Health Coaching and Paradigm Shift
You never change things by fighting the existing reality.
To change something, build a new model that makes the existing model obsolete.
R. Buckminster Fuller
Modern does not necessarily mean good or effective; it is a value neutral word.
Therefore, modern medicine does not automatically create good health; it treats
signs and symptoms and acute disease; it seeks not to cure or to help people in
the creation of good health. And so, if we want to cure chronic disease and
move toward cultivating optimal health in our communities, we need to adopt
a new philosophy, underpinned by a more effective framework.
Throughout this website, reasons are offered for the need for change in the
present health paradigm in Scotland, and in UK. This is not about kicking out
the old in favour of a shiny, new, or simply tinkering at the edges. There is much
about the present paradigm, perhaps the best in the world (eg our approach to
accidents and emergencies) which we should honour, retain and build upon.
And it starts, not just in fiddling with the present, or throwing money at our healthcare system, but in having a brand new vision of possibilities.
In summary, this would mean:-
We should move from a system which is predominantly about treating accidents, emergencies, and ill-health and with a primary care system mainly focussed on treating symptoms mostly through surgical treatments, medication, and radiation
We should commit to a system which, whilst still excelling and innovating in dealing with accidents, emergencies, and ill-health
becomes founded and predominantly focussed on
+ personalised holistic care
+ the best of approaches such as Conventional Western Medicine, Functional Medicine and Integrative Medicine, integrating the best of disciplines from Complimentary and Alternative Medicine, Holistic Medicine, Energy Medicine, Nutritional Medicine, et al
+ a wider professional health and social care team available to the patient with less being gatekept by the GP and more coordinated by a new post of health coach
+ educating and supporting the public in
+ taking more personal responsibility for their health and well-being
+ reducing all harm to their health and well-being
+ avoiding risk wherever possible
and more importantly
+ educating and supporting the public in attaining optimal health
+ focussing much more on curing, and less on just treating, with greater time spent on seeking and curing the cause of chronic conditions
+ integrating the need for a more holistic approach, which sees the patient as a whole person with inter-communicating body systems and which seeks the spiritual, mental, emotional, and environmental, not just the physical, causes of illness.
The system would inevitably cost more in terms of numbers of staff and services provided, certainly at the outset, but in the long term we should save by having a healthier population which, because people are enabled to live more optimally healthy lives, have less need of expensive and time consuming health treatments, drawing less on NHS resources, and in particular, resulting in vastly reduced costs of pharmaceutical approaches to treatment.
The implications of a new paradigm would mean ...
Changes would be needed in GP training to enable GPs
to spend more time on seeking to find the cause of an illness
to be more informed on the importance of the following as major contributory factors eg
dysfunctional gut microbiome
The paradigm or system would need to be changed to allow more time for consultations (offset by healthier people requiring fewer treatment-necessary consultations)
Each patient to have, as appropriate, a medical care team co-ordinated by a lead health coach
Each patient to have a nominated health coach who would also act as their point of contact if unsure what health services are required.
To solve chronic disease, we need medicine delivered to where people actually are, in their communities.
And before the cries of “not possible” are raised, let’s adopt a more positive attitude. Award-winning journalist and producer, Dan Buettner’s efforts to take the learnings of the Blue Zones, where people live the longest, healthiest lives, to America led to 41% reductions in the cost of health services through similar strategies.
Why is change needed?
The prevalence of long term health conditions is on the increase, with latest figures showing that there are now 4 million people in the UK diagnosed and living with diabetes alone.
Patients suffering from long-term conditions struggle to manage their disease effectively and yo-yo in and out of hospital and GP settings, accounting for 50% of all GP appointments and 70% of all inpatient bed days. This is because the focus is on disease management, not in finding a cure.
At a time when the NHS is under mounting pressure in the wake of rising demand for services from those with chronic conditions, it is becoming increasingly clear that the need to introduce new and innovative models of care is intensifying.
Technology has become essential to the way we live our life, smartphones usage is prevalent, in fact 76% of the over 50s own a mobile phone. The internet is just a touch away and healthcare providers need to recognise the role technology plays in enabling and facilitating self-care. Clinicians cannot meet every need of their patients with chronic conditions, so we need to educate patients in self-care, in order to relocate staff to where they are needed the most.
The key sources of the high costs of health and social care in developed countries, premature mortality, and multiple morbidity — the oft-named, non-communicable diseases, chronic, ongoing conditions — persist and continue to increase despite the best of what conventional medicine has to offer. The fortunes spent on diabetes medication and insulin simply lower blood glucose levels, they do not cure diabetes and so we have a population who are helped only to manage a worsening condition with little input on how to reverse the condition. But conditions such as diabetes are preventable, and increasingly, we are told, at times reversible, with inexpensive lifestyle as medicine.
But this requires new thinking, new medical models, frameworks, changes in emphasis, both visionary, and practical, and not just tweaks at the edges.
One of the solutions that is proving effective is clinical health coaching. Health coaching is a relatively new concept for the NHS, though it is well-established in other parts of the world where data shows it to be a highly-effective model of care.
Almost daily, it seems, our media reports on three things:-
(1) advances in medical science, bringing greater hope for cures in better living in chronic conditions and mystery illness
(2) outstanding life-saving deeds by teams in accident and emergency departments, paramedic and ambulance crews and
(3) how our NHS is cracking at the seams with staff and patients suffering due to systems and protocols which are no longer fit for purpose. It's not just about resources. Why plough money into a system that is not designed to cope. The reasons why the NHS was born are not the reasons behind what faces patients today.
And there’s more.
“With physicians losing faith in industrialized medicine at record speed, a new paradigm is needed to engage both physicians and patients into health creation. The ‘Functional Micropractice’ is a fascinating concept and will accelerate the movement towards truly integrated healthcare.”
Deepak Chopra, MD, FACP, Founder of the Chopra Center for Wellbeing
According to a 2012 Medscape report, 46% of primary care physicians (doctors) showed such dissatisfaction with their careers, they wouldn’t pursue medicine if they could choose again.
The state of the nation
It is predicted that in the UK, three quarters of all deaths by 2020 will be from chronic disease and illness, medical conditions that are generally progressive, conditions such as asthma, chronic obstructive pulmonary disease (COPD), diabetes, heart disease, high blood cholesterol, hypertension (high blood pressure), and stroke, and can be managed with lifestyle changes.
People with long-term conditions account for:-
50% of all GP appointments
70% of all inpatient bed days
70% of overall NHS spend
The number of people with three or more long-term conditions, often defined as multiple morbidity, is predicted to continue rise to almost 3 million by 2019.
It will come as no surprise to many, even without reading literature and research, that:
Doctors cannot remotely meet every need of every patient with a chronic conditions - how can they in ten minute appointments
They do not have time to co-ordinate and follow up patient care across present multi-disciplinary teams
Patients do not play their part - by not taking responsibility, not taking prescribed medications, ignoring lifestyle recommendations, not showing for appointments etc
Half of patients leave primary care (ie GP.) visits not understanding so not following through what their doctor told them. This is an extensive, expensive waste of resources
Though shared decision-making is associated with improved outcomes, yet only 9 per cent, almost only one in ten, of patients are involved in decision making on their health (as at 2017).
Patients, for myriad reasons, eg not wishing to waste doctors’ time, are not sufficiently pro-active in challenging the information they get, in ensuring they understand, in asking questions about medication, in seeking more natural, lifestyle approaches to health treatments, in ensuring they are heard etc
Getting the patient voice heard at a senior level in the NHS is difficult; systems are designed to defend the NHS
Average adherence rates for prescribed medications are about 50%. That is a mindboggling waste of prescribed drugs
Average adherence rates for lifestyle changes recommended are below 10% per cent. That is - 9 out of 10 patients who could improve their health through recommended lifestyle changes are not doing so, thereby continuing to suffer and use vital NHS resources
There are no statistics on the number of consultations where lifestyle recommendations are not even pursued. From personal experience I would say this could be close to 90%.
Neither doctors or patients seem to explore medicine from a more metaphysical perspective ie mind / body connection which is directly related to lifestyle.
It is clear that patients must take more responsibility for creating their own optimal health, pursuing all that is possible to prevent harm or risk, and engaging in best possible lifestyle practice.
The patient’s health is their responsibility first and foremost. But as medicine becomes more complicated to understand, if we are to continue to encourage patients to be more self-responsible and the medical system to be better founded on patient centredness, we cannot simply throw that responsibility at patients; they need to be educated, enabled, and supported AND medical staff need to recognise that slowly but surely, more and more patients are becoming increasingly very-well informed and that all resources obtained on the World Wide Web are not suspect.
Just as sports people have coaches, opera singers have teachers, business executives have coaches and mentors, patients (we perhaps should develop a new word) at times will need a “go-to” coach to seek pointers, direction, and to cheer-lead them along in any changes or health goals they seek to bring about.
Therefore, new approaches to working with, supporting and enabling patients are required which increase patient awareness, confidence, decision making, lifestyle change, and self-care.
What is health coaching?
Health Coaches are becoming increasingly recognised in the UK as essential and integral parts of people’s health and well-being care team. With the advent of social media and the plethora of health awareness programmes on television, with people living longer (and often with more than one medical condition) there a shift to live healthier lives, to answer the question, “Is this all there is?” eg to live with pain, debilitation and onwards to death.
Some people want to live in a different direction, to the reversal of disease, to living healthily, even with a health condition. But the question then is often more, “Where do I start? How do I go about it?” and our present health paradigm is simply not equipped to help patients in this regard.
Enter the answer - in the form of the Health Coach.
A certified Health Coach is an authority on wellness and how to achieve it, a supportive mentor who motivates individuals to make positive health choices and create effective and wonderful health outcomes.
Coaches educate and support clients to achieve their health desires and goals through lifestyle and behavioural changes. They know how to work with diverse groups of people and, unlike the “one pill for every ill” approach of modern medicine, equip their clients with the tools necessary to best fit their individual needs.
Coaches help people feel better through vibrant good health, through inner confidence, a belief in them self, and when to help the client dig deeper to grow a strong spiritual connection to living.
At present in the UK, most people need to find and pay for health coaching themselves.
Be aware that some health coaches may specialise; some may be trained specifically in Functional Medicine Health Coaching, some may specialise in nutrition, and some, like myself, tend to specialise in Metaphysical Health Coaching.
But some far-sighted Medical Clinics already include health coaches as part of the NHS health care team.
The time has surely come for Health Coaching to be standard practice, freeing up GP time, making better use of resources and achieving a healthier nation by guiding and supporting people to be active participants in their own health through a transformation in their relationships with their health care practitioners – GPs, nurses and therapists et al
A health coach’s role is a multifarious one and health coaching is an overarching term for multiple functions or foci of a coaching approach eg:-
In health improvement, it is a behavioural intervention that helps people establish and attain health-promoting steps which bring about lifestyle changes, with the intent of reducing health risks, improving self-management of chronic conditions, and increasing health-quality of life
as an aid in decision-making the health coach provides information or enables the patient to improve their research skills
is an aid to developing client strength – to having clients learn how to become more self-responsible, improving client communication and negotiation skills, helping them clarify better more meaningful goals, enabling conscious patient choices, including exploring the consequences of decisions,
In long-term conditions, perhaps ones where personal growth is important to the client, the coach’s role may be that which employs executive coaching skills, making specific psychological interventions using clinical skills to enable patients to explore and where necessary change their relationship with their health, by raising their awareness and responsibility, increasing their confidence and motivation, and tapping into their potential to self-manage, and to become self-motivated and able to act to achieve their goals.
Signs It’s Time to Hire a Health Coach
1. You have a doctor’s diagnosis and need help following his/her recommendations. Doctors we know are busy and don’t have time to hold your hand or check you understand or how you follow their instruction. A good health coach can work hand in hand with your doctor to help you move toward a healthier lifestyle using the guidelines your doctor establishes for you.
2. You return home after surgery and are not coping with and so need help adapting to a different lifestyle, one that requires you to change your habits and routines.
3. You want to lose weight fast. A health coach has studied numerous dietary theories, they’ll know the fads too, and they will show you how to reach and maintain your ideal weight.
4. You don’t have enough ME time. So many of us are givers, we care for others, and put so much into everyone else’s lives that we give insufficient care to ourselves. A health coach will help with that.
5. You suffer stress and can’t deal with it so well. Stress is a major reason why we get ill, even at a physical level. Health coaches can help you connect the dots between your condition and stress and then find ways to alleviate and prevent stress, and help you behave healthily. Losing pressure can sometimes equal losing weight..
6. You want to get to the root cause of your health condition. Your health coach will offer you ways or skills in how you can take any health condition, now or in the future, and dig to find the root cause.
7. You know life is asking you to change but are unsure how, or how to maintain the changes. A health coach can be the difference between quitting and giving up and achieving your goals.
8. You know you have unhealthy limiting beliefs that are affecting your health and well-being and need help to turn them around. You could get lots of information on the web or on YouTube but even then you may still get stuck in the application of turning around.
9. A sporting event, marathon or triathlon is coming up, and need to set yourself some pertinent goals. A health coach has access to everything you need to improve your pre-workout and post-workout recovery.
10. Your diagnosis is going to affect your family and you need help to help them, know when tp back off, and know how not to ignore your own needs.
11. You are elderly, living with numerous health conditions, and need to pay more attention as to how you can move better through life. A life coach can offer help but may also refer you to a physiotherapist.
12. Your family needs to make some nutrition changes, and you’d like to learn some easy new recipes. Health coaches can either provide you with recipes that are nutritious and tasty, or help you to research then talk through your findings.
13. You need a kitchen makeover. You’ve taken on a dietitian’s recommendations but you need help to assess and create a kitchen that works for you. This may involve a review of best equipment to have, especially if you have special health needs.
14. You have trouble understand reading labels on produce cans and packets.
How many doctors have time to play the above roles?
Please note, we are not suggesting that every patient requires coaching. But a doctor needs to be alert to when it may be relevant and suggest it to the patient.
Health coaching skills
Coaching starts with the Einstein premise that problems can't be solved with the same level or kind of thinking that created them.
If the patient always does what they’ve always done, they’ll always get what they’ve always had.
To create new thinking and motivation to act, to jump off the mouse wheel, to create new outcomes, the quality of the relationship and conversations between the health coach and patient or client are paramount. They need to:
Be based on trust, rapport and empathy
Grow to the point where the client can take any challenges the coach offers, not just the support
Help people make health a priority in their life and then prioritise the priority
Support and help people create a new world view, new attitudes to eg health and change
Clarify and create new insights and enable the client or patient to transform these into new actions
Use open questions, active listening and reflection as opposed to telling or lecturing
Create positive emotions to build motivation and confidence through a focus on what's good versus what's wrong
Provide timely and personalised health education and information as well as empower the client to research and source their own information
In short, health and wellness coaching is a process that is:
Fully and at times partially patient-centred
Clarifies patient-determined goals
Incorporates self-discovery and active learning processes
Encourages client / patient accountability for ABC - actions / behaviours / choices
Provides insights and education to patients
Some of the behaviour change methods/skills that health coaches use include:- goal setting, action planning, problem solving, navigating obstacles/barriers to goals, identifying and changing limiting beliefs, finding resources, self-monitoring and building self-efficacy.
The approach will more than likely be holistic - mind, body, mental, emotional and spiritual - focusing on many aspects of the clients’ lives that contribute to health and well-being, instead of only paying attention to specific part such as diet, or physical symptoms.
Nutrition will play a key part; most education training for health coaches include training that covers a wide range of dietary theories, such as plat-based diets, vegan or vegetarian diets, the Paleo diet, low carb diets, the Mediterranean diet, the Ketogenic diet, and so on. “Bio-individuality” — the belief that there is not one ideal diet that is best for all people — is considered an important underlying principle for health coaches. Instead of recommending the same type of diet or meal plans to all clients, health coaches tailor their advice to meet their clients’ goals.
As concerns grow and continue to grow globally regarding the increase in levels of obesity and chronic diseases, often related to poor nutrition, the help of health coaches seems to be needed more than ever. It is a much-needed role missing from the present healthcare system.
Coaching with The Radical Healer