OET Speaking (DIETETICS-5) - Crohn's disease

 OET Speaking (Dietetics)

Roleplay Card - Crohn's disease

Setting: Hospital

You are 26-year-old and have recently been diagnosed with Crohn's disease ( a type of inflammatory bowel disease). You have lost considerable amount of weight.(approx. 10kg /22lbs). You have been referred to to see a dietitian to advice about putting on weight. 

1.  Confirm the reason for the visit (dietary advise, weight loss following diagnosis  of Crohn's disease). Find out patient's appetite.

2.  Explore foods taken yesterday (what food. how well tolerated: nausea,  vomiting, diarrhoea, stomach cramps, etc)

3. Give information about Crohn's disease and diet (e.g., no prescriptive diet, dependent on individual, etc.,).Suggest low-fibre diet (when disease is active/in flare, limiting/avoiding high fibre foods: raw green vegetables, whole nuts/grains, fruits with skin and seeds, etc) Recommend keeping food diary  (eg. establishing pattern or symptoms, identifying issues etc.)  

 4. Reassure patient about diet (e.g. lots of suitable/enjoyable foods available. etc). Suggest additional ways of ensuring better daily nutrition (eg. multivitamins, 4-5 small meals daily, adequate hydration, meal preparation in advance simple cooking techniques: poaching steaming etc.) Find out other questions.

5. Recommend follow-up appointment in one month (e.g., review of symptoms/food diary, weight checking further advice as required, etc). Establish patient's consent for weight check today.

                                Sample Speaking.

Dietician: Good evening.  

Interlocutor: Good evening.

Diet: I'm Rachna, your Dietician in this hospital and I have been referred to to see a you to advice about your putting on weight.

Inter: I'm glad to see you.

Diet: I understand, you have been diagnosed with Crohn's disease and shall we discuss for a few minutes to find out how we  could help you gain weight?

Inter: That's excellent. Please go on.

Diet: Thank you, but before that could you please tell me your  name for my confirmation, please?

Inter: Certainly. I'm Rachna

Diet: Thank you Rachna and you are 26 year-old, am I correct?

Inter: Yes, you are right . I'm 26.

Diet: Great. I would like to know a little bit about your appetite and what you have been managing to eat. [Checking understanding] Is that OK for you?

Inter: That's OK. I've lost quite a bit of weight -about 10 kilos - but the thought of food is still nauseating .

Diet: [Re-checking] So, your appetite is very low and food is nauseating. Thank you for letting me know that. 

Now let's talk about what you ate yesterday, [Bullet point 2] so that I get a clear picture of what's working for you and what's not. Could you please tell me what you had yesterday?

Inter: I had some some toast in the morning. For lunch chicken noodle, and rice with fish for dinner. I felt uncomfortable after each meal, and had to go to bathroom quickly.

Diet: [Repeating]. So, toast, soup, rice with fish, and every time you had to go to the bathroom soon after eating. I understand, it must be frustrating because you are trying to gain weight. [bullet point2] May I ask you, how much do you know about Crohn's disease?

Inter: Not much. The doctor told me something, but I forgot it. 

Diet: That does'nt matter. I'm glad to explain it again, what is and the diet. [Explaining]. There is no prescriptive diet for this condition. However,  it is helpful to stick to a low-fibre approach. That means you must avoid things like raw green vegetables, or fruits with skin or seeds, and nuts and whole grains. [Reassuring] There are a lot of tasty, well tolerated foods you can enjoy eating. You have to experiment yourself to find out what suits you well.  [Checking understanding] Does that sound clear enough? 

Inter; Thank you, yes. I should avoid those you recommended. You gave a long list of items to avoid and it is frustrating.

Diet: [Emphasising]. I fully understand you. I can understand that., Rachna. Feeling control on food can be very tough.  - especially when you are trying to gain weight. [Reassuring] However, the good news is, there's plenty of things you can eat. And they will hep you put on weight. [Bullet point] Now, let talk about how to build your nutrition up safely. Is that OK for you?

Inter: Yes, that's fine. Thank you.

Diet: Great. I would suggest you keeping a food diary. You just jot down what you eat and how you feel after. That will help us spot any patterns. [Explaining] In terms of nutrition, please try to have 4 to 6 small meals a day, drink water regularly, and prepare simple, gentle meals like poached egg or steamed vegetables. Multivitamins might also help while your intake is limited. [Check understanding].  Do you think you can try them?

Inter: Fine. They sound good. I will try to follow your advice. 

Diet: [Checking emotions] How do you feel about these changes ?

Inter: A bit nervous, but I'm hopeful. 

Diet: [Reassuring] That is perfectly natural - and honestly, being hopeful is a great way to start. I'm sure with a bit of consistency, you can return to normalcy.  One final thing - I recommend seeing you again in a month to check your weight and check your food diary. 

Do you have any questions?

Inter: No, not indeed.

Diet: In that case let's make a quick re-cap.  

------------------ The End----------