Commentary

Just call me coach

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As primary care physicians, a large proportion of what we do every day requires addressing patient behaviors that lead to poor health, including smoking, overeating, substance abuse, and lack of sufficient physical activity, which together account for about 40% of chronic disease morbidity and mortality.1

It’s also true that many of our patients are depressed or anxious, or have a diagnosed mental illness. During hospital rounds this morning, the first 3 patients presented by the resident complained of overwhelming stress. Add in patients with chronic fatigue, chronic pain, and somatization disorders, and it is clear that we are making daily use of the biopsychosocial model of illness.

When I act as a health coach and meet my patients where they are, I feel less stressed and more able to enjoy my patients as fellow travelers on this planet.That said, we are not card-carrying psychologists, psychiatrists, or social workers, and there is precious little time for us to address behavioral and psychological issues in depth while seeing 20 to 25 patients a day, even if we have the skills to do so. I often take the easy route—referral to someone else. For many patients, referral is a good option, but many others won’t go and want us to help them. And brief therapy from physicians can have a significant impact on patients’ unhealthy behaviors, as was demonstrated years ago in a smoking cessation trial, where brief advice from family physicians increased the quit rate by 5%.2

Now a large body of research can help guide us to effective brief interventions for behavior change. Raddock and colleagues summarize a number of effective techniques in their review, "7 tools to help patients adopt healthier behaviors." Another way to increase our effectiveness as behavior change agents is sharing the load with nurses and medical assistants who are trained in these techniques.

When I act as a health coach and advocate and meet my patients where they are, using either the 5 As model or motivational interviewing, I feel less stressed and more able to enjoy my patients as fellow travelers on this planet, with strengths and frailties just like me.

Please pass the cheesecake.

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