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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 9
By Pascal Scemama de Gialluly
It then became clear to me that doctors should embrace the coaching approach in dealing with patients suffering from chronic illnesses. Placing the coaching approach at the center of the doctor-patient relationship would also get the relationship out of a non-productive duality. On one hand, patients of today reject the passivity of yesterday's patients even though, as Anderson points out, many need to be trained to become more assertive. On the other hand, there is a tendency nowadays to view the doctor-patient interaction as simply a transaction between a consumer and a provider. In the end, patients seem to want both autonomy and comfort from their doctors. As Anderson rightly suggests, the physician as coach can resolve the conflict between these contradictory patient's needs by encouraging participation and responsibility while providing support and advice.
What struck me in my research is that many physicians seem to be aware of the potential benefits of a new approach with patients but are not taking any leadership to create a new direction. There are obviously many structural obstacles to redefining the doctor-patient interaction, for example, the way doctors are compensated. Ironically, health insurers have no problem disbursing additional monies to health coaches. Why not pay physicians to also be coaches? Anderson mentions the issue of sincerity when physicians appear to act according to the way they are remunerated and not according to the patient's well-being. Unfortunately, the issue of what boundaries doctors put around their role has become far more complex than a simple choice between what is right for the patient and what is right for the physician. In fact, articulating the issue as such a choice is consistent with the increasing transactional construct of the doctor-patient relationship because, in a transaction, there is usually someone better off and someone worse off. What is needed is a vision of the doctor-patient relationship solidly grounded in a win-win relationship where what is right for the patient is also what is right for the physician. This is the potential promise of physicians also acting as health coaches.
Incorporating coaching into the doctor-patient relationship seems to challenge something more fundamental about today's medicine: the fact that it is disease-centered and not patient-centered. Physicians, not health insurers, should take the lead in paving a new direction for their interaction with patients and for medicine as a whole.