I just got back from Copenhagen, Denmark. I spent two days conducting skills training workshops and presenting a Keynote that provoked nearly two hundred diabetes health professionals. It also gave them new insights on, and skills how to, work with people who have diabetes.
The conference theme has become the newest idea for empowering people with chronic illness, 'Involving Patients in Their Care.' Involving patients seems like the right thing to do; it smacks of egalitarianism, humanism, equanimity and compassion.
And yet, it is not these things. Primarily because, as a technique that's an outgrowth of how we deliver care to people with chronic illness, it is only more work for already beleaguered patients. The millions of people who often experience balancing their life and their illness as exhausting. Who spend too much of their days, weeks and years performing the daily tasks diabetes demands. Who today must hop-scotch their way through our ever increasing, infuriating, confusing healthcare system.
Attendees at the conference
In actuality, we need to Involve providers more in their patients' lives. We need to not pull people with illness into more decision-making designed for medical practitioners, but have health professionals take a tender step into the other side of the looking glass. Here they can discover, through curiosity and open conversation, how patients live - with what challenges, resources, sources of power, family dynamics, pushes and pulls.
Only with this understanding can providers connect with patients, meeting them where they are. Perhaps the greatest force from which to help those with illness improve their self-care, and to feel cared about.
I shared during my Keynote address something MD Atul Gawande, surgeon at Brigham Women’s Hospital in Boston and Professor Harvard School of Public Health. wrote in an article in the New Yorker magazine:
“In the 1990’s we replaced medical paternalism with the belief that we should activate patients by giving them options. But in the real world they ask us, “What would you do?” Because you are the expert, you still know better. This is for you to decide we say. And that is when people feel completely abandoned.”
Gawande went on to say that palliative care clinicians also offer patients options and then they do something more. They ask, ‘What matters to you?’ And then they do something more, they listen.
And this is when patients feel seen and heard, safe and trusting. When people build resilience as if literally growing new able tissue and neurons. When people's confidence and capabilities expand. And this is when success happens for most people.
Modern medicine was born during the Industrial Age. Our conventional treatment of people with diabetes is characterized by machine values: precision, accuracy, cause and effect and standardization. We speak about individualization yet use standardized, evidence-based guidelines.
Few people with diabetes experience their visits with their healthcare providers as anything but focused on numbers - their A1c, blood sugar, blood pressure, cholesterol, how many times they did exercise, how many healthy meals they ate.
It is time to lay down our repair tools and declare people with a chronic illness are human beings not defective machines. It is time we innovate our treatment approach. To work in a manner that stimulates growth: being in relationship, respecting the expertise of both provider and patient, seeing solutions not only problems, possibilities not limitation, and holding out hope.
I have shared this strengths-based way of working, which I call the Flourishing Treatment Approach, with health professionals in the U.S., Canada, Israel, Sydney, Singapore, the Netherlands and Denmark.
Each time I am met with gratitude and enthusiasm by health professionals and the sincerest desire to move from helping their patients cope with diabetes toward helping their patients flourish with it.
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