• Fresh Views

    Being human first: Perspectives around optimizing healthcare interactions


    Tami and Deb enjoying fresh views in Chicago, finding freedom and joy in life.
    T

    Of course different people fulfill different functions in this world. It cannot be otherwise. As far as intellectual or physical abilities are concerned – knowledge, skills, talents, and energy levels – human beings differ widely. What really matters is not what function you fulfill in this world, but whether you identify with your function to such an extent that it takes you over and becomes a role that you play. When you play roles, you are unconscious.“   – Eckhart Tolle

    Deb’s been listening to an Oprah’s Book Club book on Audible, Eckhart Tolle A New Earth: Awakening to Your Life’s Purpose. While Deb has found the book deep, and a challenging “read”, she’s found that it creates an opportunity to take an introspective look at the way we engage in the world. Tolle believes everyone can find “the freedom and joy of life” if they live in the present moment.

    Deb has also been listening to Oprah’s weekly Super Soul Conversations Podcast to review each chapter of the book, typically while taking her daily walk (and it’s helping a lot to understand and internalize the concepts). During a recent podcast there was discussion between Oprah and Tolle about roles people play and how roles inhibit thinking.  In applying some of Tolle’s principles to our mission and vision here @AFreshPOVforYOU, there was an “a ha” moment for Deb around how the #languagematters movement in healthcare needs to expand to include not just the words we use, but also how we implement person first language. (check out our November blog on why language matters here)  To really put the person (not the “patient”) first, there needs to be a “person” on both sides of the interaction for true person centered care.

    One section of Oprah’s weekly podcast addressed healthcare and how when a healthcare professional “plays the role of healthcare professional”, he or she may become “unconscious” of the fact he or she is a human person while embracing their “healthcare role”. And, that the “patient” across from them is also a person. Something vital is then missing. And as a result, the person (“patient) may end up feeling disconnected and dismissed.

    The discussion brought to mind a recent #DSMA Twitter chat that @AFreshPOVforYou joined a couple of weeks ago. One question asked during the chat was: “How can healthcare practitioners facilitate more empowering or effective communication with patients or vise versa?”  One enlightened participant, the incredible behavioral and data scientist Dr. Chandra Osborn replied, “Be a human first – a practitioner second.”  

    Her reply really struck a chord, and aligns with the closing words in Tolle’s quote above, “When you play roles, you are unconscious.“ Let’s repeat that…..”When you play roles, you are unconscious”. How can there be empowering or effective communication if people are not “present” and if they are “unconscious”?

    Along those lines, We @AFreshPOVforYOU have experienced this first hand.

    Deb’s experience…

    Deb recalls a visit with her daughter to the pediatrician where they never once made eye contact. The doctor typed on the computer the whole time, asking impersonal questions and fulfilling her role. They did not feel like they were part of the conversation.

    Tami’s experience…

    Tami remembers a similar scenario while sitting alongside her mom at hospital discharge following her mom’s knee surgery. The healthcare team was talking all “around” both of them, talking to each other, asking questions, giving a multitude of instructions, rarely looking at them or expressing interest in their point of view or concerns. They did not feel like they were part of the conversation either.

    We’ve heard many similar stories from people with diabetes – how at times the relationship with their healthcare provider was not ideal. Some have stated they cancelled an appointment because they didn’t want to be scolded for an A1C value that was higher than expected. Or because their weight was up a few pounds.

    In traditional healthcare people with diabetes are expected to play the role of patient and clinicians play the role of doctor, nurse, dietitian etc.  Yet this type of engagement does not promote healthy communications and relationships. As Tolle recounts, “Authentic human interactions become impossible when you lose yourself in a role.”

    We’ve experienced being on both sides of this equation.  As diabetes educators, we are always striving to improve, but we are not perfect. We’ve made our share of mistakes, but we’ve grown and learned from them. Deb recalls one client she saw years ago that was very frustrated with her because she was following the “assigned content” for the appointment per the prescribed healthcare provider orders, and at the end of the visit the client said, “we didn’t have time for any of my questions!”  That meeting really left an impact on her, she was playing the “role” of a diabetes educator and she never made that mistake again. Fast forward to a more recent experience when she received a call from a healthcare provider who referred his patient to her.  The doctor said, “I’m not quite sure what you did, but Mr. Jones is never satisfied with anything  or anyone, but he could not stop talking about how his appointment with you was the best diabetes visit he’s ever had.”  You know what she did? She started by asking him about his family and recent vacation, and then asked what was going well with his diabetes management?  She was being a human first and he was treated like a person.

    If you follow our blog, you know that we are advocates of solution focused therapy. In the context of solution focused therapy, the client/person with diabetes is viewed as the expert and the most important element is the “therapeutic alliance” between the client and the practitioner.  The relationship is the key to being able to work together. And to build a relationship it requires being present, being conscious of one’s own behaviors, use of language, and body language which all tell a story. We believe it’s critical to enter healthcare exchanges as a human first- not playing a role – with each party recognizing their part in the conversation/interaction as valuable.

    Our goal, through incorporating principles of solutions focused therapy and coaching in diabetes care and education, is to change the conversation, the interaction and the experience of the diabetes community to improve health.  As Eckhart Tolle says, we need to “become conscious of being conscious.”  We need to work as a team, be present in all of our interactions and most of all be human.

    In closing, we leave you with a few thoughts on what you can do when you engage in a healthcare interaction.

    If you are a healthcare provider:

    1. Be human first
    2. Check your ego at the door
    3. Appreciate that the person in front of you is as an expert on their condition
    4. Listen carefully before speaking
    5. When possible, sit on the same side of the table
    6. Understand the burden associated with living with a chronic condition

    If you are a person living with a chronic condition:

    1. Be human first
    2. Actively participate in your medical appointments and your self-management to the best of your ability
    3. Work in partnership with your care team
    4. Be honest about your capabilities

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  • Fresh Views

    Take a pause to gain a fresh perspective


    Photo taken on one of Tami’s pauses

    When life gets crazy, as it often does for us, a strategy that we @AFreshPOVforYOU find particularly useful is taking a pause or break to help clear our minds and gain a fresh perspective. It could be a half hour, an afternoon, a day, or a week. Tami has found that when her mind is jumbled or she’s trying to work out a problem, taking a walk allows her to think, her creative juices to flow, and to gain a fresh perspective. (And sometimes even happen upon a stunning sunset view like the one above captured on a recent walk). Deb enjoys sitting outside in her backyard, enjoying the view of the trees, flowers and clear water in the pool.  Even getting away from our desks and out of the office at lunch brings clarity and new thinking. We’ve found when we’re hit with “writer’s block”, just putting the project away for a day or two allows us to return with a clearer mind, new ideas and new perspective. Clients we’ve worked with have shared a variety of things they do to take a pause – from taking a long run, reading a pleasure book, mowing the yard, or simply sitting and being present in the moment, Taking that pause can change your perspective….much like “turning turtle” can. You can read more about “turning turtle” in our January 30, 2019 blog.

    Have you tried stepping away for a bit when you’re in the midst of a challenge? Maybe you’re struggling with insurance benefits and getting your medication prescription filled, or maybe a co-worker questioned the food you were eating at lunch. (we know that never happens!) Taking a pause may sound counterproductive, but actually it’s not. As you step away, spend a moment acknowledging all the hard work you have done. Remind yourself  what you’ve accomplished or what is going well, even though it may feel like the world is swirling around you.

    The practice of using solutions focused brief therapy (SFBT) encourages the exercise of asking questions when trying to identify solutions. A key premise of SFBT is that the individual is the only person who can understand his or her own needs, strengths and capabilities. The practitioner can facilitate by asking questions. One opportunity to incorporate the practice of asking questions is during these moments when you need to pause and step away.

    Here are 3 questions to consider to help guide your thinking and help gain perspective:

    1. Compliment yourself on your current efforts.  What would you say to yourself?
    2. What good intentions did you have when you started out today?
    3. What is the most important quality you have and use when you are under stress or pressure and how can you leverage that now?

    Asking yourself these questions when your mind is calm, and you are not distracted can help remind you of the resources you have within you and re-focus on your strengths.

    We often find that the more challenging the season in life, the more often we need to pause. It’s an important part of self-care. Sometimes just stepping away from a situation for awhile helps to bring a fresh perspective.


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  • Fresh Views

    Spare a Rose, Save a Child Today!

    The past few years we’ve requested no roses on Valentine’s day and instead asked our husbands to make donations to the Spare a rose, save a child campaign, a program of Life for a Child.

    What is this all about?

    If you are reading this blog, you probably know us and this program. But just in case….Life for a Child is a charity that helps diabetes programs in countries that do not have insulin and other diabetes supplies needed for young people living with type 1 diabetes to, …..well live!  The vision seems so simple….no child should die of diabetes. Yet the scary reality is they do..

    How can you help?

    Spare a rose, save a child is pretty easy. Instead of a dozen roses, ask your special someone to only buy you 11 roses, and then donate $5, the cost of that one rose! One rose can provide life saving medicine and supplies for a full month for one child. Better yet, forgo the dozen roses all together and you can save a life for a whole year! Now that is a Valentine’s day gift to remember.

    Several other people have written blogs this month to raise awareness of this life changing program. For just a sampling of the advocacy taking place this month, check out Renza’s blog Diabetogenic here and Stephen’s blog Happy Medium here.

    Since we post our blog on Wednesdays and today is February 13th, we thought this would be a good last minute reminder that you don’t need to run to the store to make a meaningful difference tomorrow, just click and donate here and #SpareaRose.

    Reflecting on our recent blog on Gratitude, this Valentine’s day we are grateful for our diabetes community and want to give back. And since we learned that practicing gratitude can decrease stress and anxiety by activating the areas in the brain that release feel-good hormones serotonin and dopamine, this is really a gift that actually gives back to us!   

    Happy Valentine’s Day to all!

    Deb and Tami

  • Fresh Views

    It’s time to flourish with diabetes!: An interview with Riva Greenberg and Boudewijn Bertsch about this new world view

    Over the past few months through this blog we’ve shared some thoughts, insights and innovative approaches around living well with diabetes and creating possibilities, opportunities, and a vision for the future. Through several projects we’ve been working on we became familiar with the like-minded work of Riva Greenberg and Boudewijn Bertsch and their Flourishing Approach to living well with diabetes. So, we connected and shared ideas. We thought our readers would be interested in Riva’s and Boudewijn’s Flourishing Approach, and they were gracious enough to share their time and thoughts with us.


    Riva Greenberg and Boudewijn Bertsch.
    Photo credit: Mathias Loevgreen Bojesen

    1. Tell us about the core principles of the Flourishing Approach to living with diabetes, and how it differs from the traditional Healthy Coping approach.

    Riva (and Boudewijn): I find it interesting that we call the conventional approach to diabetes management, “Healthy Coping.” That’s truly a mixed metaphor. For people with diabetes, coping does not translate positively. Their association with coping is a sense of just getting by or struggle.

    The Flourishing Approach that we designed and have shared with thousands of health professionals around the world, is a paradigm shift and a new world-view, which I will explain.

    Our conventional approach takes a machine-view of the body and, while most health professionals don’t realize it, causes us to see and treat people like machines. The approach grew out of acute care, however in acute care, you can repair, heal or cure someone. Here machine values make sense.

    Modern medicine adopted the values of the Industrial Revolution: accuracy, precision, perfection, standards, linearity, cause and effect. These remarkably advanced medical tests and technologies. Unfortunately, they do not foster what people need to live well with a chronic illness – adaptability, growth, healing and developing resilience. Nor do they inspire the tissue of self-care – connection, confidence and commitment.

    Seeing people with diabetes as machines we see defects. In contrast, the Flourishing Approach (FA) sees a person with diabetes as a biological organism. As such we see they are now in a new state, redesigned, not disabled but differently-abled. From this orientation, the Approach brings no  judgment and the direction, rather than fixing, is to promote growth and wellness as living organisms are designed for.

    The Flourishing Approach also, unlike the conventional approach, sees diabetes as a complex condition and the person with it operating in a complex world. As such, you cannot apply cause and effect thinking. We cannot say, “Do this and that will happen,” there is too much complexity.

    Nor can we apply accuracy and precision to blood sugar management. Telling a person with diabetes that they can “control” their blood sugar is not only untrue, it sets them up for failure. Instead, we need to nurture and equip individuals to help influence their blood sugar and respond appropriately.

    The core principles in the Flourishing Approach are based on human sciences, neuroscience, biology and social sciences and according insights like we need to feel safe to function at our best. “Best practices,” culled from the masses pale against individualized “emergent practices.” The FA helps people explore their own solutions; we don’t impose standards based on averages.

    As an orientation the Flourishing Approach: 1) is relationship-centered, both practitioner and person with diabetes bring their mutual strengths, expertise and ideas together, 2) explores the patient’s context 3) uses open conversations where solutions emerge 4) is positively focused, looking for what’s working and 5) aims to achieve what’s wanted, better health, not what’s to be avoided, complications.

    2. The work we @AFreshPOVforYou are doing is centered around the solutions focused brief therapy approach. How does that align with the Flourishing approach?

    Riva (and Boudewijn): The Flourishing Approach is based on several sciences that explain how we operate as a biological organism. Solution focused brief therapy (SFBT) is one of these theories. But it’s important to understand the FA is not just a set of tools, but a different paradigm. One can use SFBT within the conventional treatment approach. For instance, we can ask patients positively-focused questions yet still assume the mantle of the expert who has the answers.

    The FA is based on Systems and Complexity theory, that we operate within systems – home, family, work, community, culture, country, and that diabetes is complex and medical sociologist Aaron Antonovsky’s ‘Sense of Coherence’ and Dr. Stephen Porges’ Polyvagal Theory.

    Porges identified a third autonomic nervous system (ANS) in addition to the sympathetic and parasympathetic. He calls it the social engagement system. In this state we are most open, flexible, creative, adaptive and push forward confidently into the world. But to be in this state we must feel safe. So, I ask practitioners when I present at conferences, “What do you do to help your patients feel safe?” They have never thought of it before. The FA being relationship-centered, not patient-centered, heightens safety.

    3. How can readers learn more about the Flourishing Approach?

    Riva (and Boudewijn): The Approach appears in two issues of the Academy of Nutrition and Dietetics, peer-reviewed journal, “On the Cutting Edge,” The Flourishing Treatment Approach: A Strengths-based Model Informed by How People Create Health and A Flourishing Approach to Mental Health in Patients With Diabetes.

    4. Would you share an impactful story/experience surrounding the Flourishing Approach.

    Riva (and Boudewijn): In January 2014 we spent three weeks sharing the Approach with the medical staff of Jnana Sanjeevini Diabetes Center in Bangalore, India. One day a dietitian came up to me. She told me she’d followed our teaching and asked her patient what he was doing well and what he’d like to try next. The whole visit, she said, was light and filled with laughter and he left excited. Normally, she said, she’d try to push him to do what she thought he should, he’d leave downhearted and nothing would change.

    We also have a diabetes nurse from Steno Diabetes Center in Denmark, where I’ve done a lot of training, tell me her patients are changing behaviors more easily, and she is happier in her work using the Approach.

    5. What one thing would you like readers to know?

    Riva (and Boudewijn): I don’t discount today’s conventional approach. It works for some. My aim is to expand health professionals’ repertoire and people with diabetes’ possibilities by using a human-, not machine-, based approach.

    We’ve had numerous innovations in diabetes medicine, tools and technologies, in software and hardware. Yet no innovation in treating patients. The Flourishing Approach is an innovation in this essential aspect we all but ignore, heart-ware.

    I’ve presented the Flourishing Approach at diabetes conferences around the world – the ADA and AADE annual conferences, the Charles H. Best Diabetes Center in Canada, and at conferences in Israel, Sydney and Singapore. I have also presented the Flourishing idea to device and pharma companies. This December I’ll be presenting it at the International Diabetes Federation World Congress in Busan, Korea.

    If anyone is interested in a presentation on the Flourishing Approach and/or workshop, where I teach a few tools from the Approach, they can contact me at riva@diabetesbydesign.com.

    Thank you Riva and Boudewijn for your encouraging solutions focused approach to flourishing with diabetes!

    To learn more, here are links to Riva’s Books: Diabetes Do’s & How-To’s; 50 Diabetes Myths That Can Ruin Your Life; The ABCs of Loving Yourself With Diabetes Here’s the link to Riva’s Blog: diabetesstories.com

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