Susan Weiner, MS, RDN, CDE, CDN, talks with health coach and diabetes patient expert Riva Greenberg about flourishing, a relationship-centered approach to diabetes care that encourages health care providers to view diabetes in the context of life as it is lived.
What does flourishing look like for people with diabetes?
Greenberg: Diabetes doesn’t dominate one’s life or become one’s identity. The very nature of being human means we have a capacity for adaptation and resilience. We can adjust successfully to changing circumstances that impact our lives, including illness. People with diabetes can find a general sense of well-being living with disease. Often a person comes to accept diabetes, to see it as a part of oneself, and integrate managing the condition into daily activities.
Many people with diabetes can also see something gained from having the disease. When I ask, “What is one positive thing diabetes has given you?” I get answers like “being more compassionate,” “finally losing weight,” “making new friends” and “self-worth from the healthy changes I’ve made.”
Flourishing with diabetes doesn’t mean never feeling overwhelmed, frustrated, angry or sad. Rather, people who flourish recover from negative feelings generally more quickly and easily.
Health professionals aim to help people cope with diabetes. How is coping different from flourishing?
Greenberg: Helping people cope focuses on problem-solving and assumes that diabetes bodies are defective. According to this model of diabetes management, the practitioner must bring those bodies closer to “normal” to help avoid complications. The practitioner is the expert, and the expertise of the patient — the patient’s personal context — may be ignored. The health care provider sets the goals and makes the treatment plan. Ultimately, the aim of treatment and the interaction do little to inspire the qualities a person needs to daily manage their self-care: hope, inspiration, fortitude, self-esteem, confidence, motivation and commitment.
If people can flourish with diabetes, rather than cope, how should health care professionals work differently with patients?
Greenberg: When the focus of care is flourishing rather than coping, the quality of the interaction changes. People with diabetes are seen as whole human beings who are not disabled, but differently abled. Visits with patients are collaborative, helping them to do their best rather than insisting they meet an imposed standard guideline. People, life and bodies are unpredictable and make diabetes self-management complex, not cause and effect. There’s no judgment about high and low blood glucose values; patients are educated to know how to best influence and respond to their numbers.
Four basic principles that reflect human biology and behavior support the flourishing approach to diabetes care: create safety, trust and connection; explore context for an individual’s strengths, resources and challenges; acknowledge and build on what patients already do well; and encourage and praise rather than criticize. People think better in the presence of praise and stop thinking in the presence of criticism.
I am not saying that our current approach has no value — it has taken many people with diabetes far — but I believe people can go further, and the flourishing approach to treatment gives practitioners tools to do that.
Can you give some examples of the tools you teach health professionals?
Greenberg: I offer a tool called flourishing conversation prompts. For example, instead of asking, “What are some challenges you have when trying to eat healthy?” I suggest you ask: “What are some successes you’re having with eating healthy?” Then follow with, “Great! How can you do just a bit more of that?”
Another tool is a logbook. When a patient comes with their logbook, typically the practitioner scans for the numbers that are out of range. Instead, look at the numbers that are in range, no matter how few. Congratulate the patient and ask how they did that. Then ask, “How could you do that a bit more?” In this way there’s no judgment or criticism. Feelings of safety are deepened, the patient feels encouraged to try a bit harder and has a step he came up with to help himself.
How do health professionals respond to the flourishing treatment approach?
Greenberg: They are often inspired and find it both innovative and common sense. I’ve presented the approach worldwide and facilitated workshops in the U.S., including at the American Association of Diabetes Educators annual conference and American Diabetes Association chapter conferences. After I described the approach in Bangalore, India, a dietitian came running up to me after her patient left. Almost giddy, she said, “My patient and I couldn’t stop smiling the whole visit. For the first time I didn’t push him like I usually do, and he’s eager to take the next step he himself came up with.” In Copenhagen, Denmark, a diabetes nurse who uses the approach shared how her patients are more motivated, feeling she’s truly their partner, and how she herself experiences more joy working as her patients’ partner.
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Riva Greenberg is author of three books and hundreds of articles on living well with diabetes, and her fourth book is in the works. She is a requested speaker and received the 2015 International Diabetes Federation Lecture Award for her work in diabetes education and advocacy. She can be reached at firstname.lastname@example.org.
Susan Weiner, MS, RDN, CDE, CDN, FAADE, is the 2015 AADE Diabetes Educator of the Year and author of The Complete Diabetes Organizer and Diabetes: 365 Tips for Living Well. She is the owner of Susan Weiner Nutrition, PLLC, and is the Endocrine Today Diabetes in Real Life column editor. She can be reached at email@example.com.
Disclosures: Greenberg reports no relevant financial disclosures. Weiner reports she is a clinical adviser to Livongo Health.