 |
|
Dialogues@RU is published
annually
by the
Writing Program at
Rutgers, The State
University of New Jersey
Volume 4
Fall 2005
The Physician as Coachin the Management of Chronic Diseases - Page 2
By Pascal Scemama de Gialluly
Health coaching is therefore using the same key elements as the other forms of coaching such as ownership, encouragement, focus and discipline. One example of such providers is Sentara Health Management which recently implemented a "Disease Management Program Utilizing 'Life Coaches' for Children with Asthma" as described by Randy Axelrod et al. in The Journal of Clinical Outcomes (38). The focus of this program is "to provide education and support that promotes optimal independent functioning, thus reducing the need for more intensive and higher-cost services" (Axelrod 38). Across these examples, there is a consistent objective to support patients in taking greater responsibility and ownership for the effective management of their conditions, often by making some behavioral change. The expectation is that such "better" patients will be more effective at self-managing their conditions, reducing their need for doctor visits and expensive procedures and therefore meeting the ultimate objective of these coaching programs: saving money. The need for insurance providers to find innovative solutions- such as coaching- to the mounting costs of treating chronic conditions is not surprising. According to a recent article by Laura Landro in the Wall Street Journal , "Chronic diseases affect at least 125 million Americans and cost more than $500 billion last year" (D1). Furthermore, "Meeks [MD and CEO of The Haelen Group] estimates that coaching saves to $2 to $3 for every dollar spent" (Scalise 2). Given the magnitude of these potential cost-savings, it is not surprising to find health care insurers at the forefront of new approaches incorporating coaching.
Not only is coaching delivering cost-saving, it also seems beneficial for patients. For example, Sentara Health Management mentions that their program "has not only met the cost-saving goals for Sentara Healthcare but has made a major contribution to improving the quality of life of asthma patients" (Axelrod 42). The coaching approach seems therefore well-suited for reducing treatment costs as well as creating long-lasting changes in behavior, which are often required to adhere to the constraining treatment plans of chronic illnesses.
One of the central elements of the implementation of coaching is the coach-coachee relationship. Interestingly, in the implementation of health coaches reviewed, the coach is never the physician but a different health care professional such as a nurse or dietitian working in conjunction with a physician. In one such implementation, the coach is a registered nurse certified in asthma disease management (Axelrod 38) who works closely with the primary care physician. In another example, it is a dietitian who coaches patients (Vale 247). One possible explanation for this separation of the role of the coach from that of the physician is the fact that coaching has, so far, been pioneered by health insurers ¾ driven by the need to reduce costs ¾ rather than by the medical profession.
The details of one particular program do, however, point to another explanation for the separation between the coach and the physician. The coaching methodology used for the treatment of coronary heart disease incorporates a step called "assertiveness training" in which "the patient is trained to be assertive in the relationship with the treating doctor, so that patients can negotiate treatment needs with the doctor" (Vale 247), and one of the conclusions of this article and study is that "Effective coaching teaches the patient to get the most from a consultation with their usual doctors" (Vale 247). This suggests that coaching is a necessary add-on to the interaction with the physician in order to compensate for the limitations of the physician-patient relationship. This point is reinforced by another conclusion of the study: "Coaching does not involve prescription of medication and hence, coaching does not seek to take over the medical management of patients" (Vale 251). This conclusion demonstrates the exclusive focus of the physician-patient relationship - in particular in the management of chronic illnesses - on diagnosis and prescription of the right medications, and supports the view of coaching as separate from the medical management of the patient. The need to use coaching in addition to a narrowly focused physician-patient interaction suggests that coaching is presently used and is actually beneficial to patients because of the limited focus of the physician-patient interaction on medications and procedures.