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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 8
By Pascal Scemama de Gialluly
One of the more intriguing aspects of Scemama's analysis is the fact that a key aspect of coaching is "assertiveness training." As explained in Scemama's paper, this type of training is used to empower the patient when discussing treatment options and other vital information with the physician. Scemama comments on the conflicts that may arise when the doctor's authoritarian nature and exclusive focus on the disease rather than the needs of the patients clashes with the patients' "contradictory needs for autonomy . . . and comfort from their doctors." In order to further establish a need for the convergence of these two roles, Scemama might have stated that if the physician were to assume the position of the coach, then he would simultaneously stimulate the patient's desire to take responsibility for his illness while offering advice on medical options for treatment, and as a result there would be no conflict involved. Furthermore, the physician would be more than simply a counselor or a support system, as Scemama stated, but the doctor would also be training the patient to be assertive and to govern his own disease.
Scemama's project inspires a multitude of questions which leave the reader interested and motivated by the essay to uncover additional information about the use of coaching in the health profession. A few of these questions surround the physician's unwillingness to act as a coach because of the lack of financial compensation. One may question the sincerity of a physician whose chief concern is not the well-being of the patient but the payment for the treatment. As Scemama states, the vital doctor-patient relationship has been transformed into merely a relationship of goods and services. Overall, Scemama offers an excellent proposition for a newly-emerging coaching field within the medical profession. Chronic illness often drains the spirit and livelihood from an individual, leaving him with a diminished desire, if any desire at all, to take control of the situation and therefore to take control of his life. Furthermore, many patients feel powerless and uninformed about their disease even after consultations with their doctors. However, through their relationship with a physician-coach, these same patients could be empowered and encouraged to be self-reliant. Therefore, Scemama's suggestion to incorporate the roles of the physician and the coach is an excellent solution to an emerging problem.
Response
Pascal Scemama de Gialluly
When I read about the use of the use of health coaches in the treatment of chronic illnesses, I was intrigued. I already had the opportunity to be exposed to the use of coaching and its benefits in the performing arts, business and personal development. In addition, as a pre-medical student, the doctor-patient relationship was of strong interest to me because it is where the scientific and human sides of medicine meet. The management of chronic illnesses constitutes a major challenge to our health care system, not only because of its costs but also because it often requires patients to make some substantial behavior and lifestyle changes. Initially, the coaching approach seemed well-suited to address these challenges. But as I looked deeper into the implementation of coaching and into the issues surrounding the doctor-patient relationship, I realized that the approach used by health insurers had some major risks. The use of coaches as a complement to the doctor-patient interaction could further exacerbate the rapid dehumanization of the doctor-patient relationships by institutionalizing a doctor-patient interaction solely focused on medical issues. Furthermore, the use of coaching outside the doctor-patient relationship also presents risk for patients. Managing a chronic illness involves having to make complex decisions involving not only medical but also personal and ethical elements. Physicians seem to be the best positioned to integrate these various elements, to help patients make the best decision possible and manifest the required behavior changes.