13. I’m impressed that … When I worry about long-term complications, I remind myself that the better I take care of myself, the healthier I will be. 1 2 3 4 (Take care of myself)
14. I’m impressed that … I can ask my health care team to understand what it’s like for me to have diabetes. 1 2 3 4 (I accept myself)
15. I’m impressed that … When I feel overwhelmed, I check to see if I feel this way because my blood glucose is out of range or has been swinging high and low. 1 2 3 4 (I monitor myself)
16. I’m impressed that … When I feel overwhelmed, I ask my team to help me set smaller goals. 1 2 3 4 (Goal setting)
17. I’m impressed that … I can help loved ones learn how to support me by talking to them or by bringing them with me to my appointments. 1 2 3 4 (Build a support team)
18. I’m impressed that … What I do also helps educate my loved ones so they can become healthier. 1 2 3 4 (I’m a good role model!)
The Takeaway
Set the stage for growth before you meet with your patients.
Two monologues do not make a dialogue.
—Jeff Daly
In this chapter, you will learn the following:
● How to communicate more effectively with patients who appear emotional, distracted, or unreachable
● How to interact with patients you may not like
● When to refer your patient to a therapist
Connecting
Armed with the tools from Chapter one, you hopefully feel more prepared to start your day with a positive mind-set. Even if you enter your office whistling a happy tune, you still are likely to encounter patients who bring their own emotional baggage to their appointments. They may feel angry, sad, frustrated, hopeless, anxious, depressed, hurt, or even guilty about having diabetes or other medical issues. These feelings can be overwhelming, but they are normal. Anticipate them. After all, living with diabetes requires patients to adjust not only their lives but also many of their hopes and dreams. That, alone, can be highly distressing.
You may wish that your patients left these negative feelings at home; however, the fact that they show their emotions so openly may demonstrate how overwhelmed they are feeling as well as how much they trust you and believe you can help them. If you don’t acknowledge their feelings in some meaningful way, these emotions can become the proverbial “elephant in the room” and negatively affect everything that happens during your session together. Angry patients, for example, are so distracted by their clenched jaws and throbbing foreheads that they miss many of the important things you say. Your patients’ emotions and inability to listen also can affect your mood and prompt you to speak in a more harsh or inappropriate manner.
When Patients Arrive
When you meet with your patients, hand them a sheet of paper on which they can take notes. Think of this handout as their personal prescription pad. On it, they can jot down information you share and suggestions you make, and then they can choose to implement the plans you collaboratively develop more effectively. At the end of the session, ask them to summarize all they learned and tell you what they have decided to do differently before their next visit.
When They Arrive in a Difficult Mood
If you suspect that a patient is not in a positive mood, remember the stop, drop, and roll (SDR) intervention. Stop for a moment. Drop any negative judgment you have about seeing this person, and roll forward with a more compassionate stance before you step into the room. Once you enter the room, set the stage for a meaningful interaction. Think LEAP and follow these four steps:
1. Listen
2. Empathize
3. Affirm
4. Positively reframe
Step 1. Listen
Carl Rogers, the father of client-centered therapy, said the following about the value of being heard:
I can testify that when you are in psychological distress and someone really hears you without passing judgment on you, without trying to take responsibility for you, without trying to mold you, it feels damn good! (Rogers, 1980)
When you encounter distressed patients, listen carefully to their concerns. Ask open-ended questions to help find out what is really on their minds. If your time is limited, ask them to take a moment and state how they feel in a single word or sentence. That request will help your patients clarify their thoughts and get right to the point. When possible, invite them to share what they have accomplished so far, to remind them of their progress as they consider their struggles. Use body language to demonstrate your sincerity—lean forward, face your patient, and make eye contact. Fight the temptation to glance at your electronic notepad or other devices. We know that should be obvious, but it is a common patient complaint that deserves note (Gualtieri, 2010). Your goal is to feel and communicate genuineness, authenticity, sincerity, and compassion; none of which can be achieved if your attention is elsewhere. Don’t worry if you don’t know what to say or how to respond. The fact that you care enough to listen is healing; it shows your patients that you see them as individuals and want to know how they think and feel. Additionally, when you attend to your patients in this way, they observe how quality listening is done and, hopefully, will employ this behavior in their own lives with emotionally distressed loved ones.
Active listening isn’t just a matter of courtesy. There are real rewards for reaching out to others in this way. When you give your patients permission to express how they feel about their diabetes or other distressing concerns, they are more likely to share additional information with you, take their medication as prescribed, show up to follow-up appointments, and follow through with the lifestyle changes you recommend (Bayne, 2013). When you identify a problematic issue, you take the first step toward resolving it. If you aren’t convinced yet, consider your wallet as well as your peace of mind. One study showed that physicians who develop empathic relationships with their patients have a lower incidence of malpractice claims (Levasseur, 1993, as cited in Bayne, 2013). This may apply to educators and other professionals as well.
Step 2. Empathize
To reflect a statement your patient shares, repeat it back to him or her in your own words. You can do this compassionately or empathically. What’s the difference?
● Being compassionate: You feel sympathetic about someone’s situation, but you don’t try to understand how they feel or explore how deeply they are suffering. For example: Habitat for Humanity helps people in need, so you write a check to the organization and send it off in the mail. You don’t read the profiles on the website or try to learn more about the recipients of your gift. You give, because you know the organization is effective and helpful.
● Being empathic: You donate to Habitat for Humanity, but you go beyond writing a check. You make an effort to learn about the recipients of your gift—who they are, what matters to them, and how they feel about their current situation. According to Danielle Ofri, author of What Doctors Feel (2013a), “this is where doctors often stumble—empathy requires being able to communicate