Appendix

Eat for Health

Dietary Counseling Form

Student Name:

(1)

During your ambulatory rotation, pick one patient to counsel regarding their diet. Discuss with them relevant factors/barriers contributing to their current eating pattern and identify tools/techniques to help them improve their diet. This can be during a clinic visit or a separate telephone encounter. After your encounter, document your interaction using the table below with an assessment and plan approach.

Patient’s age, gender, and relevant medical diagnoses

 

Date of patient encounter

 

What barriers or other factors did you identify with the patient leading to their current eating pattern? (Assessment)

 

What recommendations or goals did you discuss with the patient to help them improve their diet? (Plan)

  (2)

Imagine you are a primary care physician. Your next patient in clinic today is Mr. Patrick Barnes, a 63 y/o male that you recently diagnosed with class II congestive heart failure due to coronary artery disease. He has been started on hydrochlorothiazide, metoprolol, nitroglycerin, and atorvastatin. On exam, his BMI is 31, his blood pressure is 163/87, he has some rales, an S3 gallop, and pitting edema in the lower extremities. His cholesterol is 263 (high), and his fasting glucose is 124 (prediabetes).

Use the last five minutes of your clinic visit to discuss dietary and lifestyle changes that Mr. Barnes should make given his new diagnosis of CHF. Document your anticipated interaction using the table below with an assessment and plan approach.

In addition to the information above, this is additional background.

Mr. Barnes has worked as a freight trucker for the past 25 years. He plans to retire on his 65th birthday. While driving across the country, Mr. Barnes eats a lot of fast food. He also maintains a ready supply of soda and snacks to help him stay awake and entertained during a long day of driving. His go-to drinks and snacks include Coca-Cola, Mountain Dew, Jalapeno Cheetos, Slim Jims, white cheddar popcorn, and peanut M&Ms. On days when he wants something healthier, he’ll get some Gatorade and some trail mix to add to his M&Ms.

When Mr. Barnes is home, his wife, Melanie, cooks him dinner. Raised in the South, she likes to make soul food, much of which is fried. A typical meal might include fried chicken or chicken-fried steak, macaroni and cheese, baked beans, canned green beans, or fried okra.

Both Patrick and Melanie grew up in families where diabetes and heart disease were the norm. They’ve always just thought that chronic disease is a normal part of aging. Both graduated from high school, but neither went to college. Additionally, Melanie suffered a back injury about 20 years ago and has been on disability ever since. Without her usual salary from working as a personal care assistant, they sometimes struggle to make ends meet. Mr. Barnes is worried that he won’t be able to afford the kinds of healthy foods he sees people eating these days.

What barriers or other factors can you identify with the patient leading to their current eating pattern? (Assessment)

 

What recommendations or goals would you discuss with the patient to help them improve their diet? (Plan)