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1.When we see patients, we often start talking with them about the issues we have identified as important, for example discussing their lab values.  Instead, you might start the conversation with “tell me what concerns you about your diabetes today”  This will open up the door for conversations between patient and provider.
2.Validate the patient’s concern.  Allow them to process.  Continue to ask questions such as, what have you tried before or what has worked before.  The patient will eventually be able to set their goal and what they need to do to reach their goal.  Allow them to come up with a solution themselves, but then then provider can add their own suggestions as well. 
3.Have the patient write their goal down and how they plan on accomplishing their goal.  Write their goal and plan in their chart as a starting point for discussion at the next visit. 




Reference: Wagner EH, Austin BT, Von Koroff M. Improving outcomes in chronic illness. Managed Care Quarterly. 1996;4(2):12-25