• Fresh Views

    Transform Primary Care Encounters: Here’s Why

    Problem talk creates problems. Solution talk creates solutions. – Steve de Shazer, pioneer of solution-focused brief therapy

    Managing diabetes is complex.  We know that. Constant focus on “problems” can erode confidence. So, clients may turn to us, their healthcare team, looking for guidance to do something different. 

    As we continue our new series on transforming primary care encounters by using a solution-focused approach, today let’s talk about WHY use this approach. 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. So let’s delve a little deeper today…this is one way of thinking that may help.

    Before we begin, one significant difference in a solution-focused approach is use of the term “client” instead of “patient.”  In a solution-focused approach the clinician and person with diabetes are considered “think partners” working together to manage diabetes. Thus, the term client is more inclusive and more indicative of the approach, and is what we use. (That said, we realize that the term “patient” is widely used in many healthcare settings and we respect that.)

    Why use a solution-focused approach in primary care? 

    Since the majority of type 2 diabetes (T2D) is managed in primary care, it seems that the best place to start to change the way we engage with clients is through primary care. Without a doubt there are many competing demands during a primary care visit. And visits can often focus on “fixing” “problems” as the limited appointment time flies by.

    The Taxonomy of Burden of Treatment, published in 2015, identifies three areas where people with chronic conditions, such as diabetes, have “work to do”. So, if a person does “everything” the guidelines ask them to do, that would take about  2.5 hours/day… that’s like a part-time job – a job they didn’t ask for! And those 2.5 hours don’t take into account the nuances of the impact on their life, and factors that make living with chronic conditions challenging, like work, travel, lack of income etc.The constant focus on problems can make living with T2D even harder.

    Considering the complexity of chronic care can help build compassion and recognize the reality of day to day life – what we’re asking people to do  – and how it is impacting everything else. The way a person is treated and the way they feel about living with diabetes impacts outcomes. When doing all this work to manage their diabetes and then see their care team focus on what’s wrong or what’s not happened, instead of what is working well, negates all their hard work. This is where language and communication are key. 

    In the image at the top of this blog you can see a quick summary of how the interaction can be “flipped”. Incorporating a solution-focused approach can enhance your client relationships and build trust and open communication needed for successful diabetes management.

    Join us as our series continues on  incorporating a solution-focused approach when managing T2D in the primary care setting. We’ll share how you can incorporate the tenets into a brief visit and how you can build your solution-focused tool-kit over time. Our goal is to start slow and share small, achievable, bite-size practice changes you can implement over time. Our next post will focus on benefits of this approach for the primary care team, both clinician and person with diabetes.

    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

    JOURNEY: Today’s word to jump-start solution-focused practice

    A journey of a thousand miles begins with a single step.” – ancient Chinese proverb

    Tami and Deb with our friend Karen Kemmis ready to head off to the Kentucky Derby a few years back

    This Saturday September 5 marks the 146th running of the Kentucky Derby! If you are not familiar with this premier thoroughbred horse racing event, it is held annually in Louisville, KY, typically on the first Saturday in May. Yet, due to the pandemic, this year’s Derby was moved to the first Saturday in September in hopes that this “Fastest Two Minutes in Sports” would have an excited crowd cheering on the three-year-old thoroughbreds as they raced the one and a quarter miles to the finish line. The stands typically would be teeming with spectators from around the world oozing with fashion…ladies sporting beautiful dresses and big hats and men decked out in colorful suits…yet this year the stands will be empty. This race is often called “The Run for the Roses” because a blanket of roses is draped over the winning horse. It is the first leg of the American Triple Crown, followed by the Preakness Stakes and then the Belmont Stakes. A horse must win all three races to win the Triple Crown.

    Our husbands sporting their sharp Derby attire

    Not only is this premier horse racing event near and dear to our hearts since we had the opportunity to experience it a few years back, it causes us to take pause and reflect on the JOURNEY to qualify for the “Run for the Roses”.

    Some horses are born with talent, and are simply stronger and faster than other horses in the race. They are considered the “favorites” to win their races. But yet, the “favorite” doesn’t always win every race. Sometimes the winner is a horse with lesser talent so to speak, but who has a trainer that’s able to help maximize the horse’s potential through customized training based on the horse’s particular strengths and weaknesses, and by leveraging factors such as weather and track conditions, to give the horse the desire and best chance to win.

    As is the path to the Kentucky Derby a JOURNEY, without a doubt living with diabetes is a JOURNEY too.

    Today’s word is JOURNEY

    This journey brings not only glucose ups and downs, but twists and curves based on life’s experiences and challenges. When working with clients facing diabetes challenges, it’s key to focus on where they are in their journey and the complex decisions and choices they make on a daily, hourly, and even minute-by-minute basis. 

    We’ve shared before our fondness of Taxonomy of the Burden of Treatment paper (Tran et al) which helps clarify in a visual way the complexity and work required to manage a complex chronic condition like diabetes. When thinking about where clients are on their journey with diabetes, consider all of the factors that are impacting their decisions, choices, opportunities, and challenges. We can be supportive by helping them focus on their strengths, successes, and resilience. Just identifying one thing that is working well for them or finding an area in their life where their hard work is paying off can be incredibly impactful. 

    How often are people with diabetes recognized for the work they do?

    During one presentation at the Association of Diabetes Care & Education Specialists virtual annual meeting the current ADCES Diabetes Care and Education Specialist of the Year, Dr. Diana Isaacs, made a profound statement that resonates with a solution-focused approach: 

    In her practice’s shared medical appointments where participants wear a continuous glucose monitor (CGM), she starts off by thanking everyone for wearing the CGM for the week and recognizing the achievement in doing so. A thank you…it sounds simple, but is so powerful. How often are people with diabetes  recognized for the work they do? Diana focuses on what worked well for them during their week, and asks permission to discuss their challenges. During the session participants are able to focus on the journey of learning how they can make decisions and changes moving forward, based on their discoveries. No matter how small the changes may be, small steps add up.

    What an impactful way to make education meaningful and individualized, with the DCES stepping alongside as a “think partner” helping them take the next step on their journey. 

    As we shared in this blog around Derby time last year, when a client is faced with a scenario they’re trying to sort out, here are 3 key questions you can ask as their think parter:  

    1. What’s going well?
    2. How did you accomplish that?
    3. How can you do more of that? 

    Each week we invite readers to participate in a solution-focused challenge. This week we encourage you to:

    1. Start each session with a client by acknowledging the hard work they are doing managing their diabetes, even if it’s as simple as a thank-you for attending the session.
    2. Discuss with clients the concept of living with diabetes as being  a journey where there is always opportunity to shift directions.
    3. Offer clients support on their journey by sharing resources on peer support groups, either in person or online. Learning how others are moving forward living with diabetes can be life changing. 

    Try out one or more of the strategies we’ve shared, and reach back to  let us know how you’re doing! We’d love to help you de-stress and focus on a positive mindset.

    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 an employee of Dexcom but all comments are her own.

  • Fresh Views

    Decision Fatigue: Tips to decrease the burden

    Photo from the gardens at Bed and Breakfast on Tiffany Hill near Asheville, NC

    When was the last time you packed for a trip? It can seem like a million decisions to make: How many days do I need to pack for? What will the weather and temperature be like? What type of scenarios do I need to plan for? What shoes? And the list goes on and on. Now, factor in all of the extra supplies that living with diabetes requires. It may leave you with decision fatigue and mentally exhausted from making so many decisions. We now find ourselves experiencing this first hand, wrapping up a million loose ends in the office and packing our own suitcases to hit the road for work, then for a few days of relaxation and beautiful new views.

    What is decision fatigue?

    If you are not familiar with the term “decision fatigue”, it basically means deteriorating energy and focus following a long session of decision making. It can result in making less than optimal decisions.

    Just day to day life may leave you experiencing decision fatigue…what to eat, how much to eat, when to eat, when to exercise, how much to exercise, how to remember to take any medicines  at the right time and in the right dose, when to check blood glucose, when to go to bed, what to do for self-care and stress management…and the list goes on and on. Various sources estimate that an adult makes about 35,000 conscious decisions each day. That number of decisions may sound unreal, but in fact over 225 of those decisions each day focus on food alone. We also know that if you follow all of the diabetes self-care guidelines and incorporate all of the related action items into your daily routine, it consumers over 2.5 hours a day! And that leads to more decisions. How many of the recommendations do you or can you incorporate? How realistic is it to try to do “everything”?

    Embrace a minimally disruptive approach

    You may have heard of the concept of minimally disruptive medicine or MDM.  If it’s new to you, it’s a very interesting approach to managing diabetes, focusing on balancing workload and capacity with the ultimate goal of reducing the burden of treatment of having a chronic condition. The idea is to customize clinical recommendations and guidelines and create true person-centered care. So medicine is not one size fits all. Making the conscious choice to individualize guidelines may help decrease decision fatigue. (This is just the tip of the iceberg of MDM, we hope to write more about it in a later blog)  Having to weigh all of the options regarding care, and making daily decisions increases the burden of living with diabetes.

    4 Solution- Focused Tips to decrease the burden:

    When there are many decisions to be made, sometimes it is challenging to know what should come first, what is essential to your health and well being, and what can you postpone, delay or decide not to do. You can prioritize your issues and concerns in order to design solutions that work for you.

    1. Simplify the choices you need to make throughout the day. Maybe it’s mapping out a 1 mile or 2 mile path so that you can go on “autopilot” when you go out to walk or jog and don’t have to decide where to go. Maybe it’s pre-portioning out a mix of healthy nuts (or other snack) into zip top bags or small airtight containers in amounts that work for you. Then when it’s time for a snack you don’t have to decide what to eat.

    2. Do hard work early in the day. This is a tip we’ve shared before [read it here]. The mind is fresher and more creative in the morning. Plus,it can help you feel accomplished to get hard things done and out of the way. Maybe it’s planning meals and making a shopping list. Maybe it’s fitting in exercise before noon so it doesn’t get pushed out of the way by other things that pop up during the day..

    3. Schedule similar tasks together. Take running errands for instance. Maybe you need to swing by the pharmacy to pick up a prescription. The pharmacy is next to the grocery store. You know you need to pick up a few things to have on hand for breakfast, so you knock out both errands at once and you don’t have to decide when to fit in the grocery run.

    4. Make the decision to get started. Maybe you’ve been off track with eating and realize you need to renew your focus on portions and associated carbohydrate content but just can’t seem to get started. Make the decision to start by downloading an app to help you get focused. Or start by making a list of foods you eat frequently. You’ll have that at your fingertips to fill in carb count for the amounts that work for you.

    No matter how rational or sensible you are, you simply can’t make decision after decision without paying a mental price. And unlike physical fatigue—which we are consciously aware of—decision fatigue often happens without us knowing. By reducing the amount of decisions you make every day, you free up space for the ones that really matter!

    Since May is Mental Health Awareness Month we wanted to share these resources about Diabetes and Mental Health. As we write and develop our blog and content we actively seek to focus on the need for tools and strategies to support positive mental health. Both diabetes and mental health carry a stigma which may lead to silence and not seeking help or support. Reach out to someone today, you might just be the one thing they need!

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    Follow us on Twitter and Instagram @AFreshPOVforYou.