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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 5
By Pascal Scemama de Gialluly
Physicians are therefore in a unique position to leverage the benefits of the coaching approach not only to improve patients' health outcomes - and create cost-saving - but also to create a new middle ground between the various antagonistic forces straining the doctor-patient relationship. By becoming coaches, physicians have an opportunity to redefine the doctor-patient relationship into one acceptable to today's more empowered patients while, at the same time, reaping the benefits of the more paternalistic interaction of the past. As Lupton makes clear, patients are increasingly experiencing the polarization that exists between the "consumerist" and the "passive patient" views of the physician-patient relationship.
In a socio-cultural context in which autonomy and rationality are highly privileged and dependency upon others is largely viewed as evidence of weakness and irrationality, lay people may feel a continual tension between wanting to behave in a consumerist manner and avoid dependency on doctors . . . and their equally strongly felt desire. . . to take on the "passive patient" role. (380)
This tension and confusion combined with the limited focus of physicians on delivering diagnosis and treatment rather than on a comprehensive relationship with their patients epitomizes what has gone wrong with the doctor-patient relationship. In contrast, coaching, because of its inherent features, respects patients' autonomy while using a compassionate, supportive and sometimes brutally-honest relationship as a foundation. As a result, coaching can easily accommodate the sometimes-contradictory needs of patients for autonomy, guidance, reassurance and comfort from their doctors. The result would be a reduction of tension and confusion experienced by patients, an improved dialogue and a relationship focused on defining and achieving individual health goals consistent with the patient's clinical condition and life circumstances.
To reap the benefits of coaching, physicians must therefore make it central to the way they interact with patients. But the transition to a coaching-centered doctor-patient relationship will not be easy because, while appearing to be a mere change in communication technique, the adoption of coaching suggests and implies a profound change in the role of physicians. Concentrating on the person and his goals and his needs in the face of a disease shifts the primary focus of physicians away from the disease towards the whole person. The importance of a personalized process that is not primarily focused on disease management but on the patient's unique desires and needs is starting to be recognized in the medical community, but also faces similar considerable challenges. In "The End of the Disease Era" published in the American Journal of Medicine, Tinetti and Fried, both physicians, advocate for the shift of medical care away from disease towards the attainment of individual goals (Tinetti 179). Their premise is that:
the changed spectrum of health conditions, the complex interplay of biological and non-biological factors, the aging population and the inter-individual variability in health priorities render medical care that is centered primarily on the diagnosis and treatment of individual diseases at best out of date at worst harmful. (Tinetti 179)
They recommend an "integrated individually tailored" model extremely consistent with the coaching approach - preferences and objectives of each patient. Similarly, they conclude that:
Perhaps the greater barrier will be that the disease model is so entrenched that most clinicians and patients are unaware of its existence. What was once itself a new model, developed as a means of translating emerging scientific knowledge into better medical care, is now accepted as "truth.." (Tinetti 184)