We all-too-often give advice which patients either already know or do not want. This at best shows we care, and at worst breaks rapport and damages the doctor-patient relationship.Douglas Hing
The history of medicine shows us that the power of health often remained with the medical professional. In 1906 the British Medical Journal stated the word 'doctor' conveyed “an implied compliment that we are, par excellence, the depositories of learning and the distributor of its fruits”.
In my six years of training as a doctor, I learnt about the science of the body and diseases as well as the art of medical investigations and treatments. Working as a junior doctor in areas such as gastrointestinal surgery, respiratory and endocrine wards, sexual health clinics as well as Accident and Emergency, I tried to help patients suffering from the appalling impact of poor lifestyle choices including obesity, smoking-related lung disease, uncontrolled diabetes and alcohol abuse.
I gained knowledge and, although I did not consider myself to be a distributor of the fruits of learning, I enjoyed giving advice and understood the importance of education and its role in supporting shared decision making. I trained as an educator and completed a postgraduate certificate in healthcare education which significantly improved my skills in imparting information. I decided to specialise in General Practice where I felt patients could particularly benefit from earlier behaviour changes.
However, I quickly found that most patients already knew what they should and should not be doing. Telling my patients what to do - for example, take their medications, attend clinics, do exercises, eat healthily and stop smoking or drinking - often made little, if any, difference. Especially when socio-economic factors were having a significant impact such as issues around employment or social support.
If I spend 10 minutes with a patient, just in the rest of that week they would have 6,710 other minutes in which they are getting on with their daily lives (assuming eight hours sleep per day). The power to change is therefore ultimately with the patient. Recognising the limitations of my ability to implement change, I went on a coaching course and subsequently trained as a coach. This profoundly altered my approach. Instead of only focusing on giving advice based on my knowledge and the patient’s ideas, concerns and expectations, I developed a different set of skills to raise rapport, elicit values, identify barriers, increase commitment and challenge patients to support behaviour change and sustained self-care.
This is not at all easy. Since 2011 I have been adapting the coaching approach into clinical consultations and trained over 1000 health professionals in these skills. My experience and those of others have highlighted difficulties due to pressures such as rising patient demand, increasing health professional workload, falling professional morale, staff recruitment difficulties, as well as patient and professional resistance. The priorities of ensuring patient safety, diagnosis, prescribing, referring, giving explanations and advice (where appropriate) within a relatively short space of time means fewer opportunities for the patient’s knowledge and expertise about what works best for them.
We all-too-often give advice which patients either already know or do not want. This at best shows we care, and at worst breaks rapport and damages the doctor-patient relationship. However, it is possible for both professionals and patients to feel empowered. Engaging these patients has become less about imparting my knowledge and more about understanding motivation - in order to help influence the 6,710 ‘other’ minutes of their waking weeks.
One technique I find useful is to ask patients what’s important to them. This elicits their values - powerful underlying motivations such as family, finances or being independent. By relating these values to my priorities of clinical care we can utilise the knowledge from both myself and patients to support a more fruitful shared decision-making process, and improve behaviour change and self-care.
In my experience, this health coaching approach can mean more power for us all.
Douglas is a General Practitioner with a background in Coaching, Education and Management. He is a Clinical Director for Merton Clinical Commissioning Group and a member of the London Borough of Merton Health and Wellbeing board and Kingston Hospital Council of Governors.
Doug is a Lead Trainer in Coaching for Health which focuses on training health professionals in supporting behaviour change. He also delivers training courses on Leadership and Quality Improvement Projects, and is a Curriculum Editor for the Royal College of General Practitioners.
Doug currently splits his time professionally between General Practice and Clinical Commissioning.
Along with more traditional coaching skills, Doug and others have been training these approaches through Coaching for Health. For more information, please do get in touch.