Historical Gratitude and Where We Still Need to Innovate — “Heartware”

August 15, 2019
Diasome.comDiasome BlogHistorical Gratitude and Where We Still Need to Innovate — “Heartware”
Riva Greenberg
Riva Greenberg is a health researcher, health coach, author, advisor and requested inspirational speaker. Having lived with type 1 diabetes for 47 years, her work is dedicated to helping people with diabetes and health professionals work collaboratively in a way that helps both flourish. She is sharing the Flourishing Approach across the world. Riva has written three books and hundreds of articles, is an IDF Blue Circle Voice member, an Ambassador for Insulin for Life, has spoken at the United Nations and is recognized for her humanistic work by professional associations and organizations.
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After 47 years of living with type 1 diabetes, I am grateful. “For what?” I hear you asking. For the many tools that have become available over the past dozen years that make managing diabetes easier. That said, there’s also an area in which we’ve hardly progressed at all. I’ll get to that because that’s the work I do.

I often say I’m blessed; I benefit from historical gratitude. I can look back over nearly five decades, since my diagnosis in 1972 at the age of 18, and be grateful for the many devices and improved medicines that exist today. Imagine being diagnosed and not even having a glucose meter?! They didn’t exist for the first ten years of my diabetes life. I had to pee on a strip to see roughly where my blood sugar had been four hours earlier.

Today glucose meters are tiny, require only a small drop of blood and count down in five seconds or less. I can compare that to my first brick-sized meter with a two-minute countdown that required a big splash of blood and a paper towel to clean up the mess.

Syringe needles are shorter, thinner and less painful. Not only do we have insulin pens, but “smart pens,” that track your last shot and how much insulin you have on board. Some insulin pumps work with what has been the most life-changing device for me, the continuous glucose monitor (CGM). I could not have guessed decades ago that I’d be able to see my blood sugar without pricking my finger and know its value every five minutes and whether it was going up, down or was stable. People with diabetes themselves have invented “looping” and we know an artificial pancreas is not far from being brought to market.

We’ve had numerous improved medicines. The insulins I use now last longer, work faster, peak less and no longer cause me to wake at 3 AM sweating through my nightgown with a low. The first easy to administer nasal glucagon has just been approved by the FDA and stem cell research, islet cell transplantation and clinical trials continue to advance.

Finally, tons of research and information have been made available to people with diabetes. When I read Dr. Richard Bernstein’s book, The Diabetes Solution, more than fifteen years ago, I learned removing much of the carbohydrate from my diet would stop the blood sugar “rollercoaster” (spikes and lows) and lower my insulin dose. It did both, dramatically. 24/7, people with diabetes exchange their wisdom and experiences online, and many say it’s as valuable, or more, than the information they get from their doctor.

Yet there is one area of diabetes care in which we’ve hardly advanced at all. We haven't trained health professionals in the specific human-based skills they need to work with people who have a chronic illness. That is what I’ve been teaching for the last several years. I believe the interaction between health professionals and people with diabetes is as significant to health, wellness and success as the availability of drugs and devices.

Most health professionals treat a person with diabetes as if they have an acute condition. They examine the body, focus on the condition and attempt to fix or repair what they see as broken. Clinicians have largely been trained to see their patients, regardless of their condition, as only their bodies, or—I might make the analogy—as machines. The body is broken, and so like when a machine breaks down, their job is to fix it.

Trust me, if I fractured my spine and needed a surgeon to put me back together, go ahead, treat me like a machine. But tending to a person with diabetes, or any chronic condition, requires a different mindset and set of skills. When people must self-manage a condition, they need a supporting partner, a health professional who creates connection, trust, safety and collaboration. These are the vital energies that inspire patients to do the hard work of self-management. As my Ph.D., nurse practitioner, certified diabetes educator friend confirmed, “The secret to success in diabetes care is building relationships.”

This paradigm shift from a mechanistic to a whole-person approach is what I’ve developed and shared with practitioners in the U.S., Canada, Israel, India, Singapore, the Netherlands and Denmark. I call it the Flourishing Approach; its aim is to help people flourish, not merely cope with diabetes. It has helped health professionals be more joyful in their work and more successful, and helped their patients to feel more secure and supported in their care.

Machine-based values like precision, perfection, accuracy, and standards were imported into modern medicine at the height of the Industrial and Scientific Revolutions. They emphasize control, predictability and cause and effect. They greatly advanced medical technologies, but they are not what helps people manage a health condition.

Even recent treatment approach initiatives in diabetes, like patient empowerment and motivational interviewing, reflect the notion that patients need to be empowered and motivated, and I, the health professional, will make that happen. They represent cause-and-effect thinking: I fix you and you will work properly. But people and diabetes, both, are complex, uncontrollable and unpredictable. People are not broken machines, their biology has changed. 

Insights from neurobiology and social sciences tell us that to best help people create health we need to: 1. Explore individuals’ contexts, 2. Meet people where they are, 3. Help people develop their innate adaptability and resilience, 4. Acknowledge what people do well and build on it, and 5. Create a relationship of connection, safety and trust.

If you have diabetes, you can help your provider work with you from a more flourishing perspective. Ask them to look at you when they talk to you, repeat anything you don’t understand and slow down if necessary. Tell them what your main concern is, and if they’re prescribing a treatment plan, speak up about what you feel able and willing to do.

It is time we advance our thinking about innovation in the diabetes space to include our treatment approach. For the relationship between health professional and patient—“heartware”, as I call it — is as fundamental to patients’ success as software and hardware.

In healthcare, just as in life, relationships are the connective tissue and fertile soil from which everything grows and flourishes.

Share your story with us.

Diasome seeks to serve people with diabetes by developing cutting-edge therapies and by serving as a forum for our community to educate and inform others about the challenges and successes in living with diabetes. We actively seek perspectives from the rich and diverse world of clinicians, scientists, thought leaders and people with diabetes. To share your unique perspective with us, email Diasome at info@diasome.com

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