinicians feel more confident talking about nutrition while at the same time, helping patients like feel that they can love their bodies again. So thanks for all your support.

Ashley:

Yes, I'm on social media, specifically Instagram and LinkedIn, at exam room nutrition I also you can find my podcast on Apple or Spotify, exam nutrition and if anyone wants to just shoot me an email or connect with me, you can send me an email at Colleen at exam nutritioncom and then, if you're interested in the course it will be launching, hopefully mid to end May. We're just finishing up with some of the legal stuff with the accreditation, but if you're interested in getting on the wait list, you can go to examroomnutritioncom slash course. Colleen, thank you so much for everything you've done. Thank you for joining us on Shadow Me Next today. We can't wait to see your next steps. Thank you, ashley. Thank you so very much for listening to this episode of Shadow Me Next. If you liked this episode or if you think it could be useful for a friend, please subscribe and invite them to join us next Monday, as always. If you have any questions, let me know on Facebook or Instagram access. You want stories you need. You're always invited to shadow me next.

People on this episode

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Ashley Love

Host
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Colleen Sloan

Guest