By Chris L. Wells, PhD, PT, CCS, ATC
The recent talks about health care reform has made me think about what I can do within my physical therapy practice to further improve the health and welfare of my clients. I have found that health coaching has allowed my clients to be proactive in their approach to managing their health.
“Health coaching is the practice of health education and health promotion to enhance the well being of an individual,” (Palmer, Tubbs, & Whybrow, 2003) and achieve the health goals of the patient and health care team for the patient. The focus of health coaching is to motivate behavioral changes to improve health (Duke University Center for Integrative Medicine, 2006). In the traditional medical model, commonly the physician tells the patient what he or she needs to do and expects compliance, but does not explore the patient's interest or readiness to comply or what resources and barriers that exist that will influence the patient's success. Examples that many of my clients have shared is the instructions from the physician to lose weight or stop smoking; end of discussion or assistance.
How can we as consumers use this model and be proactive in managing our health with the ultimate goal to maintain or restore our health and function? First and foremost the client needs to be in the center of the caregiving team and be active in the decision making process and treatment plan implementation, since 95% of all medical decisions will be made by the client and the caregivers together.
First take an inventory of your health and medical conditions. Use your health team to define this list so you are well informed. Then ask yourself, what is your knowledge of the diseases that confront you as well as your understanding of general wellness recommendations? What are the treatment options? For example, many transplant recipients are diagnosed with hypertension, which is commonly defined as a blood pressure of 140/90 mmHg or higher. Treatment can include trying to identify and treat the cause, if possible, medications, weight loss, nutrition, and exercise recommendations.
Beyond the medical information, you need to ask yourself the following questions:
- Is it a goal of yours to address the medical condition or health recommendation?
- Are you ready to make behavioral changes to address the problem or goal?
- Are there any cultural or religious beliefs that would alter how you and your health care team address the medical problems or recommendations?
- What resources do you have at home and within your family, friends, and community to help you manage the problem or health goal?
- What barriers do you have to achieve your goals?
When you are talking about improving your general health and wellbeing it is also important to be honest with yourself in addressing questions like do you believe behaviors such as smoking, being overweight, eating poorly, drinking more than 1-2 alcoholic beverages a day, not routinely exercising, or not completing routine physicals to be problematic? Are you ready to modify these behaviors? If the answer is no, after fully understanding the health risk associated with these behaviors, then you should focus your efforts and health care dollars on other areas you are willing to address.
Once you have honestly answered these questions, inform the health care team of your answers so a comprehensive plan with a good chance of success can be developed. Finally, ask your team to provide you with information on how best to utilize health care professionals and facilities so you know when and who to contact with problems or questions.
Here is an example of this approach. I recently treated a woman who was referred to physical therapy because of knee pain after a fall. After going over these various questions, she was sent home to self reflect. Beyond addressing the knee dysfunction, she realized she had many unhealthy behaviors. She needed to improve her eating, lose weight, stop smoking and see her doctor on a more routine basis to manage her diabetes. Through this open process, she was willing to be enrolled in a diabetic center for care and decrease the amount of fast foods she consumed, but she remained unwilling to stop or decrease her smoking or lose weight. Consequently, we focused our therapy on a well rounded exercise program to improve her ability to go places with her family and increase the amount of fresh vegetables and protein she ate—and she only ate at McDonald's once a week. The final outcome: she was able to volunteer at a local nursing home, shop and care for her granddaughter three days a week, and saw improved blood sugar levels. At a six-month follow-up, she had lost 15 pounds, decreased her smoking and reported feeling better, with more energy.
With the complexity of health care and the difficulty many of us have in getting effective care, I believe that it is our responsibility to take charge of our own health. It's imperative to work with our health care team in achieving the goals of improving our health and wellbeing. This model has served me well as a member of the health care team but more importantly as a consumer of health care. So get up, get organized, get focused and get into action.
Duke University Center for Integrative Medicine. (2006) Health Coaching: http://dukehealth1.org/int_med/healthCoach.asp/
Huffman, M. Health Coaching: A new and exciting technique to enhance patient self-management and improve outcomes. Home Healthcare Nurse. 2007; 25(4): 271-274.
Palmer, S., Tubbs, I., Whybrow, A. Health coaching to facilitate the promotion of healthy behavior and achievement of health-related goals. International Journal of Health Promotion and Education (2003); 41(3): 91-93.