Observing Daily Practice

In this study, healthcare professionals from three high-volume bariatric centers were observed during routine outpatient consultations. The focus was not on individual performance, but on identifying patterns in how PCC principles were applied when discussing specialized multivitamin supplementation.

The findings reveal a mixed picture. Many foundational elements of respectful care were consistently present. Healthcare professionals generally avoided medical jargon, followed a logical structure, conveyed respect, and allowed space for patient questions.

However, when it came to personalizing discussions around multivitamin use, important gaps emerged.

Where Personalisation Falls Short 

Nearly half of the observed PCC elements showed room for improvement. In particular:

• Open-ended questions were often replaced by closed, protocol-driven checks.
• Patients’ perspectives and concerns about supplement intake were not consistently explored.
• Shared decision-making was rarely observed.
• Difficulties such as nausea, swallowing problems, or poor tolerance were sometimes acknowledged but not followed by tailored advice.

In several consultations, patients explicitly reported nausea related to supplement intake, yet no intake instructions were offered to reduce symptoms. Instead, the focus remained on biochemical markers or the importance of adherence, without addressing how adherence could realistically be achieved.

This disconnect is striking, especially in light of earlier patient-reported research showing that many patients perceive supplement-related information as too general and insufficiently tailored to their situation.

Why this matters 

In bariatric follow-up, healthcare professionals work within structured pathways, limited consultation time, and standardized checklists that support safe and consistent care.

Within these constraints, discussions about multivitamin use are often brief and focused on confirming adherence. While practical and necessary, this may leave limited room to explore how supplements are taken or whether patients experience difficulties such as nausea or poor tolerance.

The observations by van Es and colleagues suggest that small, pragmatic adjustments within routine consultations, such as briefly asking about intake behavior or acknowledging reported difficulties, may help improve tolerability and support long-term adherence, without adding burden to daily practice.

A Bridge to Practical Solutions

These findings directly connect to emerging evidence that supplement-related complaints are highly modifiable. If intake instructions are rarely discussed, or discussed only superficially, it becomes unsurprising that patients continue to struggle with avoidable side effects.

This invites an important clinical question:
What happens when intake behavior becomes part of the conversation, rather than remaining implicit?

That question is explored in the next article, which examines nausea related to multivitamin supplementation in detail and shows how structured intake instructions can substantially improve tolerability in everyday practice.

Clinical Implications

• Many elements of patient-centered care are present in bariatric follow-up, but personalization around multivitamin intake is often limited.
• Supplement use is frequently addressed as a checklist item rather than a behavioral process.
• Patients’ reports of nausea or poor tolerance are not always followed by tailored advice.
• Improving adherence may start with better conversations, not new prescriptions.
• Actively asking how supplements are taken creates space for practical solutions, a crucial step toward improving tolerability and long-term use.

Kruizinga, Pereira & Smelt, submitted for publication, 2026

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