by Geri Lynn Baumblatt, MA & Sangeeta Agarawal, MS, RN (right)
Miguel is a 53 year old woman of Mexican descent. She crossed the border 25 years ago and still cherishes her culture and maintains many traditional values and ways of living. A year after being diagnosed with diabetes she arrived at the hospital with hyperglycemia and wounds that aren’t healing. She felt frustrated and helpless.
Miguel wanted to accommodate this change in her health, but she was struggling to integrate it into her life. She wants to eat the foods she’s used to and work with her traditional doctor in Mexico who prescribes medicinal teas. She doesn’t like the recommended diet or insulin injections, and being more active is a challenge given that she never had to think about exercising before. So Miguel wasn’t taking insulin or making changes. She was frustrated and her healthcare team was frustrated.
I had an opportunity to take care of her. We bonded over my own attempts to cook Mexican food. I got a translator and listened to her concerns and frustrations. She wanted to get better, but this plan was not a good fit.
We talked about how she could make changes to her diet, but still eat the foods she loved. For exercise, her daughter helped us come up with a plan where should could walk her grandchildren to school and back - a good walking distance. Blending family with activity appealed to her. We were then able to talk about the importance of getting closed-toe shoes. We talked about the medicinal tea she wanted to drink and together we checked the NIH site for any potential side effects. Looked OK.
Miguel was adamant about not using needles; so we found out if she could take a metformin pills instead of insulin injections. And she agreed to take it for a while, which would also provide time for the diet and exercise to improve her health.
You probably have similar stories. In fact, many ethnic populations prefer to use natural remedies and avoid medications. Over 43% of U.S. minority populations use complementary and alternative medicine (CAM) therapies. As providers and caregivers, often we don’t proactively discuss this. But a shared decision making approach can help us make a more personalized plan while improving trust and outcomes.
Conversations about traditional and alternative therapies
Identify all the points where behavior change is needed and which changes are most critical and which are not.
You first: Consider your own feelings about the traditional treatments. Yes, if there are safety issues or red flags, we need to let people know it’s a concern for their health and safety. But for many other alternative therapies there’s room to create an integrated approach.
Invite people to a conversation & listen: How the condition is affecting them? Is it limiting what they want to do? What’s important to them? What do they want to try? People are fearful you’ll think less of them or chastise them. But this signals you’re open to understanding and hearing them out.
Give them a win first. Look for an opportunity where you can accept their alternative preference and give them a chance to try it. This sets up a partnership and people are often more open to the less negotiable changes or steps they need to take.
Suggest and explain where you think certain medications and tests are important or essential. Our natural impulse is to try and dictate the non-negotiables. But people can feel backed into a corner and won’t share their concerns. Realize they always have a choice and you have to be able to sell the idea to them and help them understand why.
Miguel found a way to adjust and control her diabetes. In fact, she teaches her grandchildren to cook and make healthy choices. She sent me a picture of all of them enjoying fruit with Mexican spices. And she has more energy to participate in play dates with them, which is what really matters to her.
Sangeeta Agarawal, MS, RN is a computer scientist, registered nurse, Clinical Ayurveda specialist, researcher and author. She worked as a successful engineer in Silicon Valley for over 10 years at IBM, Motorola and Google and was part of the team that built the first mobile video platform that was acquired by Skype before realizing her true calling in helping people towards better health. She has provided comprehensive care to cancer patients as an oncology nurse at Mayo Clinic, Stanford and UCSF. She is the vision and driving force behind Helpsy. @sanHelpsy