 |
|
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 6
By Pascal Scemama de Gialluly
Similarly, the transition to physicians acting as coaches will not happen easily given the enormous structural and economic investments in the current disease-centered view of medicine. However, efforts to integrate coaching into the doctor-patient relationship should continue because the emergence of the physician as a coach could constitute the first concrete and tangible step towards a more profound paradigm shift over time.
But are patients ready to be coached, and are physicians ready and willing to act as coaches? Patients want greater autonomy in their interaction with doctors but, as Porter suggests: "there is still a longing . . . for that old doctor, ever available, avuncular and conveying hope" (685). In particular, when suffering from chronic illnesses, patients want a committed partner that can help them manage their conditions successfully. However, coaching may not be suited for everyone since it requires an active patient participation. Considering Lupton's view in Medicine as Culture that: "The health problem of the patient . . . has an obvious impact on the extent to which the patient may feel empowered or wish to take control of the encounter" (115), severe and disabling illnesses may preclude patients taking on the role of coachee in their interactions with doctors. Fortunately, the coaching approach is inherently flexible and the amount of the patient's responsibility and ownership can be adjusted. The physician, with a knowledge of the impact of various clinical conditions on the patient and equipped with a higher level of listening and understanding of the patient's situation, is best positioned to bring such modifications to the coaching process.
As far as physicians are concerned, in his recent book Your Money or Your Life , Cutler summarizes the position of many doctors on providing their chronically ill patients with active help for behavior modifications such as diets and smoking cessation:
When asked why [physicians] do not provide these services [counseling for behavioral changes], physicians have a uniform answer: they are not paid to provide them, and so cannot afford to invest in them . . .They cannot do for patients what they know needs to be done. (30)
Physicians do recognize the role they could play in a patient's behavior modifications but are constrained by the way they are currently remunerated. It seems that, unless our healthcare system and the way physicians are paid for their services are overhauled, it is difficult to imagine that many physicians will fully embrace coaching despite its long list of benefits for all constituencies of the health care system. Paradoxically, the same economic factors that are driving health care insurers towards coaching are also an obstacle to physicians taking on the role of coaches. Given some of the risks involved with separating the coaching process from the doctor-patient interaction, perhaps health care insurers should pay physicians to be coaches rather than some other health care workers.
Coaching is part of the answer to the challenges chronic illnesses pose to our health care system, but leaving the initiative of leveraging the power of coaching to health care insurers is ultimately dangerous for both patients and physicians. By taking the lead in promoting and incorporating coaching at the center of their interaction with chronically-ill patients despite the current obstacles, physicians could improve health outcomes, achieve significant societal cost savings, and be the catalyst for a redefinition of the purpose and goals of the clinical encounter more suited to deal with the treatment and economic challenges of chronic illnesses. Such leadership from physicians could ultimately create a new momentum for a much needed overhaul of our health care system that supports what is right for patients, physicians and society as a whole.