“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)
- 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.”
- 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.”
- You can’t do this alone.
“I am here to help you.”
- 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.
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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.