Shireen: In today’s episode, we are in conversation with Dr. Deborah Greenwood and Tami Ross. Both discuss how to utilize a solution focused approach to manage chronic conditions like diabetes, their breakdown, what the solution-focused approach is, how it defers from other diabetes management approaches, and how it can positively impact an individual’s management of their diabetes.

Stay tuned.

 Tami Ross and Dr. Deborah Greenwood are solution focused diabetes care and education specialists. Passionate about positivity and empowering people with diabetes to live life to the fullest. Tami is a dietitian by training, and Dr. Greenwood is a nurse. Four years ago, they co-founded a partnership and blog entitled A Fresh POV for You, A Guide to Healthcare Professionals in Taking a Solution-Focus Approach to Practice.

Welcome Dr. Greenwood and Tami.

Dr. Greenwood: Hey It’s great to be with you. Thank you for having us on.

Tami: Thanks for having us.

Shireen: Awesome. A pleasure having both of you on Dr. Greenwood and welcome back, Tami. Of course, you’ve been part of our podcast before. You guys have a professional partnership and block focused on guiding healthcare professionals and flying the solution-focused approach. How did you guys come about working together? What started all of this?

Dr. Greenwood: Sure. Well, Tami and I go back about 12 years. We were both leaders at a national diabetes organization and it was one of those things that within five minutes we knew we were very like-minded. And so, then we became friends and then over time kind of into this professional partnership.

And so, we discovered solution-focused approach a while ago. And it kind of resonated with us over time as we were working on some other projects. We actually both were and have been early adopters of the strength-based language and talking with people about diabetes. And so, co-created a video called Changing the Conversation.

And we were really focusing on what is known as person first language, right? So, you’re talking to a person who’s living with diabetes, not a diabetic, right? And that’s just sort of one small example. But the kind of these principles around language were about decreasing stigma that can be associated with living with a chronic condition and really kind of help people live their best lives.

And when we learned about solution-focused approach, we thought, wow, these language tenets are very close to what solution-focused approach is about. And so, we tried to learn, grow and adopt some more.

Tami: Yeah. And I think too that during that time, we had a lot of soul-searching conversations. What does this look like and both of us have spent our careers working in the medical profession in primary care and endocrinology. And so often those conversations are focused on problems. Instead, we wanted to really switch the paradigm and focus on solutions and look to the future and to kind of envision what would a future where I’m happy and healthy look like.

And so out of that really, really grew this collaboration and our blog of Fresh POV For You. And we’ll go on to talk a little bit more about that.

Shireen: Which of course takes me to what exactly is this solution focused approach. And then also more specifically, how is this approach different from you know healthcare professionals and how they treat patients today?

Dr. Greenwood: Yeah. So, both Tami and I have worked I think almost our whole entire career in the diabetes world. And so, we’ve had a lot of conversations with people with diabetes. And we heard really loud and clear that, again, this blame and shame conversation happens a lot. And so, the conversations when people are talking with healthcare professionals about diabetes tend to make people feel bad, right?

Because there’s a lot of negative talk and almost like they’re not working hard enough. They’re not trying hard enough. Everything’s bad and there’s just a lot of blame. And we know that people don’t want to go to see their healthcare professional when they feel like that. And diabetes and A1C is this measure that’s very common.

And people often felt like this was like a grade. Like they were like, oh, I can’t go in and my A1C is bad. And so, when we talk about solution-focus approach, as Tami just mentioned, it is just like it says, it’s focusing on solutions as opposed to problems. It’s trying to identify what people are already doing that is working well for them, and how do we encourage them to do more.

So, you’re making an assumption that the person already has the ability to move forward and help solve problems that exist. And it’s brief in that it’s not like kind of a counseling approach where you’re looking back and you have to try to examine all those problems because it’s very future focused, right?

So, we’re not looking back, we’re saying, what’s happening today? What do you need to move in the direction that you want to go into? What can we leverage that’s working well? And in keep you doing those things. And there’s a great quote, a solution focus quote by the founder that problem-talk creates problems and solution-talk creates solutions.

So, it really reframes the thinking into these possibilities, opportunities, and really reframing into this fresh perspective that just seemed very inspiring to us. And so, there’s kind of a hallmark characteristics of solution-focused approach. So, I’ll start off with a couple and then I think Tami will talk some more.

So, as I mentioned, the first one is its future focused. So, you’re helping that person think about and design their vision for the future, right? What do they envision for themselves for the future? It’s very goal directed, and it’s setting small, reasonable goals that can be achieved that resonate with the person, right?

It’s not this other person coming in saying, you need to do this. It’s them identifying what they’re able to do and then kind of building and growing on that. And those solutions are creative, as I said, not focusing on their past problems, but thinking about what could be done. And Tami’s going to follow up with some of these other kinds of key tenants.

Tami: Yeah. I think one big difference is the idea of think partners. So as healthcare professionals, a lot of times our patients will go in to see their provider or their diabetes care and education specialist, and they may get a list of things that you need to walk 115 minutes a week. You need to lose 15 pounds.

You need to eat more vegetables, whatever it would be. And so, it’s more a prescriptive type of approach rather than a think partner approach. And with that, in solution-focused practice, we actually step alongside our patient or client. And as Deb said, we envision what is the future going to look like?

What do you want your goals to be? What’s going well? How can we do more of that and accomplish that vision for the future. So, it’s a think partner rather than that kind of hierarchy of medical professional in patient or client. I think another big hallmark is solution focus practice leverages exceptions.

And so, as the founders of solution-focused practice really shared exceptions are those times when a problem could have occurred, but somehow it didn’t. And so, it makes me think about a patient that I worked with a year or so ago. And in his visit, we learned that he was taking his diabetes medicine.

He was able to do that about half of the time. And so, exploring that, how were you able to take your medicine? What was going on that day? How can we do that more often? And so, through that conversation, what we learned is that he was successful with taking his medicine when he put it in his pocket and took it to work with him.

And so, in the end, as a think partner and us talking through the situation, he decided to put his diabetes medicine with his keys so that when he left for work, he could put both in his pocket. And when he came back for his follow up visit, he was taking his medication much more often. And so, I think that’s a good illustration of the think partner as well as leveraging those exceptions and doing more of what is already effective. And so, if people want to learn more about these hallmark characteristics, we have a whole blog series that addresses these.

Shireen: That is interesting to know. One of the things, and actually Dr. Greenwood, I’m going to shift this question to you. Diabetes is really important for many people, especially those who have been struggling with it for a while.

How has this approach really been successful in treating those with diabetes and really helping individuals manage their diabetes?

Dr. Greenwood: So, I’m going to back up to diagnosis. So, we did a series last year on primary care since people with type two diabetes are mostly managed in the primary care setting.

And our goal was to kind of help primary care providers understand the solution focused approach and to give them like a little toolbox of different things, different strategies to try. And so, one of the biggest things that I think this can be helpful with is at diagnosis.

To really change that conversation from the very beginning from, again, this is not your fault. You didn’t do anything wrong. This is a genetic condition. And there are so many things that are out of your control, right? Age, race and ethnicity. There are so many things that just can’t be changed. So, we can focus on some things that you can change and I’m here to help you. And I think even just that first question.

When someone would come into the office and instead of being like, oh, your A1C is high. Oh, this is a bad disease. You ‘re starting with we’re a team, we’re going to work together. This is a chronic condition and you’re going to have this, but there are opportunities and you’re going to learn and you’re going to grow, and I’m going to help you.

And we know it’s hard work and there’s each person is different and that’s what our goal is. Is to find out what’s going to work for you. And that might sound simple, but that never happens. And so that’s really like our kind of first tactic was to be like, let’s start by, what are you doing now that’s going well for you?

And how can I support you? Simply, simply said like that. And I think the second kind of key piece that Tami mentioned was asking these exception questions, right? So, what exceptions are. Again, it’s the problem could have happened, and it didn’t, so why not? So that’s the time to explore, so what is working well for you.

Instead of, again, stop doing this. It’s what’s working well for you and what can you continue to do? And this theory is that if you keep doing things that are working well, you have less time to do things that aren’t working well. It’s building those successes.

Shireen: Yeah. No, it makes so much sense. And, Tami, over to you. I mean, some of the keywords really within this type of therapy include things like hope, motivation, resilience. You’re really using that positive language. How can healthcare professionals really guide their patients who don’t have the hope or motivation to really feel that way and really be able to cope with their diabetes?

Tami: Yeah, I mean, I think you bring up a really important point. Hope and motivation and resilience are words that we have heard over and over through our research and different focus groups that we’ve done. And I think the really important point is in order to have hope and motivation, you have to be resilient.

And so, when we talk about resilience, what that means is it’s really the ability to bounce back. When something difficult comes your way, you’re able to bounce back or you’re able to walk through it and still hold your head up. And so, as people with diabetes face challenges each day, building that resilience in the end helps to have hope and motivation to keep moving forward.

And so, I think those three words really are linked. And you mentioned the word hope and it’s been said that COPE is just one letter away from hope. And so, by building resilience, we’re helping our patients and clients really to have hope in that positive focus for the future.

Shireen: I absolutely love the focus on positivity there. Now, you both did a research study titled Applying a Solution-Focused Approach to Life with Diabetes. It’s mentioned in the article that “participants described feeling a sense of self blame associated with diagnosis of diabetes”. How does your solution-focus therapy and this focus on it really help shift this mindset away from the self-blame?

Tami: Yeah, I think Deb’s going to take that one.

Dr. Greenwood: Yeah. Just to share a little bit more, so there’s one of the two tools and the solution-focused toolbox is called the miracle question. And it’s an exercise again to help people do that future visioning. And so, when we did our research study, we actually did it over Twitter and we walked through a miracle question approach to then be able to see how this approach resonated with people.

And so, we modified this miracle question for, for diet for diabetes. And we said, so if you could fast forward to a time where you feel satisfied with your diabetes management, what will be different in your life that will let you know things are better? And so, then there’s a series of questions that we were drawing them to help to be optimistic, to think about the future, to then think about the small steps that they can do again, doing more.

And so, there’s a process to go through this. So, we asked a bunch of questions about that. And so, during that process, one of the questions was, what strengths do you have to help you manage your diabetes every day? And that’s where we really started to hear people talk about things like resilience.

And people started to kind of narrow down on the different things that sort of bubbled up during this. And so, we identified that people do internalize all this comment around, it’s your fault that you have diabetes. And so, there’s a lot of that.

And this process sort of bubbled up that it really was a different way of thinking. And so, they felt more self-compassion the way that these questions were talking about diabetes. And they could envision themselves being resilient by the way these questions were phrased and kind of the emotions that they were bringing up.

And so, at the end of the research study these five themes emerged. What do people want at the end of the day is they want more of their own living their life, and they don’t want diabetes to be the focus, right? They want to have less time thinking about diabetes. They want to have laughter and humor. They want this self-compassion. They want support and just to do things differently.

Shireen: That what you said right there toward the end just really resonates with me, Dr. Greenwood. In fact, as you know, we do some diabetes related programming and pre-diabetes related programming. And in fact, one of the things that we learned early on as well around it was that people don’t like the label diabetic.

They don’t want to be labeled as this is a person who has diabetes. There’s so much more to life than that one label. In fact, that’s one of the reasons why we’re Yumlish and not even Yumlish Health because it’s about food. It’s about togetherness. And when we talk about that and Tami, this next question is for you. How does a solution-focused approach, how is it suitable for people with diabetes? And is it only people with diabetes can also be applied to other groups? And how would they benefit from it?

Tami: Yeah. So, a solution=focused approach can be used in different areas of healthcare, for instance. And it’s just really made its inroads into the area of diabetes here in recent years. But with that, it could be used with anyone. For years, when I see patients, one of the first things I’ll ask them is, so what’s been going well in your life?

It may be health related; it may be family related or whatnot. And it really starts that visit off on a positive note. So, no matter what the health challenge or condition may be our colleagues listening can certainly use this solution focused approach to practice in the area of nutrition.

A lot of times we look at what kinds of changes have worked well for you to help you see more of your blood sugars in target. And so very often our patients, clients are excited to come back and tell us what has been working well for them. And oh, I’ve seen that when I do this, I spend more time in range with my blood sugars.

And so, I think yes, the diabetes world, it certainly can be beneficial, but in other areas as well. And I’m not sure I answered the second part of your question. So, what was that in regard to?

Shireen: Yeah, I think, and this actually leads me to the next part of it of how can someone benefit from it. And what I’m also hearing you say, Tami, is that a lot of this approach is really focused on psychological ways, right? To tackle that diabetes distress. How does this approach, or how can it be combined with, and of course, Tami with your background as a dietitian. How can this approach really be combined with nutrition therapy to reverse or even put someone in remission of their diabetes or can it?

Tami: Yeah, I really like that you mentioned remission because the majority of individuals that have diabetes either have pre-diabetes or type two diabetes. And what we know is that lifestyle change, medications, there’s a number of different factors that come into play that can bring blood sugar back into the non-diabetes range.

And so, in a sense, diabetes may be in remission in that blood sugars appear to be in the non-diabetes range. But if you go back to doing whatever you were doing before you stop your healthy eating or being physically active, those blood sugars may go right back up. And so really, we take the approach of looking at remission rather than reversal in that sense.

It’s just what the evidence is showing us right now. But a solution-focused approach in nutrition is hugely impactful in helping with weight management, with blood sugar control. And so really it can be used to make a big, big difference not only in what you’re eating, but in physical activity and other healthy lifestyle perspectives as well.

Shireen: I love it. And I’ll just throw this question out there. As you’ve sort of taken on this approach, how have healthcare providers responded back? And what has their response sort of been from what they’re used to doing and the way they deliver care today versus this approach in adopting some of the principles within it?

What are some of the things that you hear from healthcare providers? Be it primary care providers? I would think that would be sort of that main audience. But what are you hearing from them? Tami, I’ll pose that to you first and then to Dr. Greenwood.

Tami: Yeah, so it’s been overwhelmingly very positive. A primary care provider that we know actually really encouraged us. We’ve given national podium presentations on this. Deb has presented internationally on this, and so really there was that encouragement from our colleagues and providers to share this because it can transform a visit in a matter of minutes.

If you open a visit with a patient and say what has been going well. Rather than starting in on, oh, your A1C is not at target. You’ve gained five pounds. Rather than focusing on the problems, focusing on what’s going well. And so really it was the encouragement of our provider colleagues that have encouraged our whole blog series that was focused on primary care. Deb, what else do you have to add?

Dr. Greenwood: Yeah. Obviously, Tami and I are diabetes care and education specialists, so that was our initial like audience. And we’ve done, as Tami said, a couple of presentations. And the last time we did one, it was late in the day, like five o’clock at night and we’re like, ugh, no one’s going to come.

And we had a packed house full of diabetes care and education specialists wanting to learn. I think people find it refreshing, like it’s a different way to think. And it just resonates so well with people living with diabetes. And I will tell you from the stuff that we’ve done on Twitter in the past. We’ve heard directly from people with diabetes that if only I could have my appointments, my visits be this way I feel like things would be so much better.

I can’t remember exactly what it was, but there was some Twitter conversation a while back and someone responded. You need to get those ladies that talk about solution-focus approach in on this conversation because this person could use some of what they’ve got to learn.

Shireen: I love it. I absolutely love it. And so, to what you also said and Tami, this question is back over to you. I’m going to try to squeeze it in 30 seconds here. But really quickly, Tami, if I am a patient listening to this podcast right today, how do I change that conversation with my PCP? At my next appointment, what can I do differently to move the conversation in that way?

Tami: That’s a really good question. Thinking about it from the patient perspective, maybe starting the visit with, you know, here were some of the goals you gave me, but here’s the progress that I made. Here’s what’s going well. I’m really happy to see this. I appreciate when you recognize all the hard work that I’ve been doing because managing a chronic condition, like diabetes is more than a part-time job.

And so, I think bringing that to their provider’s attention. That’s a way to start the conversation off. Deb, do you have anything to add to that?

Dr. Greenwood: I mean, I think just encourage people to self-advocate. That I know it’s hard but to ask for what they need. And if sometimes that means finding a different provider that has a different way of thinking about things. Maybe that’s the right choice as well.

Shireen: And with that, unfortunately we are toward the end of the episode at this point. Dr. Greenwood, can you tell us how our listeners can connect with you and just learn more about this work that you’re doing?

Dr. Greenwood: Well, sure. We would love to have you check out our blog, afreshpovforyou.com. We post a couple times a month. And we also will post our blog to Twitter @afreshpovforyou. And we share it on our LinkedIn account. So yeah, please, please follow along.

Shireen: Awesome. Well, thank you both so very much for joining me on this episode. To our listeners, you know the drill. At this point in the episode, you will head over to our social media and answer this quick question. Have you or a loved one tried a solution-focused approach with your primary care with a physician to really manage your chronic condition?

And if so, we’d love to hear about your experience and how it worked out for you. So again, head over to our Facebook, our Instagram, find this podcast post, and again, answer this simple question, have you or a loved one tried a solution-focus approach with your primary care and how did it work out for you? We will continue the conversation there. With that, Dr. Greenwood, Tami, thank you so very much for your time again.

Dr. Greenwood: Thank you.

Tami: Thank you.

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