{"id":33826,"date":"2013-08-22T08:25:22","date_gmt":"2013-08-22T12:25:22","guid":{"rendered":"http:\/\/asweetlife.org\/?post_type=feature&p=33826"},"modified":"2016-01-09T06:07:24","modified_gmt":"2016-01-09T11:07:24","slug":"how-does-your-diabetes-educator-make-you-feel","status":"publish","type":"post","link":"https:\/\/asweetlife.org\/?p=33826","title":{"rendered":"How Does Your Diabetes Educator Make You Feel?"},"content":{"rendered":"

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Despite my love and appreciation for the medical profession as a whole, I, like many people with diabetes, do not like diabetes educators. In fact, I don\u2019t just not like them; I feel openly hostile toward them. Nearly every interaction I\u2019ve had with a certified diabetes educator (CDE) has left me feeling judged and condescended to, no matter how well my actual diabetes care was going at the time.<\/p>\n

I feel bad about these sentiments, because most CDEs are very nice people. They\u2019re so nice, in fact, that they have devoted their careers to trying to help other <\/em>people, deliberately entering a field that nearly guarantees that they will be overworked and underpaid. In reward for their efforts, they are often faced with patients who don\u2019t listen, don\u2019t act on their suggestions, take out their anger on them, or \u2013 this definitely applies to me \u2013 express skepticism at everything they say. It\u2019s amazing anyone signs up!<\/p>\n

Given this mutual frustration and mistrust, I was very excited by a talk I attended at this month\u2019s American Association of Diabetes Educators (AADE) conference<\/a> in Philadelphia. Titled \u201cMaking Shifts Happen: From Drama to Empowered Conversation,\u201d it suggested a powerful new approach that might change this dynamic for patients and diabetes educators alike.<\/p>\n

The two speakers were Paige Reddan, MS, RD, CDE, who\u2019s been living with Type 1 since 1993, and David Emerald Wolmeldorff, who has Type 2 diabetes and is the author of the book The Power of TED<\/a>\u00a0(The Empowerment Dynamic), on which the talk was based.<\/p>\n

In a nutshell, the point of the talk \u2013 and the TED approach to diabetes \u2013 is to redefine the role each person plays in relationship to diabetes. In most situations, explained Wolmeldorff, a patient and CDE are two players in what he calls \u201cthe dreaded drama triangle\u201d (a play on the Karpman drama triangle<\/a>). This triangle consists of three interconnected roles: the victim (in this case the person with diabetes), the persecutor (diabetes itself) and the rescuer (the diabetes educator).<\/p>\n

Intuitively, this makes sense: diabetes is the persecutor victimizing the person with diabetes, and the educator (or any diabetes-related professional) is there to \u201crescue\u201d the victim by providing expert help and support that only they are qualified to provide. But the problem is that this desire to help the victim \u2013 well intentioned though it might be \u2013 can actually perpetrate the person\u2019s sense of victimhood.<\/p>\n

While diabetes can certainly feel like an unwanted persecutor, viewing yourself as a victim of diabetes is very disempowering and stressful. Part of the definition of being a victim, after all, is not being in control; not being in control means that you don\u2019t have the power to proactively change the situation. And being powerless provokes anxiety.<\/p>\n

In this situation, diabetes becomes something to be feared, a problem that you just want to go away. And while the diabetes educator may truly want to \u201crescue\u201d you from this, in reality, by perpetrating this anxiety and sense of victimhood, they\u2019re often just enabling the cycle. As Wolmeldorff explained, when you feel anxious about something, you often will take action to get rid of that anxiety. But when the anxiety goes away, you may revert to your previous behaviors. In the case of diabetes, where your previous behaviors may have been causing<\/em> the anxiety, reverting to those behaviors will make your anxiety spike again \u2013 perhaps with a touch of guilt thrown in at your perceived lack of willpower or self control (perceptions that the CDE may inadvertently \u2013 or advertently \u2013 reinforce as well). So you take action, your anxiety goes down, you stop taking that action, and it returns again. You feel guilty, stressed, and even more like a victim. It\u2019s an emotional version of yo-yo dieting.<\/p>\n

Instead, Wolmeldorff and Reddin offered an alternative triangle, which he calls TED: \u201cThe Empowerment Dynamic.\u201d In this situation, the diabetes educator is no longer the rescuer, but the coach. Diabetes itself is no longer the persecutor, but the challenge. And the person with diabetes is not a victim, but a creator.<\/p>\n

What this means in practice is that instead of being driven by anxiety caused by a perceived problem, the person with diabetes defines what he or she actually wants <\/em>\u00a0— a shift in perception that makes it much more likely for he or she to maintain a change in behavior. Think about it: the point of fixing a problem is to make it go away. The point of working toward a goal is to bring the goal closer.<\/p>\n

Here\u2019s a sample scenario of how this might play out: whereas a \u201crescuer\u201d CDE might perpetrate anxiety in the patient by saying, \u201cYou really need to get your numbers under control \u2013 do you know about the risks of amputation?\u201d a coach-oriented CDE might say something like, \u201cWhat are some of your goals for your health?\u201d or \u201cWhat changes do you wish you could make?\u201d — or even just, \u201cWhat can I help you with today?\u201d<\/p>\n

The patient might need some encouragement \u2013 indeed, most of us are used to being treated as victims, not creators. But if you keep asking open-ended questions, we\u2019ll likely be able to come up with something. It doesn\u2019t even need to be specific — even something as broad as \u201cI want to feel healthier\u201d can provide a great entry point.<\/p>\n

In that case, a coach-oriented CDE could say something like, \u201cThat\u2019s great that you want to feel healthier. What is one small thing you could do tomorrow to help you work toward that goal?\u201d Maybe it\u2019s taking a 10-minute walk after dinner. Maybe it\u2019s only eating half of dessert. Whatever it is should be concrete, clearly defined, achievable, and \u2013 while brainstorming together is a great idea — ultimately decided upon by the patient herself.<\/p>\n

In this model, anxiety is replaced by a positive goal, and the patient has a self-defined path to get there, baby-step at a time. The next time the CDE and the patient meets, the coach CDE would try to praise whatever steps the patient had made toward the goal and help the patient brainstorm next steps. Instead of criticizing failures, the point is to create attainable, patient-defined goals \u2013 and recognize patients for their efforts in achieving them.<\/p>\n

This may sound gimmicky, but if you have any doubt to its value, think of the last time you had a frustrating experience with a CDE \u2013 or any diabetes health care professional, for that matter. What if, instead of starting your appointment by poring over your glucometer\u2019s numbers and circling highs and lows (i.e. starting with perceived problems first), they simply sat down and asked you what you wanted to talk about or work on that day? What if, instead of feeling ashamed and judged by a CDE \u2013 and annoyed since they are not the one personally living with your version of the disease \u2013 you felt supported, encouraged and actually listened <\/em>to?<\/p>\n

If this all sounds obvious to you then, first, I hope you will consider a career as a certified diabetes educator and, second, I wish you\u2019d been at the question-and-answer session. The room was packed with CDEs, people who not only had made career choices to help people with diabetes, but were attending a conference to learn more about how to help people with diabetes, and had deliberately chosen a session targeted toward helping them help people with diabetes. In other words: they really want to help!<\/p>\n

And yet as I listened to the questions from the audience \u2013 and chatted with some CDEs afterwards \u2013 I realized how often even the best-intentioned CDEs inadvertently perpetrate the so-called dreaded drama triangle with their patients. They told stories of how frustrated they felt when they repeatedly warned patients of the complications that would ensue if the patient didn\u2019t follow their suggestions. (This is completely understandable from their perspective \u2013 who wants to have a patient lose their foot? \u2013 but also very anxiety provoking and victimizing for the patient.) They explained how they started appointments by looking over their patients\u2019 numbers, circling highs and lows with a pen (presumably to identify areas to work on, but completely forgetting to acknowledge all the effort all the \u201cgood\u201d numbers took to achieve). They might say things like, \u201cYou really need to lose some weight,\u201d or \u201cYou should really be on insulin\u201d \u2013 both of which might be true, but both of which phrasings come across as accusatory, scary and shaming — and assume that the educator, not the patient, has all the answers. When I suggested to one (very nice, very compassionate) CDE that she might begin appointments simply by asking her patients what they\u2019d like to talk about that day, she actually took notes. (Note: this is an excellent self-esteem boost, though I do realize the irony of taking on the \u201crescuer\u201d role myself.)<\/p>\n

For more information, I recommend checking out Wolmeldorff\u2019s book \u2013 The Power of TED. And if you have a negative experience with a CDE or medical professional, instead of fuming silently or spending the evening thinking about all the clever things you could have said (my preferred response), consider bringing up this approach with them yourself. Most CDEs genuinely want to improve their patients\u2019 lives. Maybe, rather than criticizing them, we should empower them instead.<\/p>\n

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