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Doctors as Coaches, Giving Up the High Horse


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As a writer who focuses on ways that our society can prevent the lifestyle-related chronic illnesses that afflict us so harshly, much of what I read and observe provides little reason for optimism. An aging primary care workforce not being replaced... children starting younger and spending ever more time interacting with screens... the income gap persisting and widening, along with its accompanying gaps in health and well-being.

But a recent conference at Harvard Medical School, with the theme "Exercise Is Medicine," left me feeling somewhat hopeful. The conference brought together scores of physicians who want to live healthfully themselves and to work as partners with their patients to help them do the same.

Edward Phillips, MD, an assistant professor of physical medicine and rehabilitation, is working to transform U.S. medical school curriculums to encourage doctors to prescribe exercise and to focus on promoting healthy behaviors. At his two-day continuing medical education training "Active Lives: Transforming Ourselves and Our Patients," every 90 minutes or so, the doctors were up and moving, exercising right at their seats or taking more formal, vigorous activity breaks in rooms alongside the main lecture hall. Lunchtime included an invitation to walk outside as a group.

I've attended many medical meetings but never one as much fun or as health promoting for participants as this one.

Although the conference's theme focused on exercise, the presenters helped attendees learn to do better on several lifestyle fronts – including eating better and avoiding tobacco – and to help their patients live more healthfully, using innovative methods. One of these methods, "motivational interviewing," particularly intrigued me. It grew out of techniques that have been used successfully in the past to help substance abusers give up addictions and adopt healthy behaviors.

Doctors Learn to Listen With Motivational Interviewing

To act as coaches, health care providers must learn to be respectful listeners and to treat patients as equal partners in their own care. This contrasts sharply with the old view of doctors as experts, lecturing patients and issuing orders. Marie Dacey, EdD, who teaches psychology at the Massachusetts College of Pharmacy and Health Sciences, and Joji Suzuki, MD, who teaches psychiatry at Harvard Medical School, instruct physicians on motivational interviewing. In this approach, providers avoid telling patients what to do and how to do it. Instead, they promote exploring what motivates a particular patient, what the patient already knows about needed lifestyle changes and what path patients can envision taking.

For example: A physician operating under the old, top-down, orders-giving paradigm might lecture an overweight man about the health risks and say, "Look, you've got to lose weight. Here's the Weight Watchers website. Sign up. It works for a lot of people." In contrast, a doctor skilled in motivational interviewing would find out what aspects of being obese actually troubled the patient. The man might say he wants more energy to play with his children. The doctor might then ask him if he's ever lost weight in the past and, if so, what worked before that he might try again. The conversation would be a gentle exploration of the issue, with the patient generating ideas rather than being a passive vessel for advice.

Importantly, Dacey showed that a meaningful exchange that leaves the patient feeling respected and engaged need not take long. A short video, produced by the University of Florida Department of Psychiatry, demonstrated this new, more effective way, with the doctor working closely with the patient, like a coach.

After we watched the demonstration, Dacey asked us how long we thought the respectful doctor-patient exchange had been. People shouted out "12 minutes," "15 minutes" and other guesses in that range. In fact, the doctor had listened to her patient, conversed with her respectfully and helped her to decide herself to start to work on smoking cessation in just six and half minutes.

More Blog Posts by Milly Dawson

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Milly Dawson, MS, MPH is the founder of the National Healthy Work Institute, a research and consulting firm that  works with employers that are committed to helping employees lead healthier lives. Milly has written two books and for publications including Woman’s Day, Yoga Journal, The New York Times syndicate and diverse medical journals. A former Foreign Service Officer, she earned an MS in psychology at Tufts and her MPH at Johns Hopkins Bloomberg School of Public Health.

Tags for this article:
Lifestyle and Prevention   Diet and Nutrition   Obesity   Exercise/Physical Activity   Alcohol/Drug Abuse   Smoking   Communicate with your Doctors   Promote your Health  

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