Tell Me Something Good!

July 10, 2018

How can we help our diabetes patients break out of the negative feedback loop and find positivity? Edward C. Chao, DO, shares 3 simple steps. 

We are surrounded by, indeed, bombarded by, negative feedback-all day, every day.  We see it in our clinics - patients who are not at goal for their diabetes, formulary restrictions, patients developing diabetes complications, and the list goes on.

What if we hit the “reset” button?

What about pausing, for just a few seconds, to notice what’s going well with our patients, including those who are living with diabetes? Here are 3 thoughts on actively hitting “reset.”

1. Ask the patient, for a change, “What’s going well?”

This question is the flip side of the questions we tend to ask: “What bothers you about your diabetes?” or “What annoys you about your diabetes?” and that I’ve discussed in previous blogs. I find that eliciting the patient’s point of view on what is actually working in their self-care regimen can be encouraging and inspiring, both for the patient and for me. 

Diabetes can be demanding and frustrating. We counsel our patients to perform multiple self-management tasks, all in the service of a larger and critical (if distant) goal: reducing the risk of potential complications that may develop decades down the road. Performance of these tasks may for some run counter to human nature as well as the urgency of daily life-work, bills, children, and a hundred other worries. Since our patients, like us, can be their own toughest critics, asking what is going well can remind everyone that no matter what the current struggles are, there is at least one facet that is improving or that is better since the last follow-up. Sometimes, the responses can be surprising, funny, and thought-provoking.

Next: Point out the Positive, Look for Support

2. Point out positive factors

What if the patient responds with, “Nothing,” or “I can’t think of anything good?” Well, why not take the lead? You could remind the patient that his or her A1c is continuing to trend downward. Or, point out something seemingly small, such as noting the patient has consistently implemented a single change that was identified at the last visit. One of my patients, after expressing hesitation for a few visits, decided to start cutting out regular sodas. About 6 months later, building momentum from this one small tweak, he had lost 20 pounds!

3. You are not alone; look for support

This goes for both your patients and you! Just as you encourage your patients to develop a community of support-spouses or significant others, children, siblings, parents, friends, neighbors, or colleagues-you as the health care professional can also draw upon tremendous resources to help you hit your reset button and stay positive. Health care is a team sport, and we’re seeing more clinics embrace this formally.

None of us, in a brief office visit, can cram in all the discussions we feel are essential-proper injection technique, how to check feet, etc. The VA has dietitians, certified diabetes educators, nurses, and pharmacists working together to help patients and their physicians (or PAs, NPs) optimize their care.

It truly takes a village to stay positive. What are some tools that have worked for you and your team?