The guidance we share within this book is not only for those who work with patients who have diabetes. It also is for health care providers who work with individuals who have any challenging medical issue. If you are just beginning your training, read through the entire book first and fill its margins with your personal thoughts. Take a careful look at your own behaviors, both in your work setting and outside of it. Many of the approaches we share can help you communicate more effectively with everyone in your life, not only with your patients and their families but also with loved ones, acquaintances, and colleagues, especially in this era of integrated care. Refer to this book often as you move through your program.
If you are a seasoned health care professional, we invite you to read through the entire book as well. Be introspective and explore the different ways to handle strong emotions you may feel, from time to time, that may be prompted by stresses in today’s health care environment. Use what we share to help you become an even more effective provider, partner, and friend. Many of the approaches may be new to you. We hope that you find them invigorating and effective. We use them ourselves and know how transformative they can be.
The DAWN2 (Diabetes Attitudes Wishes and Needs) study showed that “support which focuses on both clinical and the psychosocial needs of people with diabetes and their families is necessary to ensure successful treatment outcomes” (Novo Nordisk A/S, 2013). The approaches we present in this book can help achieve that goal and can enable you to bring your best self to every personal encounter, at work, and in other areas of your life.
I would like to acknowledge Melissa Brail, LMFT, program director, Jewish Community Services of South Florida, for her sage advice, and Maxine Cohn for her incomparable writing guidance. I also would like to thank Wendy for her thoughtful and enthusiastic collaboration and Victor Van Beuren and the hardworking American Diabetes Association publishing team for giving us this wonderful opportunity.
—Janis Roszler
Thirty five years ago, I was hired by Dr. Jay Skyler at the Diabetes Research Institute, University of Miami Medical School. It was a time when medicine rarely included psychologists and social workers on their teams. He was ahead of his time in recognizing the connection between emotions and diabetes. Today we have made incredible strides in health psychology and now recognize its essential role not just as an adjunct for difficult cases but as a necessary component of work with all patients and their families. From the beginning, I felt I really came to understand the “Person” in diabetes through my dearest friend and collaborator Gary Kleiman. Barbara Singer, Suzanne Wolfson, Maureen Murray, and Ellen Ullman added depth and perspective. I am thankful for the opportunities I have had with my colleagues and patients at the DRI, with Dr. Daniel Mintz at the head, along with Drs. Goldberg, Meninghini, and Nemery.
Thanks to Dr. Sandy Bernstein, Psychologist; Suzanne Pallot, MSW; Marilyn Charwat, psychotherapist; and Carole Weinstein, MA; for keeping me grounded in respect for “psychology’s place.” And thanks to my sisters, Marcia Lavipour and Mary Ellen Schwab, also professionals, who likewise keep me “alert” (as only siblings can do!).
Thanks to my loving nieces, nephews, and brothers-in-law and to our “kids” Bruce and Teri, Dean and Jen, and our granddaughter Chelsi.
Thanks to my friends for their connection.
And thank you, Janis, for inviting me to join you in writing this book. Your originality and creativity are invigorating.
—Wendy Satin Rapaport
It’s not you, it’s me. … You’re giving me the “It’s not you, it’s me” routine? I invented “It’s not you, it’s me.” Nobody tells me it’s them, not me. If it’s anybody, it’s me.
—George Costanza, Seinfeld
In this chapter, you will learn the following:
● The mutual influence you and your patients have on each other
● How to start your day more effectively
● The stop, drop, and roll intervention
We’re in This Together
Have you ever had a patient break down and cry? As a health care provider, you probably have had more than your share of challenging encounters with patients who come to an appointment or group session with emotions that make it harder for you to provide your best care. Think of the patient who is angry, or the one who aggressively counters everything you say with a quote from a television host or noncredentialed Internet blogger. Who’s to blame for these tough interactions? We are willing to bet that many of your colleagues, and perhaps you as well, place the blame squarely on the shoulders of the difficult patients. If that’s the case, we’d like to invite you to adopt a more enlightened, circular, mutually influencing perspective toward these encounters.
When patients enter a session in a difficult mood, it can make it much harder for them to hear what you have to say and remember the guidance you provide. Their emotional state at the time of your interaction provides one possible answer to that age-old question, “Why didn’t my patient do what I said?” But, what part might your emotions play in this patient–health care provider tango? Your body language, level of enthusiasm, and focus affects how patients respond to you. It’s a circular relationship—your mood affects your patient’s mood and vice versa. A back and forth occurs between both of you. Once the meeting you have with your first patient brings you down, you are more likely to take that “down feeling” into the session with the next patient and negatively affect that relationship as well.
An Israeli study (Kushnir, 2011) examined the impact physicians’ moods had on their patient interactions. On “good-mood days,” the subjects verbally interacted with their patients for a significantly longer amount of time, whereas those who entered the exam rooms with a negative attitude not only conversed less with their patients, but also increased the number of prescriptions they wrote and referrals they made. According to Fiscella (2004), patients who receive more positive verbal attention from their health care providers place greater trust in them.
The level of trust patients have in their health care providers forms the “cornerstone” of the patient–health care provider relationship (Weng, 2008). Trust also enhances healing (Mikesell, 2013). Hojat (2011) observed that patients who interacted with caring, empathetic physicians were “significantly more likely” to have better A1C values (56%) than those who interacted with less empathetic doctors (40%, P < 0.001). A greater number also enjoyed better low-density lipoprotein cholesterol (LDL-C) control (59%) versus those with less empathetic doctors (44%, P < 0.001).
Both you and your patient share responsibility for the quality of interaction that takes place when you meet. You are both part of the system; you affect your patients and they affect you. Sorry, George. It’s not you, it’s not me … it’s us.
Starting Your Day
How you start your day and how you temper your mood and your thoughts can help achieve more effective and fulfilling interactions for you, your patients, loved ones, colleagues, and friends.
“Peggy,” a registered nurse and diabetes educator, barely made it to work on time. After hitting the snooze alarm repeatedly, she finally dragged herself out of bed. She was in no mood to go to work. Then she tried on several outfits, each feeling too tight for the long day she had ahead. As she stormed out the door, she breezed by her husband and ignored his question about their plans for the evening. When she entered the office, without as much as a good morning,