How coaching a patient can improve care

In my years of seeing patients, I know that sometimes they can still surprise me. I can see that they want to quit smoking, or they want to lose weight—sometimes with a feeling of desperation—but they feel powerless to achieve their goals. As their physician, I want to see them get healthy so that they can prevent infections, diabetes, and all the other effects that are so difficult for patients to manage. For each patient, how can I find the key that will unlock the solution to their good health?

Case study:

A patient in her mid-20s was generally healthy, very bright, and thinking about applying to law school. However, for reasons she didn’t understand, she had developed a crippling fear of speaking in front of people. During presentations in front of her colleagues, she was frozen when she stood to talk and she thought, “It’s because I had surgery on my face, and everyone sees me as disfigured. They don’t even hear what I’m saying.” The trauma escalated, and she felt frozen when she even thought about speaking in public. Suddenly she worried that perhaps more was going on. Maybe the surgery had caused a neurological impairment? Maybe she’d developed a tumor?

Her doctor listened and said, “First, let’s do a workup to see if there’s anything neurologically wrong.” He performed an exam and determined that there was no problem. Then he used the technique of appreciative inquiry, which focuses on the patient’s positive experiences. “Tell me about a time in the past,” the doctor said, “in which you spoke in front of people and felt good about it.” After a pause she revealed that she had been able to speak successfully in front of people in high school and college. In fact, she had been valedictorian in high school and had graduated from a rigorous college program magna cum laude. During their conversation, she admitted that her friends and family didn’t seem bothered by her facial scars.

The physician said, “You’re intelligent, and I know you can overcome this fear. I would like you to look inside yourself and start focusing on your many strengths. What do you think about doing that?” Then together they decided that she would work with a wellness coach to help her find specific ways to focus on her strengths and overcome her fears.

The coach—who was trained to relate to patients using empathy, appreciative inquiry, motivational interviewing, and more—quickly developed a trusting relationship with the patient to learn about her struggles and her hopes for her life. With the coach’s encouragement, the patient developed goals and decided how to approach new opportunities to speak in front of a group. With small steps, the patient made progress and developed a newfound confidence whenever she had a presentation.

A few months later, she visited the physician for a follow-up appointment. Her demeanor and confidence were so changed that the physician remarked, “You’re a new person!” because the difference was so profound. As they talked, she revealed that after focusing on her strengths and trying new approaches to public speaking, she developed the courage to give a huge presentation at work and was extremely well received. Then she said, “My facial scars? I think I was using them as an excuse to explain why I wasn’t speaking as well as I wanted. People don’t really care about that at all.”

Lessons learned

What does this illustrate? To me, it shows that it’s our job as physicians to find out what will work for each patient.

Before I related to my patients in this way, I was frustrated with those who just wouldn’t follow through to get better. I thought, “Well, they’re just not responsible people. There’s nothing I can do about that.” I didn’t realize that my patients were failing themselves because I hadn’t taken the time to make that caring connection with them.

Once I am able to tap into a patient’s emotional life, I can help the patient discover the barriers that prevent him or her from quitting smoking, losing weight, taking medication properly, or exercising. And once we see the problem clearly, we can work on overcoming the barriers together. Working with a trained coach helps my patients work through the nitty-gritty of the tasks. And when my patients come back to see me, I cheer their progress and use my technique of appreciative inquiry to keep them on the road to good health.

To learn more about physician coaching and earn CME, attend a weekend workshop in Seattle for the Coach Approach: Transforming Health Care through Patient Engagement. Training takes place September 8-10 and November 6-8.

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