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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 3
By Pascal Scemama de Gialluly
The fact that coaching seems to be used to compensate for a deficient doctor-patient relationship also finds support in the larger evolution of this relationship. According to Porter's analysis, the physician-patient relationship has been increasingly moving away from a relationship to a dehumanized delivery of goods and services. Surprisingly, Porter's suggestion is that it is the advancement of science that has primarily contributed to this gradual reduction of the doctor-patient interaction:
But though doctors became therapeutically more potent, in large measure they ceased to give patients what they want. With effective weapons against organic disease, they tended to forget the psychological significance and benefits of the doctor-patient relationship. (671)
This disinvestment in the relational aspects of the doctor-patient interaction has led physicians to focus solely on delivering science at the expense of nurturing a relationship with patients. The result has been a gradual narrowing of the scope of the doctor-patient relationship and its dehumanization. In addition, the benefits of a strong relationship between doctors and patients have been slowly de-emphasized and lost and it is those benefits that are now greatly needed for helping patients managing chronic illnesses. The result is that, at a time when these benefits are most needed, the current state of the doctor-patient interaction makes it very difficult for physicians to help patients create the behavior and lifestyle change needed to manage their chronic illnesses. In this context, the use of coaching is an attempt to recapture the benefits of a stronger relationship between patients and healthcare providers.
While coaching does bring a solution to the current deficiencies of the doctor-patient relationship, its use as a separate process from the physician-patient interaction also works to accentuate and perpetuate the role of physician as a scientific expert delivering diagnosis and prescription services, and can only work to further degrade the importance of this relationship. For physicians, this constitutes another step towards a dehumanization and a narrowing of their role. Furthermore, this trend is not only problematic for doctors, but also presents a number of issues and dangers for patients because physicians have a key contribution to make in many of the non-clinical parts of patient's care and have a unique position to yield considerable influence and support for the patient. In her article "Consumerism, Reflexivity and the Medical Encounter," Lupton highlights the increasingly popular "consumerist view" of the relationship in which "medical services should be treated just like any other commodity . . . Those who adopted this model of doctor-patient relations view doctors simply as suppliers of services" (Lupton 373). However, Lupton warns that:
the consumerist approach may be counterproductive, undermining the very trust and faith that is central to the healing and comfort that very ill people desperately seek in the medical encounter. We need doctors to provide us not only with medical expertise and knowledge but with emotional comfort, concern and empathy towards our suffering and personalized care. (380)
Her analysis suggests that many patients, in particular those suffering from chronic conditions, need the physician to play the dual role of expert knowledge deliverer and counselor. She continues by highlighting the risks of separating these two roles when she says:
If we cannot invest our trust and faith in the expertise of at least some of the medical practitioners to whom we have access, relying on embodied and affective experience and judgment as guides, the alternative may be paralysis and distress in the face of conflicting options. (Lupton 380)