Friday, April 5, 2013

My tips of the day on "Health Coaching" in General Practice

Most of us have been trained under the "acute health" model where we are the expert and we give out advice to our patients.  This of course works very well in the acute health setting.

Imagine someone coming into the emergency department critically unwell with a MI.  He or she does not want a long talk about the disease process and to be engaged in motivational counselling.  They just want an "expert" to take charge of their care and help them through that critical moment.

However, does this work in the Primary Care setting?

In my opinion, unfortunately not.

In General Practice, chronic diseases are prevalent and often, require a different approach.  People often know in broad terms what they should or shouldn't do.  For example, people with diabetes know that they should avoid those cakes and exercise more.  People with obesity and diabetes know that they should eat less and exercise more.  Lack of information is not necessarily the problem here but motivation to take sustained action might be the real barrier.

Health coaching incorporates motivational counselling,  a collaborative, non judgemental and patient centred approach, facilitative rather then directive, and importantly, empowers the patient to take responsibility and make decisions about their own health.

Questions that are consistent with the health coaching philosophy are.......
  • What do you want to achieve from today?
  • So today you are here for a flu injection, a sore right knee and a funny mole on you arm.  Are there something else?
  • You got a number of problems today and unfortunately, we are unable to deal with them all due to time restraint.  What is the most important thing that you would like me to address for you today?
  • So you have thought about quitting smoking.  How motivated are you from 0-10?  10 being "Yes I will do it" to Zero meaning "No, don't even talk about it".
  • If I was a genie and I can give you one wish related to your health, what would you ask of me?
  • What do you think is causing your symptoms?
  • With regards to your high cholesterol, you have 3 options.  One is to do nothing and accept the risk.  Two is to work hard on your diet and exercise.  And three is to take medications.  What do you want to do?
  • You seem to be in a bit of a bind?  On one hand, you want to reduce your risk of stroke by taking this medication but on the other hand, you are scared of the medication and its side effect?  How do you think I can help you to make up your mind?

No comments:

Post a Comment