Coaches can help with lifestyle goals in a way that doctors cannot

More Americans are overweight and out of shape than ever before.  Their sedentary, high-calorie lifestyles are causing an epidemic of obesity, high blood pressure, heart disease, and degenerative arthritis among other preventable conditions.  If those aren’t bad enough, obesity and a sedentary lifestyle also raise the risk of breast cancer, colon cancer, and other common forms of cancer.

Doctors all across the nation are struggling to treat these lifestyle-induced conditions with new and advanced medicines.  Medical care helps a little, but if the lifestyle doesn’t change, the illnesses get worse.  So doctors try to help there too, advising their patients to:  “Lose some weight.  Start working out.  Eat fewer calories.  Stop smoking.”  Indeed, doctors are expected to help their patients live a healthy life.

Why is that?  Physicians aren’t trained to help patients change their behavior.  And they shouldn’t be.  In actual practice most doctors need three or more years of residency after four years of medical school just to be great at treating diseases. Then they must be continuous learners to keep up with the ever-changing field of medicine.  It’s tough to make sure that you’re treating patients to the most current and best recommendations.  So doctors are working hard just to give the right treatments, and we want them to be behavior change experts too?  Forget about it.

If you’re a patient, your unhealthy lifestyle is not a medical problem.  It’s a behavior problem.  If you’re a doctor reading this, I recommend you just be the medical expert.  Stick to diagnosis and treatment.  Regarding helping your patients change their lifestyles, I’m letting you off the hook.  Explain to your patients that their lifestyle is causing their illnesses and you recommend they live differently.  Once.  Then just do the prescribing.

Well then you ask, “Who will help patients change?”  I recommend life coaches, also called personal coaches.  These are professionals dedicated solely to enabling individuals change behavior to achieve their goals.  Coaches help clients achieve greater focus, see new possibilities, identify methods to change, and adopt new behaviors.  It works.  It’s what coaches do.

Now, for you patients – coaches are prepared and ready to help you with your lifestyle goals in a way that doctors are not.  I know because I am both a doctor and a coach.  Expect your doctor to help you with your medical problems, not your lifestyle problems.  As a doctor, I prescribe a coach.

Peter J. Weiss is an internal medicine physician and former health plan CEO.  He is author of More Health Less Care and can be reached at More Health, Less Care: Building America’s Wellness System.

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  • http://www.pacificpsych.com/ pacificpsych

    I have a somewhat different take on this.

    Anyone can call themselves a life coach. Any Tom, Dick and Harry with no training in anything can advertise that they’re a life coach. As a result of seeing who does life coaching, I used to think the whole concept was ridiculous.

    At some point I realized that I do ‘coaching’ in my work as a psychiatrist. It’s nothing other than a sliver of psychotherapeutic work, which I do anyway. Discussion of a particular problem in the here and now? Check. Making interpretations which allow the patient to gain insight about a situation that’s happening right now? Check. Thinking together about solutions to a work or personal crisis? Helping the patient view something in different ways? Of course.

    Encouraging an active solution, be it volunteering, making changes at the work place or rearranging their life in some other way? Discussing and making a plan for exercise? Doing relaxation? Check, check and check, and that’s not an all encompassing list.

    I’ve found that these short interventions can be very beneficial. Doesn’t last forever? Few things do. It’s a form of informed encouragement. The emphasis being ‘informed’.

    Basically, you’re doing the fun part of psychiatry, with people who appreciate it, instead of sitting in some horrible community mental health center filling paperwork all day and writing scripts.

    I wouldn’t, therefore, say that MDs don’t know how to help with lifestyle problems – I think patients who enter a medical setting have a different frame of mind than those who will pay for a life coach. You can explain till you’re blue in the face that you do everything in the realm of ‘wellness’, but if you have that psychiatrist title, people are fixated on the idea that “all you do is give pills”. It’s amazing how deep set this notion is. Calling yourself something else is just a way to break through this barrier. I think having an MD ‘coach’ beats by a long shot most other types.

    • http://www.heartbeat-coaching.com Janet Beatrice

      @pacificpsych – While it’s true that anyone can call themselves a life coach, a certified life coach has training that does indeed create lasting change. I know. I have a life coach, and through my training, I finally discovered my passion. What was it? Life coaching!

      I am now enrolled in an intensive training program. I’m learning a variety of skills, tools, and techniques that will allow me to become the best life coach I can be. If I don’t fulfill the requirements – and that includes mentor sessions in which my ability to coach is assessed – I will not become certified.

      I’m already a competent life coach, and I’m halfway through my training. I’m coaching people professionally at half the price I’ll charge as a certified life coach.

      But I know that I’m not there yet – that I still need to master the skills I’ve learned and there is yet more to learn!

      So yes, life coaching can be very effective if you’re willing to do the work (which is not easy but is enjoyable as we tap into your motivation and help you release blocks to success, among other things).

      I would recommend that anyone looking for a life coach visit the International Coaching Federation (www.coachfederation.org). On the right there is block you can click on to find a certified coach. You can choose what specialties you want to be coached in and find a coach in the niche you’re interested in.

      Janet

  • http://www.themusicwithinus.com Lisa Chu

    Peter, thanks for this post! I went to medical school and then left the field before doing a residency. My brother is a doctor. My parents are obsessed with western medicine. So I grew up steeped in the medical mindset. And now I’m a life coach. I finally get to work with people in a healing, transformative way that enables them to see through their own illusions to the pure peace of awareness.

    I never respected or even knew what “life coaches” did until about a year and a half ago. Now I know that, like doctors, not all life coaches are the same. I had hit a wall physically and emotionally for the first time in my life, and nothing in my toolbox of business-based analysis, intellectually based reasoning, or just plain work-harder-until-it-gets-better experiences was working for me. Ever since before going to medical school, I had been in the business of believing I could actually change other people’s behavior, and take responsibility for other people’s lives.

    These were core beliefs that never left me, even after I left medicine.

    What training to be a coach has taught me is a whole new level of insight into human experience that was never taught in medical school. And thank you for saying that it was rightfully so. The problem with this is that many doctors-in-training believe that they not only can but *should* be able to change their patients’ behavior, because it’s a doctor’s job to solve problems, by whatever means necessary.

    I’ve learned a whole new way of interacting with people that is more in alignment with our true nature. At our core, we humans all want to feel connected to what is true for us, what feels good in our bodies, and what we deeply desire. No one can tell another person what’s best for them. And no one can “get” another person to change. However, a great coach who sees the inherent beauty in the core of each human being can help guide them toward their own best life, by supporting the delicate process of change.

    I think both patients and doctors have been lulled by our culture into expecting results from pills, surgery, and one-time office visits or hospital stays, isolated from any examination of thought patterns, belief systems, and behaviors.

    As long as we (patients and doctors) continue to believe that medical problems are “separate” from how we live our lives, we won’t see the necessary changes in our health care system.

    The change you’re talking about is necessary. It’s also slow, painful, and ultimately needs to be done at the individual level – “jumping on the bandwagon” never really works long-term. I totally believe in this kind of transformation, and am encouraged to see a practicing M.D. who has the courage to voice the truth as you’re seeing it.

    Physician-coach partnerships? Yay! A great prescription and bright future for wellness…and medicine.

  • http://healthyweightcenter@hotmail.com Jennifer Warren

    Peter, I am happy to see that you now feel you are a “coach” (after some training at CoachU, I believe, according to your website?) But I am somewhat alarmed and saddened that you did not receive training to be a “health coach” during your residency. I see that you received your internal medicine residency training in the late 1980′s; perhaps things had changed by the early 1990′s, when I did my family medicine residency, but I have to say, our training was focused very heavily on helping our patients achieve lifestyle change. We were trained in the bio-psycho-social model, with a ‘holistic’ approach, had a psychologist on staff (at the Eastern Maine Medical Center Residency Program), and were taught to do far more than merely diagnose problems and write prescriptions.

    I’ll admit that our current medical reimbursement system does not pay well for helping our patients achieve a healthier lifestyle, but I have to respectfully disagree with you when you ‘let doctors ‘off the hook’ by telling them it is not their job to help patients achieve a healthier lifestyle. It is the very core of our mission, I believe. Physicians are generally still very well respected by our individual patients, and as such, are in a unique position to educate them, and help them change their lives for the better. If we don’t do everything we can, and are capable of doing, to help our patients, we are shirking our duties. As physicians, we should not allow insurance companies or the medical reimbursement system to dictate our mission.

    So when you say: “Physicians aren’t trained to help patients change their behavior” and “If you’re a patient, your unhealthy lifestyle is not a medical problem” I must say, I could not see things more differently.

  • http://www.drjohnm.blogspot.com DrJohnM

    Dr Weiss…

    You are right on target here. After the patient returns arrhythmia-free after a catheter ablation, or syncope-free after a pacemaker implant, or alive after an appropriate ICD shock, what is left to discuss? Sedentarism, obesity and abysmal sleep habits are common themes. As you suggest, these troubles are surely more the realm of behavior therapists (coaches) than ablators or installers.

    On a busy office day, when the cycling “coach” in me comes out, one thing is a certainty: I run behind.

    Compared to changing unhealthy behaviors, AF ablation is a snap.

    JMM

  • http://healthyweightcenter@hotmail.com Jennifer Warren

    John M. – thanks – you just pointed out a complaint of many primary care physicians! In many ways it IS an easier job to simply do an ablation, than address underlying causes of disease, and treat those! Yet this job, prevention and early treatment, as difficult as you admit it is, is not compensated well in the current system.

    For overall health in our country, as well as cost savings, it would probably make sense to compensate primary care physicians appropriately for the work they do for the health of patients and the country..

  • http://www.patbarone.com Pat Barone

    What strikes me most about this conversation are the generalities being made. Yes, many patients endure life threatening conditions, yet return to old behaviors that caused the problem in the first place. They do not care to change, or it is too threatening to them (yes, living without food as a soother, friend or emotional barrier is scarier than death). And yet, there are many people who do want to change, and simply haven’t found the tools in the medical community. They don’t know how to facilitate change, and their doctors can’t help them.

    I was one of them. My own doctor told me not to bother trying to lose weight (“let’s increase your antidepressant dose”) for years before I took matters in my own hands. I started by conducting research into permanent weight loss. I discovered 99% of weight is regained – but 99% of the methods we use, especially those touted in the media, are temporary weight loss routes.

    I scraped and meandered. I found what worked and didn’t for my unique physical body. I threw out most of what media and advertising taught. I lost over 70 lbs. and I’ve maintained that weight loss for over 10 years now. I wish I’d had a coach to help me through that because, now that I know what coaching is and have experienced it, I know it would have made my road easier to travel. Therapists and psychiatrists did not help me – every single one of the dozen or so I saw had the idea that I could not or would not ultimately change. I felt I was a nameless, faceless statistic to each of them, thoroughly labeled as “obese and unchangeable.”

    I stress that this was my experience and not all doctors do this. I now thoroughly vet my healthcare providers and insist they “see” me – I’ve had some amazing experiences with doctors when we establish a relationship.

    After my weight loss, though I was thoroughly schooled in nutrition and exercise by that point, I chose to get training and credentialing as a coach to further help those already showing up at my doorstep wanting help because they could not find it in the medical community. I think it’s important to educate everyone, especially the medical professional, about the training and certification criteria for professional coaches. True, there are many calling themselves “life coaches” with little or no training. Training programs, where you can get a “certification” in six weeks on the internet, abound. But, the International Coach Federation (ICF) accredits coach training programs after thorough investigation and assurance they meet teaching criteria. They also credential coaches. (www.coachfederation.org)

    Becoming a credentialed coach (which involved training, supervision, and testing beyond what I experienced getting my master’s degree) was important to me because I want to offer high quality services to my clients. I make it a point of educating every consumer I see. I believe we should be just as demanding when hiring a coach as we are when we chose a doctor.

    I’d like to see the medical professional expand it’s paradigm to include preventive care and proactive change. Coaching is in perfect alignment with that change and can easily be accessed via medical referral. At the very least, that will take several things: (1) preventive care doctors who are paid for their time and expertise, and thoroughly know their patients (which would prevent those preemptive generalizations); (2) coverage via insurance; (3) open minds; (4) an attitude of inclusion to other professionals, such as coaches; and (5) true belief in change, both in their patients and in themselves.

    I’d like to see these changes because of the opportunity it presents to both doctor and patient to actually find meaning amid this thing we’ve created called healthcare.

    Pat Barone, CPCC, PCC
    http://www.patbarone.com
    http://www.stoprentingweightloss.com

  • http://www.blueprinthealth.co.za Heloise Avenant

    I agree that physicians aren’t trained to do that, but they better learn how to implement something like Solution Focussed coaching of Motivational Interviewing. And health systems will have to define reimbursement policies – that’s if the “new” US system of the Patient Centred Medical Home is going to be successful. Either that, or physicians should employ coaches in their practices.

    After spending 3 years to retrain myself as a physician turning health coach, I am of the opinion that there will have to be new curriculums where physicians branch of into integrative medicine (while others might go into family medicine) – behavioural medicine needs to be mainstream. Duke University has done a lot of work in that direction already.

  • Sara Van Laar

    The mentality or belief system of Dr, caring professionals and patients are changing and that is an important aspect of overall wellness. It affects the mental, physical and spiritual wellbeing of all. I believe it stems from having a clear goal of our purpose here in the world and continuous learning with respect and love to all human beings.
    Co-active Coaching is a way to help. Sara