Mike: Susan, I want to follow my meal plan, but my schedule is too hectic.
Susan: It’s not easy to fit diabetes into your busy life. It sounds like you want to follow it, but haven’t figured out how to fit it into your life. Is that right? (Reflect/confirm.) Let’s see what you are willing to do.
Compare that exchange with this empathic exchange:
Mike: Susan, I want to follow my meal plan, but my schedule is too hectic.
Susan: It sounds like you might be upset because you’re too busy to follow the meal plan we created last time. Is that right? (Reflect/confirm.)
Mike: Yes, I really want to eat well, but my schedule is crazy.
Susan: That must be frustrating, because I know you care a lot about your diabetes. I’d really like to hear about what’s getting in your way. (Empathy.)
Both being compassionate and empathic are important options that require good listening skills. Being empathic, the gold standard in connecting, takes a little additional time and effort that we believe is well spent. But being compassionate is valuable too. If you don’t have time to be empathic with each of your patients, be compassionate.
Step 3. Affirm
The way our patients feel and act is common; they are not alone. Assure Mike that his feelings, even uncomfortable ones, are natural feelings that many people have and will most likely pass:
Susan: Hi, Mike. You’re too busy to follow the meal plan we created last time? Thanks for letting me know. That must be aggravating, because you told me how much you care about your health. Many of my patients find that following a new meal plan gets easier with time. (Affirm.) Your frustration should decrease as you become more familiar with your plan and start to get into a new routine. It’s not easy, but it’s worth it.
People respond more positively when they know that others behave the same way they do. In 2010, Dr. Nat Strand became the first individual with type 1 diabetes to win television’s The Amazing Race, an intensely demanding, global scavenger hunt. Over the course of 23 grueling days, she and her teammate, Dr. Kat Chang, traveled 32,000 miles across four continents, 10 countries, and 31 cities. They raced dog sleds in the Arctic Circle, speed skated in South Korea, and even got lost for a frustrating 6 hours while driving through the deserts of Oman. Their ultimate goal? To win the $1 million prize. Throughout the competition, Nat struggled to keep her blood glucose well-controlled, which dipped into the low 40s and soared into the high 300s when the race became particularly stressful—like the time when she battled her intense fear of heights to leap off a 150-foot crane that hovered over California’s Long Beach Pier. Although her experience was far from typical, viewers with diabetes empathized with her efforts to maintain control of her diabetes. After the competition, she received hundreds of supportive messages from folks who were happy to see that, like them, Nat also struggled with abnormal glucose levels (affirmation).
Step 4. Positively Reframe
During your session, Mike complains that his wife meddles too much in his diabetes care. She questions his food choices and reminds him to check his blood, even though he doesn’t need reminding. He says that she acts this way because she likes to annoy him. You ask if he thinks it is possible that she may do these actions because she cares so deeply about him and his health. The new more optimistic “spin” you offered is a positive reframe. You encourage Mike to thank his wife for caring about him and assure her that she doesn’t have to monitor him so closely. If her actions continue to bother him, the couple can meet with the therapist on your team who can help them communicate more effectively with one another.
If the above supportive exchanges aren’t your approach, what comes out of your mouth may feel awkward or phony. This is partly because it is new for you; learning to ride a bike or play tennis is also awkward in the beginning. The more you engage in this type of interaction, the more easily you will find wording that fits your personal style and point of view. Even Carl Rogers, quoted earlier, struggled to become adept as a listener (Rogers, 1980). If you want, you can use the “fake it ‘till you make it” approach. The truth is that you don’t have to feel empathic to act empathic. As a matter of fact, the more heartfelt comments you make to those around you, the more empathic you are likely to become (Wise, 2013). The good news is that your efforts are not one directional. When you help patients see an issue in a more positive light (positive reframe) that optimistic message also can positively affect how you perceive the issue. Try this technique with your family, friends, and others you deal with each day. Observe how it affects your attitude. As you read through this book, we will share additional ways to apply this.
If you think showing empathy compromises your ability to be seen as an expert or crosses some sort of professional boundary, you are mistaken. It increases your competency. When you connect to your patients as individuals and recognize their feelings, you give them permission to have empathy for themselves. Your professional behavior demonstrates how people can take a momentary break from their troubling issues, yet still be aware and responsible. As they follow your lead, they, hopefully, will give themselves emotional breaks as well. When they do, great changes can happen.
After you respond to your patients’ initial comments, ask what they’d like to do to take better care of their health. Here is an example: Joan says she feels depressed because the neuropathic pain in her feet forced her to drop out of her favorite aerobics class. This class was an important social outlet for her, which had a positive impact on her mood. Now that it is gone, she fears that she may lose even more parts of her life as her diabetes progresses. How would you respond?
Consider the following possible response:
Tell Joan that you are impressed that, as depressed as she feels, she is still able to recognize how dropping out of this class affects her mood, her diabetes, and her social situation. Next, ask her what she thinks she could to do to meet her physical and social needs. Let her know that therapy can help her manage her fear and keep her negative feelings from affecting her ability to care for her health. If a therapist is not readily available, urge her to participate in a local support group, meet with a spiritual advisor, or reach out to another member of her personal support system. If you are available, you also can offer to set up an additional appointment with her so that the two of you can discuss more of her concerns.
Team Up
Be collaborative and invite your patients to share behavioral changes they feel ready to try. If you want them to become more active, for example, ask what type of physical activity they’d like to do, with whom, and at what time. When you tell people what to do, you assume that you know what is best for their lives. If you urge them to do what you think is best, you initially may get positive results, but you also may undermine their confidence and ability to come up with future self-care strategies of their own. Inviting them to brainstorm with you helps them develop healthy problem-solving behaviors when you are not around (Berg, 2012).
If you have a secure work e-mail, share it with your patients and invite them to tell you about positive moments they encounter between appointments. According to the U.S. Department of Health and Human Services, HIPAA’s Privacy Rule “allows covered health care providers to communicate electronically, such as through e-mail, with their patients, provided they apply reasonable safeguards when doing so” (Health Information Privacy, 2008). It is not necessary to send a lengthy response. Just tell them to expect to hear back from you and then reply with a happy face “:)” or a simple “Great!” to let them know you received and enjoyed their message. Positive e-mail interactions and other innovative communication options help support your patients and reinforce important health messages while you are apart.
Explore Cultural Beliefs
To help you learn more about your patients’ cultural views about diabetes, ask the following three questions (Anderson, 2002):
● What does having diabetes mean to you?
● What