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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 1
By Pascal Scemama de Gialluly
Treating chronic diseases has become a major challenge to our health care system. The costs of managing chronic conditions have become enormous and successful health outcomes often require significant behavior and lifestyle modifications from patients in addition to medical procedures and medications. As the major deliverer of health care to patients, physicians are in a natural and unique position to help patients create the changes necessary to successfully manage their condition and, as a result, create better health outcomes. However, such a role has become difficult or even impossible given the deterioration of the doctor-patient relationship over the last fifty years, as detailed by Roy Porter in his history of medicine The Greatest Benefit to Mankind , and given the financial pressures of health maintenance organizations on doctors. It is in this context that health insurance providers are pioneering the use of non-physician health coaches as a complement to the doctor-patient relationship. This implementation of coaching separate from the doctor-patient relationship is, however, risky for both patients and physicians. Instead, coaching should become the heart of the interaction between physicians and patients. In addition to bringing health benefits to patients, coaching could revitalize the doctor-patient relationship by reducing the current polarization between the old paternalistic and the new consumerist models of the doctor-patient interaction as analyzed by Deborah Lupton in Medicine as Culture and "Consumerism, Reflexivity and the Medical Encounter" in the journal Social Sciences & Medicine, and could ultimately help meet the challenges chronic illnesses are creating throughout our healthcare system.
Coaching may be new to medicine but it is commonly used in many disciplines and professions. Originating in the performing arts and professional sports, coaching is also being used both in business and in personal development and has given rise to a whole new professional field. According to the International Coach Federation, an organization of business and personal coaches,
[p]rofessional coaches provide an ongoing partnership designed to help clients produce fulfilling results in their personal and professional lives. Coaches help people improve their performances and enhance the quality of their lives. Coaches are trained to listen, to observe and to customize their approach to individual client needs. They seek to elicit solutions and strategies from the client; they believe the client is naturally creative and resourceful. The coach's job is to provide support to enhance the skills, resources, and creativity that the client already has. ("About Coaching")
In this definition, some of the key distinguishing features of coaching become apparent. The objective of coaching is to produce tangible results. It is therefore action-oriented and focused on reaching specific goals defined by the individual. Coaches need to be effective listeners and need to tailor their approach to each individual. A significant part of the coaching process involves eliciting and defining goals and objectives as well as strategies to reach them. Finally, the most important feature of coaching is the relationship between the coach and the coachee: a partnership based on the premise that the client has a lot to bring to the process and he is taking responsibility for the achievement of his goals.
These characteristics are consistent with the ones medical programs are trying to incorporate in their use of coaching. Margarite Vale et al. in the Journal of Clinical Epidemiology describe such a program in which coaching is defined as a "method of training patients to take responsibility for the achievement of the target levels for their particular modifiable risk factors [in this example, cholesterol level]" (Vale 246). A recent article by Dagmara Scalise in Hospitals & Health Networks states: "Good coaches produce good athletes through encouragement, training and discipline. Now some [health care insurers] are betting that the same approach will produce better patients ¾ leading to better outcomes and saving money. Their method: a form of disease management known as health coaching" (1).