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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 4
By Pascal Scemama de Gialluly
Lupton's arguments therefore suggest that, even though patients definitely want more empowerment in their interaction with doctors, they still need the guidance of the physician in making the best decisions for themselves, especially when confronted with complex choices. To be effective, this guidance has to take into account the patient's desires, needs and emotions, and, as a result, cannot be delivered via the mere communication of medical facts but instead through a human relationship. Patients may seek this relational component outside the interaction with their physician and may find some relief with separate health coaches or alternative therapists, but Lupton concludes that "[n]evertheless, the authority and expertise that attend biomedicine and those who are medically trained still carry much weight, and no participants [in the study] had completely rejected biomedicine in favour of alternative therapies" (378). Lupton, therefore, points to the importance of the physician's role beyond the one of clinician and, in fact, suggests that physicians must find a way to address the emotional, relational and personalized needs of patients because from the patient's perspective, they are uniquely positioned to do so.
Such an example of the need to integrate coaching within the physician's role can be found in a study of the importance of goal-setting in clinical medicine. An article written by Elizabeth Bradley, et al. in Social Science & Medicine clearly articulates the value of goal-setting:
By promoting outcomes-based plans of care, enhancing acceptance of clinical recommendations, and facilitating the resolution of conflicting goals, a clear statement of goals may increase the chances of achieving desired outcomes, a result valued by clinicians, patients and families. (Bradley 267)
In other words, desired results are more likely to be attained if they were set as clear goals at the outset of the treatment. In addition, the study findings emphasize the importance of goal-setting in the treatment of chronic diseases:
Conflicts about goals, both among clinicians and between clinicians and patients or families, may be especially prevalent in cases of chronic illnesses when multiple parties are involved in patient's care, and the goals of care are not always obvious since "cure" is not feasible. (Bradley 268)
The conclusions of this study point to the notion that goal setting is central to the care of patients with chronic conditions because it is the place where conflicts between the various parties involved in the treatment and the patients can be addressed. Finally, the importance of the role of the physician in goal setting is strongly emphasized:
The translation [of general goals into specific goals to the patients] is especially complex in clinical medicine in which identification of feasible and meaningful specific goals may require substantial experience and knowledge concerning diagnosis and treatment of disease. Patients and families, who possess general goals, must depend on clinician's expertise for identifying specific recommendations. (Bradley 276)
As a result, because of their medical expertise, physicians have a crucial role to play in goal-setting, also a major part of the coaching process. This role requires them to partner with their patients in order to assist them in translating general goals into meaningful and tailored goals consistent with their clinical conditions and desired outcomes.