• Fresh Views

    Benefits of Being in Nature

    Teton mountain range in Wyoming

    Nature itself is the best physician.– Hippocrates

    Given that our blog posts are called “Fresh Views”, we are always on the lookout for opportunities to experience these views first hand. You may have read a previous blog where we talked about “imprinting” these fresh views so they’ll stay with us forever. Given the season, we wanted to share some of the benefits we find in nature by sharing some beautiful photos from our time in the great outdoors that have allowed us to reduce our anxiety, improve our mood, and promote a sense of calm for both of us.

    With summer in full swing, we’re both enjoying the opportunity to spend more time in nature. Did you know that there are many benefits of being in nature? Whether for an hour, a day or a week, we find so many benefits spending time in nature. And there is actually scientific evidence that identifies many beneficial effects from spending time in nature and the impact it has on health, including reducing stress and anxiety, improving one’s mental health, and promoting healing. Studies show that 120 minutes spread out over the week may be the ideal amount of time. 

    While we both love our dramatic mountain scenery and listening to the ocean waves crash on the sand, even a local park or garden can do the trick. Any place that gives your mind a break, provides time to reflect on what’s going well for you, gives you the freedom to think of other things in your life that are also going well, and consider how you can do more of that. We find that our mood immediately improves and our sense of self improves.

    Tami and her husband spent some time in Yellowstone and Grand Teton National Parks earlier this summer. Surreal beauty. Coincidentally, Deb is headed to Grand Teton later this summer too.

    Yellowstone National Park

    The cool breeze, peace, and reflection of the mountains was so calming and brought a smile to their faces. This was definitely an image they  imprinted.

    Yellowstone National Park thermal hot spring

    On this trip, Tami and Mike got far more than recommended 120 minutes of being in nature! The thermal hot springs are fascinating and offer other-worldly beauty! Focusing on them and the mountains provided a mental break from the demands of daily life.

    A mother goose protecting her 6 babies under her wings from the rain. Don’t miss the couple of curious goslings sticking their heads out!

    Sunrise in Jackson Hole, Wyoming

    Sunrise in Jackson Hole, Wyoming over a creek where otters were playing. A time to reflect on and appreciate the many sights from the day prior, think about other things in life that are going well, and look forward to what the current day will bring.

    Deb is fortunate to have a California State Park at the end of her street.  She enjoys weekend morning walks along Folsom Lake. On a clear day she can see the  snowy mountains from Lake Tahoe in the distance, and in the spring the lavender Lupine super bloom is often breathtaking. Taking these walks really gives her mind a break and provides an opportunity to reflect and simply enjoy the beauty of nature so readily in her reach.

    View of Sierra Nevada Mountain Range from Folsom Lake, CA
    Lupine Super Bloom, along the shores of Folsom Lake, CA

    And when summer arrives and the lake is full, there is nothing better than being in a boat on the lake, anchoring in a cove, and enjoying the cool water on a hot 105 degree June day. It’s amazing how relaxing with the beautiful scenery around you can really promote calm and lift one’s mood almost instantaneously.

    Enjoying a later afternoon boat ride and a dip in the cool water on a 105 degree day

    While Deb and Mark really look forward to their week in Wyoming and viewing the majesty of the Grand Tetons, they appreciate the nature that is nearby that can provide a much needed respite from the daily grind of life.

    We hope these images of nature have inspired you to find rest, relaxation, and rejuvenation with nature this summer, whether near or far.

    If you would like to try to imprint the images you see, follow these easy steps:

    1. When you find yourself gazing at a striking view or in a most memorable uplifting  moment…pause. Be present in the moment.
    2. Take a deep breath in and a cleansing breath out.
    3. Gaze at the view – noting where you are and who you are with. Take in colors, lighting, sounds, smells (maybe even taste if it’s food or beverage related).
    4. Then take time to appreciate and acknowledge what you see before you and are experiencing (many liken this to having an “attitude of gratitude”).
    5. Allow that view or moment – every detail – along with those positive feelings to etch into your mind’s eye so you can recall them in the future.

    We welcome anyone interested in our approach to Subscribe to our blog and we’ll email you when a new post is published!

    If you are a health care professional and interested in learning more about our solution-focused practice and approach, when you subscribe to our blog, we’ll send you in return a FREE resource of 10 Solution-Focused Questions to start a solution-focused discussion with your clients. 

    Follow us on Twitter and Instagram @AFreshPOVforYou

    Deb is employed by Dexcom, but her words and opinions in this blog are her own.

    Tami is employed by the University of Kentucky HealthCare Barnstable Brown Diabetes Center, but her words and opinions in this blog are her own.

  • Fresh Views

    When Life Give You Lemons

    Courtesy of Deb’s backyard lemon tree

    When life gives you lemons, make lemonade. – Proverb

    Hey, it’s Tami writing today!  The life circumstances of these past 2 weeks in my world brought this proverb to mind: When life gives you lemons, make lemonade. If you follow our blog, you know that our primary focus is on taking a solution-focused approach to life to positively impact the future, particularly life with diabetes…rather than focusing on problems. It’s all about how you respond. So when life hands you situations that may initially be perceived as a “problem” (a lemon, if you will), focusing on how that can ultimately be transformed into something sweet (lemonade, or better yet, diet lemonade!) is the game changer.

    So today, here are 5 reflections I want to share, relating from conversations with a couple of friends that have recently unexpectedly lost spouses/partners, Covid-19 rearing it’s ugly head, and transitions galore these last few weeks:

    1. Even in the tough days, try to be present and appreciate every minute of life. We’ve written in the past about the impact of finding joy and expressing gratitude.
    2. Rest and sleep are way more powerful in healing the mind and body than we give it credit for. Personally, the day seems more manageable when I get 8 hours of sleep instead of 6 ½.
    3.  A good belly laugh can make things seem not quite so dark or overwhelming. A perfectly timed meme from a friend has done just that for me. As comedian Milton Berle said, Laughter is an instant vacation. We’ve written about the  benefit of laughter here.
    4. Embrace the power of “can do”. One friend walking through a significant loss shared with me a “track” she plays in her mind, “You HAVE done xx. So you KNOW you can do it. You CAN do it again. You WILL do it.” She shared that this positive self-talk and doing more of what works has given her the momentum to keep moving forward. 
    5. I constantly remind myself that even the tough “lemon” days are part of my story. While I may not fully see it now, how I respond shapes my future. And I can share and use my experiences to impact and encourage others. 

    I hope these reflections that have become evident to me over the last few weeks are in some way encouraging and motivating to you, and can be shared with those clients you work with.

    We welcome anyone interested in our approach to Subscribe to our blog and we’ll email you when a new post is published!

    If you are a health care professional and interested in learning more about our solution-focused practice and approach, when you subscribe to our blog, we’ll send you in return a FREE resource of 10 Solution-Focused Questions to start a solution-focused discussion with your clients. 

    Follow us on Twitter and Instagram @AFreshPOVforYou

    Deb is employed by Dexcom, but her words and opinions in this blog are her own.

    Tami is employed by the University of Kentucky HealthCare Barnstable Brown Diabetes Center, but her words and opinions in this blog are her own.

  • Fresh Views

    Summer 2022 Fresh Views

    Happy Summer from us here @A Fresh POV for you as we break to refresh and recharge! We continue towards our Mission to guide healthcare professionals in a solution-focused approach so clients can embrace possibilities, opportunities, and a fresh vision for the future. You will not want to miss our next post on highlights from the upcoming American Diabetes Association Scientific Sessions! 

    If you’ve followed our blog, you know that we enjoy sharing a fresh inspiring view with each post. Here are a few fresh views that we have enjoyed this summer! 

    Tami’s visit to Cherokee National Forest in Tennessee
    View from a favorite local winery near Deb in Lincoln, CA
    Stunning roadside waterfall in Townsend, Tennessee
    View over San Diego marina
    Tami never tires of sunset views from her Kentucky home

    We hope you enjoyed these beautiful “Fresh Views” as much as we did! And we hope you are enjoying your summer.

    If you have any suggestions regarding future blog topics or series please let us know!

    We welcome anyone interested in our approach to Subscribe to our blog and we’ll email you when a new post is published!

    If you are a health care professional and interested in learning more about our solution-focused practice and approach, when you subscribe to our blog, we’ll send you in return a FREE resource of 10 Solution-Focused Questions to start a solution-focused discussion with your clients. 

    Follow us on Twitter and Instagram @AFreshPOVforYou

    Deb is employed by Dexcom, but her words and opinions in this blog are her own.

    Tami is employed by the University of Kentucky HealthCare Barnstable Brown Diabetes Center, but her words and opinions in this blog are her own.

  • Fresh Views

    Happy Memorial Day! 6 Solution-focused Strategies for Picnics and Gatherings

    Where did Spring go?! Memorial Day is at hand, and that means it’s time to kick-off summer! If you’ve been following our series on Transforming Primary Care Encounters Using a Solution-Focused approach, we’re going to take a few weeks off from this series,  but will revisit and closeout the series with a few more important considerations and tactics later this summer. 

    Will you be gathering with family and friends on Memorial Day? Sometimes it can be challenging to maintain healthy habits during group gatherings, especially if everyone is not on the same page. It’s helpful to have strategies in your back pocket to pull out. So, today we want to share with you 6 solution-focused strategies for navigating picnics and gatherings that you can share with your clients (or even try out yourself)! 

    #1 – Portion your plate by the healthy plate for diabetes. When you are ready to sample the celebration spread, if there’s a choice on plate size, go with a smaller plate (maybe the ones that are out for salads or desserts). Then fill half the plate with non-starchy vegetables (such as veggie salads, green beans, or sliced tomatoes), one fourth of the plate with lean protein foods (such as a grilled turkey burger or grilled chicken), and one fourth with carbohydrate foods (this is where potato salad, corn on the cob, watermelon, or a sweet treat may fit). Partitioned paper plates can do the portioning for you. Not sure partitioned paper plates still exist? Here you go, just a click away.  When asked how high one can “pile the plate”…try to keep it no higher than a deck of cards is thick. This simple strategy has brought success for many when navigating picnics and celebrations. And, Tami recalls one client she worked with that embraced this as a “year-round” strategy, purchasing the “old fashioned” partitioned 9-inch paper plates to use at home. He went on to lose over 30 pounds managing his portions and blood glucose in this manner. And he was thrilled that he didn’t have to wash dishes!

    #2 – Stick with small tastings. Maybe there are a number of things on the picnic table that you want to enjoy. And maybe you are not sure exactly what is in some of the dishes or how much carbohydrate they contain. One tried and true strategy is to stick with small tastings. You can sample a number of different items if you choose, fitting them within the plate sections reviewed above. And there’s a lesser chance of sending blood glucose out of range with small tastings versus a serving spoon portion. This is a great strategy for travel as well, discussed in our blog on Traveling with Diabetes.

    #3- Eat fresh and local. We are fans of supporting local farmers and enjoying local produce at the peak of ripeness. When trying to decide what to take to a gathering, think local and fresh. Picnics can be laden with rich casseroles and sides, so taking a fresh, low carbohydrate side that you know will work for you helps to insure there is something you can eat at the event. One of our favorite go-to’s that is ALWAYS the first dish to disappear is this (you may know it as Caprese salad): juicy ripe sliced tomatoes on a platter, topped with a slice of fresh mozzarella cheese, chopped fresh basil (or a dollop of pesto sauce), then drizzled with olive oil and balsamic vinegar. Sometimes we’ll layer sliced avocado on the tomatoes as well. Serve with  salt and pepper grinders alongside so everyone can manage what goes on their salad.  

    A version of the Caprese salad we enjoy made with yellow tomatoes

    #4 – Fill the day with fitness. With the eating and celebrating, fitting in fitness can help manage blood glucose and spend more time in range. Whether it’s participating in a local walk/run, swimming, playing cornhole, or joining the kids in a water balloon toss. How can you fit in fitness during Memorial Day weekend? We are believers in making a commitment to move even more when we know there is a weekend or vacation ahead filled with a few indulgences. Take a walk early in the day. That makes sure that movement doesn’t get pushed out by other holiday activities. And if you find blood glucose out of range 1-2 hours after you eat, take another walk to help lower blood glucose.

    #5 – Bring something to share that incorporates seasonal produce. Many of the food traditions associated with Memorial Day are filled with the best summer has to offer. Not only is flavor at its peak, seasonal produce is packed with nutrients (and lower in cost). Deb has local, fresh grown strawberry stands nearby at this time of year, so makes a weekly journey to purchase and enjoy their sweet flavor.

    #6 – Focus on fellowship and laughter. We believe that laughter is the best medicine, and we try very hard to practice what we preach. Scientists have shown that laughter is a great stress reliever and causes mental relaxation. Laughter can even improve blood pressure, pain, and immunity. Most importantly it strengthens human connections when we laugh together.

    Here with our husbands, we enjoyed some laughs atop a rooftop among igloos when we were together a few months ago
    We got some more laughs wrapping up in the furs in the rooftop igloos

    We hope you enjoy some laughter, friendship, family and great food this holiday! We are taking our own advice and will be enjoying some travels, adventures, and connecting with great friends and will be back soon with more content to share.  

    If you have any suggestions regarding future blog topics or series please let us know!

    We welcome anyone interested in our approach to Subscribe to our blog and we’ll email you when a new post is published!

    If you are a health care professional and interested in learning more about our solution-focused practice and approach, when you subscribe to our blog, we’ll send you in return a FREE resource of 10 Solution-Focused Questions to start a solution-focused discussion with your clients. 

    Follow us on Twitter and Instagram @AFreshPOVforYou

    Deb is employed by Dexcom, but her words and opinions in this blog are her own.

    Tami is employed by the University of Kentucky HealthCare Barnstable Brown DIabetes Center, but her words and opinions in this blog are her own.

  • Fresh Views

    Transform Primary Care Encounters: “Diabetes Only” Visits

    Success is built sequentially. It’s one thing at a time. – Gary W. Keller

    Building on our last blog about how to have a productive type 2 diabetes (T2D) diagnosis conversation using a solution-focused approach, NOW let’s focus on how to incorporate these techniques into follow up visits. These follow-up visits are ideally “diabetes only” visits. In a brief primary care visit that is addressing multiple issues, it can be too challenging to focus on specific diabetes priorities. The American Diabetes Association recommends scheduling  “diabetes only” appointments to focus on and address diabetes-related concerns. This diabetes only visit is an opportunity to be a think partner with your client to answer questions, address concerns, and map out a plan together.

    Using a solution-focused approach at a “diabetes only” visit?

    Since asking eliciting questions is a primary tenet of a solution-focused encounter, we encourage starting all visits by listening and learning from your client. Even though the client is new to diabetes, they are the expert in that they know what works in their life in other aspects, and they know what they are capable of doing now. (Read more about experts here)

    The goal is to focus on things that are working well, and when something works, do more of it! Help your clients to recognize their strengths by identifying exceptions. We’ve written about exceptions here). “Diabetes only” visits can be structured in a systematic way.

    10-step model for a “diabetes only” visit

    1. Start with a question. “I’m looking forward to hearing how things have been going since our last visit. Can you tell me one thing that went well for you this past week (or since we last met)?”
    1. Explore the reply further. “How do you think you can do more of (that)?”
    1. Personalize. “I want to make sure this visit is successful for you, what do you need to know or learn by the end of the visit?”
    1. Empower. Empower people with diabetes with tailored education and support to ensure their questions, needs and desires are met.
    1. Set a SMART goal.  A SMART goal  helps move the individual towards the direction they want to move based on your conversation. It helps quantify progress with measurable steps and keeps things reasonable and achievable.
    1. Ask a scaling question. “On a scale of 0-10 where zero is never and 10 is all the time, how confident are you that you can achieve your goal?
    • Use their answer to finish the visit and provide one action for them to focus on.
      • If 0-4: Encourage them to revise their smart goal, it might be too difficult to achieve.
      • If 5-7: Identify one strength they already have and build upon it. “What is one thing you do where you feel confident in your actions? How can  you do more of that?”
      • If 8-10:  Encourage them to challenge themselves and consider a goal that might move them closer to their overall health behavior outcomes.
    1. Review  the four critical conversations. As we discussed in the last blog, we encourage you to build upon these conversations at each visit. (adapted from ADA Overcoming Therapeutic Inertia

    Conversation 1: The nature of T2D is to change over time, as your insulin production changes.

    “Although diabetes is progressive, and can change over time, your actions can make a difference in slowing the progression over time.”

    Conversation 2: Your treatment plan will change over time as your diabetes changes.

    “We will work with you to find a treatment plan that achieves health goals while also considering your preferences and values.”

    Conversation 3: You can’t do this alone.

    “Seek help from family, friends and community support resources.”

    Conversation 4: Share your difficulties with managing your diabetes.

    “Your healthcare team is on your side and we will support you in whatever ways you need to manage your diabetes”

    1. Refer for diabetes self-management education and support.
    1. Thank them for coming in and for working hard.
    1. Plan follow-up. Plan the next diabetes only visit.

    Join us next time as we continue our series on incorporating a solution-focused approach when managing T2D in the primary care setting. We’ll continue to help you  build your solution-focused tool-kit. Our goal is to start slow and share small, achievable bite-size practice changes you can implement over time. 

    We welcome anyone interested in our approach to Subscribe to our blog and we’ll email you when a new post is published!

    If you are a health care professional and interested in learning more about our solution-focused practice and approach, when you subscribe to our blog, we’ll send you in return a FREE resource of 10 Solution-Focused Questions to start a solution-focused discussion with your clients. 

    Follow us on Twitter and Instagram @AFreshPOVforYou

    Deb is employed by Dexcom, but her words and opinions in this blog are her own.

    Tami is employed by the University of Kentucky HealthCare Barnstable Brown Diabetes Center, but her words and opinions in this blog are her own.

  • Fresh Views

    Transform Primary Care Encounters: Tackling the Diabetes Diagnosis

    “Health is a state of body. Wellness is a state of being.” ~ J. Stanford

    Our prior post in our series on transforming primary care encounters focused on combating therapeutic inertia. Today, we’d like to start from the very beginning – the conversation when the client first learns they have type 2 diabetes (T2D).  When beginning diabetes conversions using a solution-focused approach, we believe you will find that your relationship with your clients can improve and it will create an opportunity for ongoing shared decision-making.

    As a reminder, a solution-focused approach is the opposite of a “problem-focused” approach. The goal is to help the person with T2D recognize exceptions (when their problems did not happen) and help them to focus on their health behavior changes by doing “more of what works.”

    Using a solution-focused approach at the T2D diagnosis conversation?

    When preparing for the diagnosis conversation, first put yourself in your clients shoes. How would you want the conversation to go? What would you want to hear? Also consider your body language, your tone and word choice. We know in a busy primary care office, so much time is spent documenting in the EHR, but for this very important discussion, take a moment and step away from the computer, lean in to your client, show empathy and compassion while you say some very important words. Many are overwhelmed when they hear the news that they have T2D, and often won’t hear much of the rest of the conversation. Ask questions and engage in problem free talk, instead of giving a list of instructions. Maybe you simply state, “I know this is hard to hear, how can I help?” and “What information would you like to hear from me today as you start to learn about T2D?” Consider making this appointment brief and bring them back for a follow up “diabetes only” visit once they have time to absorb and process the information. 

    To build upon our blog on therapeutic inertia, we’re including some impactful information from the American Diabetes Association that encourages four critical conversations that promote “early positive conversations about the nature of diabetes.” These conversations address many tenets we value in a solution-focused approach, including person-centered, strength-based language, problem-free talk, listening, and building a partnership with clients.

    4 critical conversations

    There are four critical conversations that need to happen very early in the diagnosis. We encourage you to build upon these questions at each visit. Start small with a few comments and then build upon them as the person is learning to accept the diagnosis and is ready to learn more. At diagnosis, conversation #1 is the most significant. (adapted from ADA Overcoming Therapeutic Inertia)

    1. The nature of T2D is to change over time, as your insulin production changes.

    “I want you to know that diabetes is not a personal failure and it doesn’t mean you’ve done something wrong.”

    1. Your treatment plan will change over time as your diabetes changes.

    “You may need to add new medications as your diabetes changes. This is not a personal failure, just a part of how diabetes treatment progresses.”

    1. You can’t do this alone.

    “I am here to help you.”

    1. Share your difficulties with managing your diabetes.

    “Managing diabetes day in and day out can be hard. Share anything that may be getting in the way of managing your diabetes and also share your successes.”

    Close the diagnosis visit with a scaling question.

    On a scale of 0-10 where zero is no stress and 10 is the worst stress you’ve ever experienced, where are you right now?

    Use their answer to finish the visit and provide one action for them to focus on.

    • If 0-4:  encourage them to do some research online at trusted sources like the ADA, Diatribe, or ADCES.
    • If 5-7:  identify one strength they already have and build upon it
      • “What is one thing you do for yourself every day that makes you feel healthy? How can  you do more of that?”
    • If 8-10: just encourage them to breathe and take some time to let it sink in and to come back with questions in one week
      • “I know how hard this can be, take some time, write down questions you have, and let’s meet and talk more next week.”

    Reinforce that small changes can help move them in the right direction, and that you do not expect perfection. If they do the best that they can do, that’s the best they can do.  Remind them that you are partners on this journey. We believe that creating a supportive environment from day one, can empower people to learn to live with their diabetes.

    Keep reading our series on incorporating a solution-focused approach when managing T2D in the primary care setting. Next time we will focus on the first follow up visit after diagnosis.  Stop back by in 2 weeks as we share more tips to build your solution-focused tool-kit over time. 

    We welcome anyone interested in our approach to Subscribe to our blog and we’ll email you when a new post is published!

    If you are a health care professional and interested in learning more about our solution-focused practice and approach, when you subscribe to our blog, we’ll send you in return a FREE resource of 10 Solution-Focused Questions to start a solution-focused discussion with your clients. 

    Follow us on Twitter and Instagram @AFreshPOVforYou

    Deb is employed by Dexcom, but her words and opinions in this blog are her own.

    Tami is employed by the University of Kentucky HealthCare Barnstable Brown Diabetes Center, but her words and opinions in this blog are her own.

  • Fresh Views

    Transform Primary Care Encounters: Stop Therapeutic Inertia

    Where you stand determines what you see and what you do not see; it determines also the angle you see it from; a change in where you stand changes everything. – Steve de Shazer, pioneer of solution-focused brief therapy   

    As we continue our series on transforming primary care encounters, today we’re tackling the topic of combatting therapeutic inertia.  

    What is therapeutic inertia?

    In a general sense, “therapeutic inertia” is a lack of timely adjustment to the treatment plan when a client’s treatment goals are not being met. In the diabetes management arena, therapeutic inertia means being slow to add or change the care plan if a client’s A1C is above target. Delays in implementing the most effective care for each person with diabetes can  happen at any phase of diabetes treatment and can range for instance from referring for diabetes and nutrition education, to starting the first medication, or intensifying medication management, including starting insulin.

    Why stop therapeutic inertia?

    The evidence is clear on two things:

    1. Managing glucose levels early in the course of diabetes leads to better long-term outcomes and reduces risk of complications.
    2. Those who reach their A1C targets soon after they’re diagnosed with diabetes are more likely to keep their glucose in target. 

    This is such a timely and impactful topic that ADA has launched an initiative called Overcoming Therapeutic Inertia. There are many resources for primary care clinicians to learn practical tips to focus on diabetes care in a proactive, timely way to improve outcomes. Learn more here.

    Does shared decision making play a role?

    One key tenet of shared-decision making is that all care decisions are discussed together with the client, and decisions are made together, which will ultimately mean more people with diabetes are following their treatment plan. Research shows us that when people are not involved in their diabetes medication decisions, they often no longer take the medicine.

    When we talk about therapeutic inertia we are addressing both the clinician reluctance to advance therapy and the client’s reluctance to follow through with prescribed therapy. When we add shared decision-making we remove some of the barriers to medication taking. We discuss the potential side effects of the medication, costs, schedule and impact to their lifestyle.  These are important decisions that need to be understood for individuals to embrace new therapy.

    So how does incorporating a solution-focused approach address therapeutic inertia?

    A solution-focused approach that encourages shared decision-making can be a tool to overcome inertia. As we’ve discussed previously, incorporating  a solution-focused approach removes the shame and blame often associated with diabetes. When you discuss the clients goals and outcomes and what is working well for them, together you can identify the best therapy. 

    A solution-focused approach is a questioning approach, asking questions allows you to delve down to identify what is most important. An example of a medication-related question might be: What is most important to you when choosing a medication, the potential of weight gain or the need to check glucose before meals? ”And what else?” questions can be incorporated to learn more. 

    Since asking eliciting questions is a primary tenet, we encourage you to start all visits by listening and learning from your client. Remember, the client is the expert (read more about experts here), and even though they may be new to diabetes, they know what works in their life in other aspects, they know what they are capable of doing now. 

    When incorporating a solution-focused approach, each person will map out their own successful plan based on their lives, needs, strengths and desires. The care plan becomes personalized and directly relevant to the client. If something works, do more of it, help them recognize their strengths by identifying exceptions ( written about exceptions here.)

    This solution-focused shared decision-making can build relationships and guide clients towards achieving goals, thus overcoming therapeutic inertia.

    Next up

    Join us next time as we continue our series on incorporating a solution-focused approach when managing T2D in the primary care setting. We’ll visit the moment of diagnosis with diabetes and share tips/tactics you can use to continue to help you  build your solution-focused tool-kit.

    We welcome anyone interested in our approach to Subscribe to our blog and we’ll email you when a new post is published!

    If you are a health care professional and interested in learning more about our solution-focused practice and approach, when you subscribe to our blog, we’ll send you in return a FREE resource of 10 Solution-Focused Questions to start a solution-focused discussion with your clients. 

    Follow us on Twitter and Instagram @AFreshPOVforYou

    Deb is employed by Dexcom, but her words and opinions in this blog are her own.

    Tami is employed by the University of Kentucky HealthCare Barnstable Brown DIabetes Center, but her words and opinions in this blog are her own.

  • Fresh Views

    Transform Primary Care Encounters: 7 Practical Tips to Get Started

    If it ain’t broke, don’t fix it. Once you know what works, do more of it. If it’s not working, do something different. – Steve de Shazer and Insoo Kim Berg, pioneers of solution-focused brief therapy

    Our last blog spotlighted the power of words and using person-first, strengths-based language in diabetes related conversations in primary care. As we continue our series on transforming primary care encounters by incorporating solution-focused techniques, maybe your interest is piqued by this new approach, but you’re not quite sure how to begin to incorporate it into your practice?  Today we share 7 practical tips to get started. 

    1 – Ask “exception” questions. Exceptions are times when an expected problem does not occur. These are times we want to identify, focus on, and encourage the client to explore. These exceptions help the client move towards their desired future. Here are 2 examples of “exception” questions:

    • You mentioned that you typically struggle to be physically active in the evenings but you were able to go to the gym after work last week? How did you manage to do that?
    • Cooking meals at home has been a challenge for you, yet you cooked two times last week. What changed to allow you to make that happen? And what else?

    2 – Use person-first, strengths-based language. This may seem simple, but is hugely impactful. This means using language that is neutral, non-judgmental, and free from stigma. Language that is inclusive, respectful, and imparts hope. Word choice that fosters collaboration with your client and is person- centered. Focusing on language can remove the stigma associated with diabetes.

    3 – Practice problem-free talk. By incorporating this one impactful change you will already notice how the quality of visits and client engagements will improve – building the therapeutic relationship, hope, and motivation. The conversation at the beginning of an encounter is critical to build the therapeutic relationship. By starting the conversation with the goal of the client, you acknowledge that you are focused on their needs and desires and are committed to helping to meet their goals.  Two great ways you could begin a visit are to ask your client:

    • What would make this a successful appointment for you? 
    • At the end of this visit, what would you need to know/learn to say this was worth your time?

    4 – Ask the Miracle Question.

    The Miracle Question applied to diabetes is one tool or technique in a solution-focused tool-box to help clients envision a future that is more problem-free. 

    • Miracle Question: If you could fast-forward to a time where you feel satisfied with your diabetes management, what will be different in your life that will let you know things are better?

    You can learn more about the Miracle Question applied to diabetes in a previous blog post here. The Miracle Question helps people identify those “exceptions” mentioned in #1. The Miracle Question challenges a person to look past their obstacles and feelings of hopelessness to focus on possibilities, opportunities, and a vision for the future. The goal is to help one identify what they’ve actually known all along, and that they have the power to make choices and changes that can move them forward. By focusing on “exceptions”, goals become different. Focus turns to what is desired in our life instead of what “won’t happen” anymore.

    5 – Ask eliciting questions. When incorporating a solution-focused approach you need to ask eliciting questions to uncover solutions and guide the individual. It is key that these questions are open-ended and help the individual see how they can be successful. Instead of asking  questions that focus on the problems (since living with a chronic condition cannot benefit from a “quick fix”), instead, explore their strengths and resources they already possess and how those resources can apply to their diabetes management.

    • What has been going well since I last saw you?” 

    That one question can  start the visit on a positive note, acknowledge  the work that it took to accomplish that, and then leverage how the client can continue those positive behaviors and build on them for future health success. Questions can also focus on details when the person identifies a success:

    • How exactly did you do that? What exactly did you do differently?

    6- Ask future visioning questions. These questions can focus on the short-term or long-term views of the client’s preferred future. These questions help the individual realize that solutions are possible and help them see their desired future state. As you recall one of the key tenets is the client is the expert about their own life and their own diabetes. (Read more about experts here)

    • What would you like to see yourself doing in the next (day, week, month) to move you forward towards your goals? And what else? 

    Following up with “what else?” encourages people to dig deeper and think through in detail what they are capable of.

    7 – Use scaling questions. Scaling questions are a great tool to move away from all or nothing thinking. They focus on progress, motivation, and confidence.

    • On a scale of 0-10 where 0 is not confident at all and 10 is very confident, how much confidence do you have that you can meet your goal to (insert personal goal here)?  

    If less than a 7, follow up with one of these:

    • What could move you to a 7? 
    • What would need to happen to move you one number higher?
    • What would one number higher look like? 
    • How would others notice you’re more confident?
    • How come you’re not at a lower number? How did you do that?

    Keep reading our series on incorporating a solution-focused approach when managing T2D in the primary care setting. Our next blog will focus on therapeutic inertia. Curious what that means? Stop back by in 2 weeks as we share more tips to build your solution-focused tool-kit over time. 

    We welcome anyone interested in our approach to Subscribe to our blog and we’ll email you when a new post is published!

    If you are a health care professional and interested in learning more about our solution-focused practice and approach, when you subscribe to our blog, we’ll send you in return a FREE resource of 10 Solution-Focused Questions to start a solution-focused discussion with your clients. 

    Follow us on Twitter and Instagram @AFreshPOVforYou

    Deb is employed by Dexcom, but her words and opinions in this blog are her own.

    Tami is employed by the University of Kentucky HealthCare Barnstable Brown DIabetes Center, but her words and opinions in this blog are her own.

  • Fresh Views

    Transform Primary Care Encounters: The Power of Person-First, Strengths-Based Language

    The language for solution development is different from that needed to describe a problem. Steve de Shazer, pioneer of solution-focused brief therapy

    If you are just catching up on our thoughts around transforming primary care visits by incorporating solution-focused (SF) tools and techniques, check out our last post about the benefits of using a SF approach. This week in our series we are spotlighting the power of words – meaning the words that we choose in conversations and interactions with clients. As the authors of the transformative paper The Use of Language in Diabetes Care and Education (Diabetes Care 2017;40:1790–1799 | ) call out: 

    “Words are immediately shaped into meanings when people hear or read them, and those meanings can affect how a person views him or herself…Words have the power to “elevate or destroy”.”

    Person-first, strengths-based language

    We’ve written extensively about the power and benefit of using person-first, strengths-based language in diabetes care and education and how #languagematters. Research clearly shows that positive language is associated with positive health outcomes. And on the flip side, when people are faced with language that is judgemental, blames and shames, they are less likely to share openly with their healthcare team. 

    3 examples of how flipping a few words can flip the conversation:

    • Refer to one as a “person with diabetes”, rather than a “diabetic” (which labels them).
    • Refer to “check” blood glucose, rather than  “test” blood glucose” (which implies good/bad or pass/fail)  
    • Describe the scenario such as, “You take your medicine about half the time.”, rather than labeling one “noncompliant” (which shames)

    A SF approach is not possible unless there is open communication facilitated by strengths-based language. 

    Why does language matter in primary care?

    Again, language is powerful. We’ve discussed that the relationship between the healthcare provider (HCP) and the client is different. Instead of a hierarchical position, in SF relationships, the HCP and the client are considered “think partners”. They work together to identify solutions to move that individual forward towards achieving their goals. Thus, the language must follow to build the relationship.

    Importantly, the goal for those with type 2 diabetes (T2D) is to feel they are part of a partnership in their diabetes management with their HCP, where they can discuss their challenges and their strengths and work together. Is it possible to create and strengthen this relationship when words such as non-compliant, cheating, not working hard enough, or other shaming and blaming words are used? 

    When we use words that focus on what people “can do”, and words that describe their actions, we recognize and acknowledge that diabetes is managed by the person living with it and we acknowledge that it’s one piece of their life and not their whole life. When a person living with diabetes engages with their primary care team as a partner, much can be accomplished. As we’ve noted before, you are able to “flip” the conversation from a negative to a positive and foster that “think partner” relationship.

    Imagine a situation where an individual living with T2D looks forward to their primary care appointments because they are going to share with and learn from their HCP with no fear of judgment. They’ll talk about their struggles and challenges in a truthful manner and together they’ll identify areas that are working and small steps that can be taken to lead towards success.

    The most important lesson you can take away from this discussion is that using strengths-based language is actually easy to do. As our friend and colleague Jane K. Dickinson says, “when you put the person first (not the diabetes), the language will follow.” 

    Our goal is that people living with T2D will develop a positive relationship with their primary care team, and all involved will understand the challenges, the opportunities, and the need for an empowering approach towards diabetes care and education. And we believe that a change in language can lead that.

    If you’re not sure how to begin, consider starting your next encounter with one of these questions:

    1. Thanks for coming in today. What’s been going well for you in your diabetes management?
    2. It’s so nice to see you today, managing diabetes is really hard work – it’s like a part-time job. Tell me what  you’ve been happy/pleased with  about your diabetes management since we last met?
    3. We all need support in some manner. Diabetes is a team effort. How can I support you and support the changes you want to make? I’m here for you.

    We hope you’ve been learning little nuggets with each blog post as you build your solution-focused tool box for managing T2D in primary care. Keep reading our series on incorporating a solution-focused approach when managing T2D in the primary care setting. Our goal is to start slow and share small, achievable, bite-size practice changes you can implement over time. 

    We welcome anyone interested in our approach to Subscribe to our blog and we’ll email you when a new post is published!

    If you are a health care professional and interested in learning more about our solution-focused practice and approach, when you subscribe to our blog, we’ll send you in return a FREE resource of 10 Solution-Focused Questions to start a solution-focused discussion with your clients. 

    Follow us on Twitter and Instagram @AFreshPOVforYou

    Deb is employed by Dexcom, but her words and opinions in this blog are her own.

    Tami is employed by the University of Kentucky HealthCare Barnstable Brown Diabetes Center, but her words and opinions in this blog are her own.

  • Fresh Views

    Transform Primary Care Encounters: Benefits for All Involved

    Once you know what works, do more of it. – Steve de Shazer and Insoo Kim Berg, pioneers of solution-focused brief therapy

    As we continue our new series on transforming primary care encounters by using a solution-focused approach, today let’s talk about the benefits of this approach. Benefits to you as a health care provider and more importantly benefits to your clients. We’ve had several primary care providers encourage us to share more on this approach as they found it to be a transformational way of thinking and engaging with clients. 

    What are the benefits to the client?

    Without a doubt, managing diabetes is complex and burdensome. In 2019, we conducted a qualitative research study with Twitter Chat data from a #DSMA chat we moderated around a solution-focused tool called “The Miracle Question”. We first presented these findings in 2019 at the 55th Annual Meeting of the European Association for the Study of Diabetes Conference in Barcelona, Spain. Two compelling comments from participants with diabetes that came out of that study. 

    • “Diabetes interrupts my life… every minute.”
    • “Success would look like people realizing what diabetes is and we can stop with these assumptions and jokes about diabetes.”

    As we’ve written about many times, individuals that live with type 2 diabetes (T2D) have many obstacles to overcome due to the lack of understanding about the condition.We know that T2D has a genetic link and is more common in individuals of color, those with a family history, and that risk increases with aging. While making more healthful behavior changes is critical to living a healthy life, the genetic nature of the condition is not well known in the general community and not discussed enough in medicine, the community at large, and the media.

    The goal is to help the person with T2D recognize exceptions (a time when their problem does not happen) and help them to focus on their health behavior changes by doing “more of what works.” Give our previous blog here a quick read to get up to catch up on the basic tenets of the solution-focused approach and how implementing an approach that focuses on solutions instead of problems can “flip” the conversation in primary care and build stronger relationships.  

    Ultimately, developing stronger relationships will facilitate positive discussions about therapy including medication, food choices, physical activity and more.

    What are the benefits to the provider? 

    Brief intervention. One of the most important benefits of incorporating a solution-focused approach in primary care is that it is a “brief” intervention. With often many competing demands to address during a primary care encounter, you do not need to delve deep into problem-solving mode. Instead you discuss what’s already working well and step alongside the client as a “think partner” to do more of what “works.”

    Ownership transferred to the client. Ideally a solution-focused approach incorporates questions to generate discussion (we’ll share some of these in a future post). . In this way, the primary care provider helps the client elicit “change talk” instead of “telling” the client what to do. Tami had a client this past week that said those very words… “I really like that you’re not telling me what to do, but spending time talking to me and brainstorming ideas so I can decide what I want to do.”  The client will have ownership over their decisions and be more invested in the next steps. This is really the first step in shared decision-making.

    Greater individualization of care. The recent 2022 ADA Standards of Care presents much greater emphasis on individualization and personalization of care. What better approach to individualize the care plan than asking the individual what is working for them and what they think might be the best next steps. Together you can identify small steps towards their goals. 

    Come back in two weeks for our thoughts on the power of language when managing T2D in the primary care setting. We’ll re-introduce the concept of person-first, strengths-based language and use in a solution-focused approach with tips for the primary care team, both clinician and person with diabetes. We’ll continue to help you build your solution-focused tool-kit over time. 

    We welcome anyone interested in our approach to Subscribe to our blog and we’ll email you when a new post is published!

    If you are a health care professional and interested in learning more about our solution-focused practice and approach, when you subscribe to our blog, we’ll send you in return a FREE resource of 10 Solution-Focused Questions to start a solution-focused discussion with your clients. 

    Follow us on Twitter and Instagram @AFreshPOVforYou

    Deb is employed by Dexcom, but her words and opinions in this blog are her own.

    Tami is employed by the University of Kentucky HealthCare Barnstable Brown DIabetes Center, but her words and opinions in this blog are her own.

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