Ineffective Path:
COACH: Let’s get back to your conversation with Lisa. You’ve been able to discuss her motivations, now use the skills you’ve learned to discuss her barriers to change and collaborate on a plan.
SUSAN: We should chat a bit more about how you plan on managing your diabetes.
COACH: When you tell Lisa what to talk about instead of asking her, she is less likely to be ready to collaborate. Try asking questions to foster more of an open dialogue about what to talk about.
LISA: Sure.
SUSAN: I have some ideas about how you can better manage your diabetes.
LISA: Oh yeah? Well, I have some thoughts too.
SUSAN: Oh, okay. Share away.
COACH: Even if you think you know what’s best for Lisa, it’s often better to use reflections and ask questions to let your patient feel in control of their own solutions. Lisa knows her situation better than anyone else! Asking Lisa to ’fire away’ and share her ideas was a nice recovery.
LISA: So, recently I’ve been thinking about,
LISA: The idea of my diabetes affecting my long term health, you know? I know all about the ugly stuff that can happen.
LISA: I know I should look after myself better.
LISA: It’s hard to remember to take my meds, and check my sugars. But it seems like it won’t take as much time as getting more exercise or what have you, so I’d rather focus on that.
SUSAN: If you set a timer on your phone, it might help you remember to take your meds.
LISA: Yeah, I’ve tried that when it goes off, I usually have to deal with whatever’s at hand. Screaming kid, argument with my mom, early shift at work. I have such a hard time keeping track of everything that I make this big, master calendar with everyone’s schedules. It’s kinda stupid, but that’s just what my life has come to.
COACH: By choosing a course of action for Lisa, you’re not giving her the space to come up with her own solutions, which she’d be more willing to stick to in the long term. Next time, consider asking her about ideas for remembering to take meds.
SUSAN: And why haven’t you been using that calendar for yourself?
LISA: I do, I write the shifts I’m working, so my family knows where I am.
COACH: Starting a question with “why” often adds an unwanted judgmental tone, and when you asked about Lisa’s calendar she felt like you were implying she couldn’t find her own solutions. Try using more reflections and open ended questions to collaborate with Lisa.
SUSAN: You should put your medication schedule on that calendar too.
LISA: Doctors orders, huh.
SUSAN: Just trying to problem solve.
LISA: I mean, I’ll think about it. And go with something that works best for me.
SUSAN: You sure you, yeah, I’m good.
COACH: Words like “should” can make you appear pushy and unwilling to consider other options. Instead of giving an opinion, try asking Lisa to brainstorm her own solutions. If it is her idea, it is more likely lead to a plan she’ll be able to stick to long term.
LISA: If I keep in mind why I’m doing it: staying healthy, that is, it might help me stick to the plan.
SUSAN: Tell me your goal for the next few months. It should be specific and realistic.
LISA: Uh, “yes ma’am”.
LISA: Well.
COACH: Asking Lisa to set a specific and realistic goal at this point is somewhat premature and directive. Consider undoing your choice and trying a different option. It would be better and more collaborative to ask permission to focus on a goal, which supports her autonomy and may increase buy in.
LISA: The most important thing is figuring out a way to take my meds better.
SUSAN: I think you’re going to be able to stick with your goal this time around.
LISA: I’m gonna try.
COACH: You may be aiming to encourage Lisa, though the statement has a patronizing tone. Instead, consider affirming her past efforts and interest in self care to help Lisa feel empowered, with less risk of feeling judged.
SUSAN: I’m sure if you try really hard, you’ll be able to take care of yourself, just like you take care of your family.
LISA: (scoffs) Sure.
COACH: Though this choice is encouraging, which is admirable, the vague language and exhortation led Lisa to feel like you don’t understand her challenges. Consider being more specific about the behavior you admire.
SUSAN: Who do you have to help you with managing your diabetes?
LISA: No one, really. Just me.
SUSAN: How would you feel about including your family more in that process?
LISA: I mean, I don’t want to burden them. But I see what you’re saying. Maybe I could sit down with my mom, see if she’d be willing to help set the kids up with cereal in the morning, so I could be sure to have time to take my pills.
SUSAN: So even a little more time could make a big difference.
LISA: It’s worth a shot.
COACH: Great idea! Asking open ended questions about sources of support provides an opportunity to increase openness to an action plan.
SUSAN: Would it be okay if I go over what we talked about?
SUSAN: You’ll figure out a plan to take your medication that works for you,
SUSAN: You’ll chat with your mom about helping with your kids’ breakfast,
SUSAN: And hopefully I’ll see you at your next appointment. Right?
LISA: Sure. Thanks.
SUSAN: Happy to help.
COACH: Lisa left her appointment with an intention to figure out how to be better at taking her medication.
COACH: However, Lisa felt frustrated by her conversation with Nurse Belle, and missed her next appointment. When she showed up a few months later, her A1C levels had gotten higher, she did not report any changes in behavior, and she said she was feeling even more tired since her last visit.
COACH: Now you can take a look at your performance dashboard, which will go into more detail about your choices throughout the conversation.
Effective Path:
COACH: Let’s get back to your conversation with Lisa. You’ve been able to discuss her motivations, now use the skills you’ve learned to discuss her barriers to change and collaborate on a plan.
SUSAN: Well, thanks for talking everything through with me so far. Sounds like we’re ready to figure out how to make healthy choices work better with your routine.
LISA: Sounds good to me!
SUSAN: How do you think you could take steps to better manage your diabetes?
COACH: Nice job using open ended questions to explore Lisa’s ideas, instead of being directive or lecturing her.
LISA: So, recently I’ve been thinking about,
LISA: The idea of my diabetes affecting my long term health, you know? I know all about the ugly stuff that can happen.
LISA: I know I should look after myself better.
LISA: It’s hard to remember to take my meds, and check my sugars. But it seems like it won’t take as much time as getting more exercise or what have you, so I’d rather focus on that.
SUSAN: What are some of your obstacles to regularly taking your medication?
LISA: (sighs) I’m so busy keeping track of each of my kids’ schedules that I guess I lose track of my own.
SUSAN: How do you stay on top of your kids’ schedules?
LISA: I, it might be a little silly, but I print out this calendar, and color code it for each kid. They got to choose the colors, which makes them happy. And then I know what’s going on, you know?
SUSAN: You keep track of a lot of people’s schedules, which seems like a strength of yours.
LISA: Yeah, I am pretty good at staying on top of other people. I guess, starting with the new calendar next week, I could put something on the calendar every day in my own color at the times I need to take my meds. I could even do that before I printed it out!
SUSAN: That sounds like a great plan.
LISA: I’m pretty good with computers, came from my time in the Coast Guard, banging out the paperwork every time I had to write up some drunken incident at a seaside bar! (laughs) That makes sense! Anything else that would help you to remember to take your medications?
COACH: Great affirmation! It stimulated Lisa to think about and identify some specific steps she could take to address barriers.
LISA: If I keep in mind why I’m doing it: staying healthy, that is, it might help me stick to the plan.
LISA: Y’know, I thought you were going to come in and give me a big ol’ lecture today. I’m glad you’re not that kind of person.
SUSAN: Thanks. You know more about what works well for your family than I ever will.
SUSAN: To build on what we were just talking about, in regard to your diabetes management, what would be a specific, realistic goal over the next three months?
LISA: Well,
LISA: The most important thing for me would be, starting with the new calendar next week, I could put my med schedule up in my own color, and really make an effort to take my medication.
SUSAN: When would be a good time for me to check in on how things are going? Ha. I don’t know, my schedule is all over the place. A call might be a little tricky. Any other options?
SUSAN: You’re welcome to send a secure text message to update me on the plan.
LISA: Okay, I should be able to shoot you a quick text next week.
SUSAN: Sounds good.
COACH: Great idea to ask about preferences for follow up to the plan. It increases the likelihood of following through and provides an opportunity for subsequent problem solving.
LISA’S THOUGHT: I’m glad I have someone I can talk to about all this.
SUSAN: No change is too small here. Any change you make is a step toward being healthier.
LISA: That’s good to keep in mind, and less pressure is a bit of a weight off my shoulders. Thanks.
SUSAN: Who do you have to help you with managing your diabetes?
LISA: No one, really. Just me.
SUSAN: How would you feel about including your family more in that process?
LISA: I mean, I don’t want to burden them. But I see what you’re saying. Maybe I could sit down with my mom, see if she’d be willing to help set the kids up with cereal in the morning, so I could be sure to have time to take my pills.
SUSAN: So even a little more time could make a big difference.
LISA: It’s worth a shot.
COACH: Great idea! Asking open ended questions about sources of support provides an opportunity to increase openness to an action plan.
SUSAN: You do an impressive job of taking care of people, and I’m sure you’ll be able to look after your health too.
LISA: Thanks. I hope so.
LISA: I’m good at taking care of people, keeping track of my kids’ schedules. I can take care of myself too.
SUSAN: Would it be okay if I go over what we talked about?
LISA: Yup. I gotta get going.
LISA: Sure, go right ahead.
SUSAN: You’re going to put your medication schedule on your family calendar,
SUSAN: You’ll chat with your mom about helping with your kids’ breakfast,
SUSAN: And you’ll check your calendar and let me know when it would be a good time for a follow up appointment. How’s that sound?
LISA: Sounds good to me.
SUSAN: Thanks so much for talking, Lisa. I look forward to hearing from you next week.
LISA: All right. I’ll text you an update then.
COACH: Lisa left her appointment with a plan to take her medication more regularly by putting it on her family calendar.
COACH: Lisa felt empowered by her visit with Nurse Belle, and followed through on her plan to better manage her diabetes. During Lisa’s next appointment, her A1C levels had improved, and she said she was feeling a little less tired in general.
COACH: Now you can take a look at your performance dashboard, which will go into more detail about your choices throughout the conversation.