Week 20: Treatment Plan Exercise

Here is our exercise from last week's group:

"You are a health care provider. A new patient comes to establish care with you. He/she is bright, funny, and well educated. You like him/her instantly. Your patient explains to you that their main frustration is their weight. Your patient explains that this has been an issue for many years, and that they have tried numerous approaches with varying degrees of success.

Knowing what you know, what are your recommendations for your patient?"

Here are some of our group members' ideas:

• Examine their reasons for wanting to lose weight
• Talk with them about their goals/objectives: staying the same/weight loss?
• Ask if this is a reasonable time to tackle weight loss goals
• Ask what the patient can or will do to lose weight
• Ask the patient to meet with you frequently
• Suggest, "if you stumble, just get right back up."
• Ask your patient if they are willing to track their food intake and exercise routines, so you can review them together
• Explore your patient's sources of support
• Create with your patient a practical plan for a short term approach - as well as longer-term strategies
• Suggest tools, i.e., My Fitness Pal, Sparkpeople, for tracking.

The next question: "Your patient returns with some success, though not as much weight loss as the patient desired. What do you recommend now?"

Our group's ideas:

• Review the original plan
• Remind them that if they are trying to lose weight, any loss is good
• Check if their expectations are realistic, or just "wishful thinking"
• If your patient isn't following their specific program, find out where they are deviating and explore if this is making a signigicant difference
• Explore why the patient is/is not staying with their plan
• Explore: is this realistic at this time? If not, adjust goals, add exercise, just keep going
• Are there factors which sabattoge the patient's efforts?
• If your patient isn't succeeding, leave a door open - a way back without shame or the sense of failure.

A wise group, don't you think? One of our themes was that we really do know what we need. But sometimes, when we depersonalize a question, i.e, "what would you do for your best friend in this situation?" - we find our own best advice.

Our third question involved when to recommend weight loss surgery, and we'll continue on this topic next week.

Remember, we're all in this together.
Linda Gromko, MD