primary care Archives – Page 2 of 2

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.

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.

Doing things differently leads to something exceptional. – unknown

Watching the sun set at Wise Villa Winery, Lincoln, California and thinking of new opportunities for 2022

With the start of the new year, one of our goals is to share the basic tenets of a solution-focused approach and how to incorporate these techniques into a brief primary care visit. We’ve had several primary care providers encourage us to share more on this…so here we go launching a series to slowly guide the evolution of practice! Follow our blog so you don’t miss out on practical guidance and tips to transform primary care encounters. (And if you work in a setting other than primary care, you’ll still want to follow because many of the tips can be applied to other practice settings.)

Why do we embrace a solution-focused approach?

Consider this…the traditional medical model of care is “problem-focused” – meaning you need to identify the “cause” to “fix the problem”. However, when faced with a life-long chronic condition (such as diabetes) that requires changes in health behaviors, “fixing a problem” is not so simple. One can quickly feel a sense of failure, feeling at fault where they’ve made “ bad decisions”, or some other negative feeling.

In our experience, it is common for those living with type 2 diabetes (T2D) to not want to reveal their health condition because of negativity towards T2D in the press, in the community, as well as from the medical field. Blame and shame are rampant. It is hard to be positive and move forward when viewing your whole life through this negative lens. This is where incorporating a solution-focused approach can be a game changer for both the clinician and the person living with diabetes. The whole conversation is “flipped” from a negative to a positive, helping to identify strengths and solutions instead of rehashing all of life’s issues that are not going well.

What is a solution-focused approach to care and education?

A solution-focused approach has its beginnings in counseling psychology, but has made inroads in a number of fields, and we are focusing on application to life with diabetes.

Here are 7 key tenets of this approach:

Ask questions. In a solution-focused approach asking eliciting questions is the key to uncovering solutions and guiding the individual. These questions help the individual realize that solutions are possible and help them see their desired future state.
The client is the expert. Key to this approach is first recognizing the individual is a person that lives with their chronic condition on their own and manages their daily life, so they are not a “patient” in this model. They know what they need and understand their condition and how it impacts their greater life. We recognize they are the center of the team and we value their input. Read more about experts here.
If something works, do more of it. The premise here is that if you do “more” of what is going well, then in general you will have less time and opportunity to engage in what is not working well. Helping the individual recognize their strengths and successes builds confidence needed to manage a complex condition. It can be as simple as opening the visit with the question, “What do you feel like has been going well with your diabetes?”
Focus on exceptions. Exceptions are times when the problem “might” have occurred but didn’t. This could be something small and often overlooked, but when you can highlight these opportunities you can then focus on solutions that are in front of you. You can read blogs we’ve written about exceptions here.
Small changes move you forward. The goal is to help the client take small steps to move their goals forward and each small step can lead to more success.
Clients already possess the resources they need for change. Most people are aware of what works for them and have the ability to identify solutions. We can help people to recognize these resources and help them to develop resiliency to manage their condition.
Language matters. We know and evidence shows that the language we use in healthcare is associated with health outcomes. When people are blamed and shamed for their health condition they are less likely to see their healthcare team and less likely to talk with their care team when they are not meeting health goals. The use of person-first, strength-based language in a solution-focused approach is critical to develop a therapeutic relationship with clients.

We hope you will see that this approach can help both clinicians and people with diabetes to collaborate in managing diabetes.

Join us for our series on incorporating a solution-focused approach when managing T2D in the primary care setting. We’ll share how you can incorporate these 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.

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

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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