A New Tool to Motivate Patients’ Self-Care


Well, here’s one for the diabetes professionals, educators and nurse practitioners–although as a patient you may learn something too. July 26th at the Marriott East Side Hotel in mid-town Manhattan I attended Dr. William Polonsky’s seminar, “Understanding Behavioral Change to Help Improve Diabetes Outcomes,” which he delivered to more than 120 diabetes professionals. You can look here forfuture programs

Dr. Polonsky is a noted figure in diabetes, in fact I started this blog talking about him. He’s a psychologist, diabetes educator, Associate Clinical Professor of Psychiatry at the University of California, President and Founder of the Behavioral Diabetes Institute (BDI) in San Diego, the only institute looking at the emotional side of managing diabetes. He’s also the author of several coping with diabetes books. The program he’s created helps practitioners identify and address their patients’ psychological hindrances to self-management. He identifies 7 “Tipping Points” — tipping points being those hindrances that get in patients’ way–and helps educators coach patient’s through them tipping them toward better self-care. Invariably, if you work with patients you will recognize these among your patient population. If you’re a patient, you may just notice one of these emotional blocks applies to you:

1. Depression, which can be tipped toward a positive, engaged outlook on life

2. It’s no big deal, which can be tipped toward recognition of personal risk

3. Inevitability of complications which can be tipped toward hope

4. Treatment skepticim which can be tipped toward a realization that treatment can work

5. Unrealistic action plans which can be tipped toward clarity of action

6. Poor social support which can be tipped toward optimal social support

7. Environmental pressures which can be tipped toward new, effective ways of coping with stresses

The “tipping” is done by helping patients address their underlying emotional or psychological block or wrong-thinking and through inquiry and coaching getting to the root of the block and helping patients see a more positive outcome, this helps them get more invested in managing their diabetes.

Polonsky went for a laugh first by asking his audience, “How many of you have run into a patient in the last month that wasn’t taking perfect care of himself?”  He to the expected response as laughter spread across the room. He then told us that no patient is unmotivated to live a long and healthy life although sometimes it appears that way; the problem is that taking care of diabetes often doesn’t seem very rewarding. Imagine an educator saying to a patient, “You know Mrs. Smith if you take this medication I’m prescribing, see a battery of doctors regularly, get an A1C test every three months, watch what you eat and exercise every day, check your blood sugar all the time and do this 24 hours a day the rest of your life, here’s what’s in it for you — Nothing! If you’re lucky nothing is likely to happen.” It takes a lot of motivation for the average patient to perform the over 150 (they were counted by diabetes educators) self-care tasks day after day after day just to maybe not have something bad happen, maybe.

Polonsky’s course, sponsored by Roche, gives healthcare providers resources, training and support to help them identify and evaluate their patient’s tipping points and address them to create partnered, meaningful treatment plans. If you’re an interested healthcare provider, you’ll find more information here and on the BDI web site. If you’re a patient take a look at his brochure on the BDI site: The emotional side of diabetes: 10 Things You Need to Know. It’s a reassuring read, especially if you notice you may have a tipping point of your own

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