Chronic Disease Management

SUSAN: Let me go over what we’ve talked about so far, to make sure we’re on the same page.

LISA: Okay.

SUSAN: So far I’m hearing you’ve been busy,

SUSAN: Looking after your three kids,

SUSAN: Taking care of your mom,

SUSAN: Working your job at the diner,

SUSAN: and you want to try to take better care of your own health because

SUSAN: you don’t want any health complications affecting your quality of life.

LISA: Yeah. I like my body being in tip top shape, well, at least, in good enough shape!

COACH: Let’s pause here to look at how effective your choices were in eliciting motivations from Lisa. Then you will have a chance to conclude the conversation by discussing her barriers to change and collaborating on a plan.

Effective Path:

SUSAN: It’s good to see you again.

LISA: Good to see you too. Sorry, I meant to get myself here last month, things have just been busy at home.

SUSAN: I know how that can be. I’m glad you’re here now.

SUSAN: All right, let’s get started.

SUSAN: What would you like out of today’s visit?

COACH: Nice work! An open ended question like this is an effective way to set an agenda and learn about Lisa’s needs. By letting Lisa decide what she would like to discuss, you open the discussion to concerns that she may have.

LISA: Talk a little about my diabetes, I guess. I’ve been feeling pretty good, but I haven’t really been looking after myself recently.

SUSAN: So, you’d like to address your diabetes and it sounds like you’ve had some trouble caring for yourself.

LISA: Yeah, I, I feel tired, and sometimes I forget to take my meds. I know, I’ve been told before how important it is.

LISA: But I’m so busy, it kind of gets lost. It’s just not what I’m usually thinking about.

SUSAN: I hear you’ve been busy, and it’s a challenge to take your medications regularly, yet you know it’s important.

LISA: (sighs) My mom’s been bugging me to come in. Says it’s “good for me”. It’s just so hard, you know? For a while things were looking up, I lost ten pounds. But then, I gained it all back. There’s just, there’s so much going on. So I make do.

COACH: Great response. Using this double sided reflection recognizes and validates Lisa’s concerns and reflects Lisa’s interest in “keeping up” with meds. Noticing and reflecting change talk evoked more change talk to from Lisa.

LISA: I mean for the past, (sighs) I don’t know how long, I’ve had so much on my mind. My kids always need to be driven from place to place, my mom is always critical of how I’m living my life, and I’m working long hours at the diner which throws me out of whack.

SUSAN: Sounds like you have a lot going on. It’s understandable that’s impacting both you and your diabetes.

LISA: Right.

SUSAN: Can we explore those areas of your life a bit more, and see how they might be connected to your health?

LISA: Sure. Why not.

SUSAN: How does your work schedule, “throw you out of whack,” like you said?

LISA: Well, it all adds up. Money is a little hard to come by these days, so I kind of have to take the shifts I can get. And after being on my feet for sixteen hours, working a double. I just don’t have much left in me.

SUSAN: What if you talked to your boss about all this?

LISA: (scoffs)I could try that, but there’s not much to be done about it. Waitressing is a grind, and you gotta put a pretty face on the whole time, which is draining after a while. I, I appreciate the thought, though.

LISA’S THOUGHT: I’m not sure how much waitressing you’ve done, but I think you get where I’m coming from at least.

SUSAN: It seems like you’re working hard to support your family.

LISA: I try my best. After my loser ex went off and did what he did, what was I supposed to do? (sighs) Sometimes it can really feel like it’s me against the world.

COACH: Great choice to offer an affirmation about Lisa’s efforts to support her family! It led to Lisa’s disclosure of other important information about her situation that will help both of you collaborate on a plan.

LISA: Things just add up for me. And to make it all worse, I don’t usually get a good night’s sleep.

SUSAN: Tell me more about that.

LISA: Well after I finally get the kids down I try to lie down, I mean, I’m used to getting bladder or yeast infections a couple of times a year, and that would keep me up. Now it’s a regular thing, it’s awful.

SUSAN: That sounds frustrating.

LISA: Yeah. And it’s a bit embarrassing to even be talking about it. But not getting enough sleep definitely adds up.

SUSAN: It seems like this has been part of a pattern of feeling more tired recently.

LISA: It’s been a hard couple of years. (chuckles) It’s not always easy to see, when you’re in the middle of a shitstorm. I mean, it was like I get diabetes, my dad dies, and my husband starts cheating on me, boom, boom, boom. And then there I am, all alone, with four people depending on me. So, I did what I had to. Even if it meant putting my own needs to the side.

SUSAN: So you’ve been focusing on others’ needs before your own, yet you realize there might be more you could do for yourself.

LISA: Yeah. I guess we can talk about that a bit. Unless there’s something else you wanted to talk about?

COACH: Great choice! Offering an affirmation about Lisa’s efforts to support her family led to Lisa’s disclosure of other important information about her situation that will help in collaborating with her on a plan.

SUSAN: How has it been, having your mom with you?

COACH: Great open ended question to explore Lisa’s experience. Since this is a personal topic for Lisa, you may want to use reflections to show Lisa you’re listening, and let her be the one to decide if she wants to share more.

LISA: Well, it’s never been easy talking to her. But with everything else going on, it’s really started to wear me down. I mean I know how much she cares about me, and the kids. But it’s just brought up a lot of old stuff between us. She’s constantly making comments about how I look, or what I’m doing. It’s not the best feeling, hearing that every day.

SUSAN: It sounds like maybe not in the best way, your mom wants you to stay healthy.

COACH: By reflecting what Lisa has told you about her mom, including reframing her mom’s efforts, you’ve helped Lisa focus on her mom as a potential source of support.

LISA: She worries about me. Even when what she’s saying is pretty critical, I know where her heart is. She’s one of the big reasons I came in today.

SUSAN: It seems like your mom can be critical, which is irritating, and at the same time, wants you to stay healthy.

LISA: Yeah, she can be a real pain, but I don’t know, she’s lived with diabetes for a while, and she knows what could happen.

COACH: Great double sided reflection! You accurately reflected Lisa’s feelings while also reflecting Lisa’s perception that her mom wants her to be healthy.

LISA: I do get what you’re saying. She’s prolly trying to help, whether or not it comes off that way.

SUSAN: Well, you know your mom better than I do. From what you said, it seems like she’s trying to be an ally, especially as you both continue living with your diabetes together.

LISA: She’s really been on a kick, recently. Not sure why she decided to start cranking it to eleven. Honestly, part of the reason I came today was to shut her up.

SUSAN: That sounds pretty draining.

LISA: Yeah. She’s so critical of how I live my life.

LISA: Yeah, I’m starting to see that things have been more difficult recently. I’m good, unless there’s more to talk through?

SUSAN: It sounds like your kids have been wearing you out recently.

LISA: Well, I love ’em, but getting them where they’re going can be a lot, sometimes.

LISA: Gracie’s got dance, Tucker’s got football practice, and Rita, she’s always at some friend’s house. But of course, they need mama to take the time, AND the money, to give them a ride.

LISA: My mom tries helping, but she doesn’t like driving so much any more, Being a good momma really is like a second job. That you don’t get paid for.

SUSAN: You’re doing an awful lot to be there for your kids.

LISA: I’m trying my best.

SUSAN: I hear you’re busy with your kids. How are you taking time to care for yourself, look after your own health?

LISA: I, I don’t know. I got a babysitter last month, and took an aerobics class a friend was teaching, but it’s been a little while. There’s just not enough time, with everything I have to do for my kids.

COACH: Great choice! You used a reflection about how busy Lisa is and followed it with an open ended question that tapped into her motivation for self care. Note how this choice also opened the door for Lisa to bring up other concerns.

SUSAN: It seems like your kids have been especially tiring lately, maybe more than usual.

COACH: Great work! By reflecting Lisa’s tiredness, you showed her you were earnestly listening and trying to understand her perspective.

LISA: Could be. Things have been busy, that’s for sure.

LISA: I guess. Sometimes I can get lost in taking care of my kids instead of taking care of myself.

SUSAN: That seems pretty understandable.

LISA: All right, I can definitely see how things have been more difficult recently. Thanks for talking everything through with me. I’m good.

SUSAN: Okay, let’s move on then.

SUSAN: So, when you have diabetes and your blood sugars are running high, it means your muscles and organs aren’t getting the energy they need and you feel tired. The medications help your body to use the sugar in your blood to give you the energy you need to keep you going.

SUSAN: High blood sugar levels increase the amount of urine you produce so it may explain why you’ve been needing to use the bathroom at night.

SUSAN: What do you think of that?

LISA: I think I followed that. I, I guess I just didn’t connect the dots.

COACH: When you shared information with too much jargon, Lisa had a harder time understanding and felt confused about how it related to her health. Using plain language can help foster both understanding and collaboration. Remember, you can always undo your last choice.

SUSAN: I want to make sure the information I shared was clear. So, please tell me what you understood about how diabetes could be affecting your health?

LISA: Well, if I don’t take care of myself and eat well, take meds, exercise or what have you,

LISA: it can mean my body won’t be able to have the energy, uh, blood sugars it needs to keep me going

COACH: Nice job asking Lisa to share what she understood in a way that suggested any misunderstanding might be due to your lack of clarity. Because you shared information clearly and without jargon, Lisa understood and could clearly connect the information to her situation.

LISA: And also, my trips to the bathroom at night could be from my blood sugars being too high.

SUSAN: You have a solid understanding of how taking care of both yourself and your diabetes can help you stay well.

LISA: Thanks. I think so too.

LISA: I, I’ve heard for years about going blind, getting something amputated. It’s hard to think about stuff like that.

SUSAN: Seems like it’s scary to think about health complications like that.

LISA: Yeah. Definitely scary. You never think it could happen to you, but (sigh).

LISA: I know this is serious. And I could definitely have some long term health problems from it.

SUSAN: You’re right, it’s hard to think about the complications, yet knowing you can avoid them by managing your diabetes is a good thing.

LISA: Definitely don’t want to find myself in here with you holding a hacksaw or something. (laughs) No, definitely don’t want that.

SUSAN: So let’s talk a bit more about how we can keep you healthy.

LISA: Sounds good.