My Story My father s first stroke Medical School My father s second stroke The book, Life After Stroke: The Guide to Recovering Your Health and Preven

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1 Integrating Primary Care Physicians into Health Coaching Elizabeth Pegg Frates, MD Assistant Director of Medical Education Institute of Lifestyle Medicine Harvard Medical School

2 My Story My father s first stroke Medical School My father s second stroke The book, Life After Stroke: The Guide to Recovering Your Health and Preventing Another Stroke Coach training

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5 Knowledge Knowledge is power. Sir Francis Bacon Knowledge is a powerful tool on the road to behavior change. For most people, p knowledge alone is not sufficient to create lasting behavior change.

6 Mount Lasting Change

7 Objectives 1)To describe the mindset of physicians and compare it to the mindset of coaches 2)To identify creative communication strategies to educate healthcare providers about health coaching

8 Objectives 3)To demonstrate how to build successful relationships between healthcare providers and health coaches. 4)To review the activities of the Institute of Lifestyle Medicine at Harvard Medical School

9 The Different Mindsets Physician Coach Relies on knowledge Relies on motivation Treats patients t Hlp Helps clients hlp help themselves

10 The Different Mindsets Treats diseases Prevents diseases Is trained to solve problems by prescribing pills or performing procedures. Is trained to foster healthy habits- physical activity, yg good nutrition, stress management, and smoking cessation

11 The Different Mindsets Is trained to have all the answers Is trained to help clients find their own answers Relies on her confidence in medical knowledge and skills to diagnose, treat, and heal patients Relies on her self- efficacy to help clients on their journey to lasting behavior change

12 The Different Mindsets Feels responsible for the patients disease, treatments, and health Focuses on the problems Feels that clients are ultimately responsible for their actions, behaviors, and health Focuses on what is working well

13 The Different Mindsets Feels she must interrupt if patients start going off topic Asks many closed-ended ended questions to figure out the diagnosis Feels she can learn from clients no matter what topic they choose to discuss Asks only open ended questions to allow the client to reflect and dive down deeper

14 The Different Mindsets Feels that if advice comes from her, the expert, patients will follow it. Feels that clients are more likely to tenaciously pursue their own ideas.

15 The Different Mindsets Wrestling with the patient Dancing with the client

16 The Difference Physicians are trained as the experts and educators. Coaches are trained as the communicators and motivators.

17 The Sum Experts + Educators + Communicators + Motivators = A powerful team to instill lasting behavior change

18 Educating Healthcare Providers Different learning styles Solitary Collaborative Auditory Visual Interactive Hands-on

19 Educating Healthcare Providers: Traditional Approach Continuing medical education courses Textbooks, books Webinars Research articles Grand Rounds Workshops Journal Clubs

20 Educating Healthcare Providers: Informal Approach Word of mouth s Advertisements in medical journals Exhibits at medical meetings Surveys Offer sample coaching to healthcare providers Physician make over contests

21 Meeting Healthcare Providers Attend workshops Attend Grand Rounds at hospitals Attend medical conferences Attend lectures presented at hospitals

22 Meeting Healthcare Providers The best source.your clients. With your client s permission, you can send a progress report to the primary care physician who takes care of your client.

23 How to Build Relationships with Communication Empathy Respect Mutual goals Trust Symbiosis Communication Healthcare Providers

24 Communication Symbiosis Empathy Trust Respect Mutual Goals

25 Stages of Change All healthcare providers are not in the same stage Pre contemplation Contemplation Preparation Action Mi Maintenance

26 The Institute of Lifestyle Medicine Harvard Medical School Founded in 2007 by Dr. Edward Phillips Two physiatrists, one internist, two administrators Mission: To reduce lifestyle-related disease and mortality through physician-directed intervention.

27 ILM Activities Live CME Courses March 2006: series of courses in four cities in India with the Apollo Hospital November 2008: Introduction to Lifestyle Medicine November 2009: Active Doctors, Active Patients

28 ILM Activities On line CME Courses Lifestyle Medicine for Stress Management Lifestyle Medicine for Weight Management

29 ILM Activities Textbook ACSM's Exercise is Medicine: A Clinician's Guide to Exercise Prescription (early 2009, Lippincott, Williams & Wilkins). Co authored by Edward Phillips, MD and Steven Jonas, MD, MPH.

30 ILM Activities Collaborations Medical Societies American College of Sports Medicine Massachusetts Medical Society Hospitals Apollo Hospitals in India Coaches Wellcoaches Corporation with Margaret Moore

31 ILM Activities Direct Patient Care MGH Back Bay Clinic Working with Primary Care Physicians

32 ILM Activities Research MGH Back Bay 30 newly diagnosed hypertensive patients from MGH Back Bay undergo intervention of ILM MD services. 30 matched control patients, newly diagnosed hypertensives, from another MGH clinic receiving routine care, not the ILM MD services.

33 ILM Research One hour visit with Lifestyle Medicine MD. Present options such as exercise prescription, pedometer monitoring, referral to a wellness coach, nutrition consult, and weight loss clinics. Consultation report sent back to PCP. PCP follow BP, HR, weight, physical activity levels.

34 ILM Future Endeavors Physician Make-Over Exercise Prescription Tool Kit Workshops for physicians On line CME Course Live CME Courses Lectures for medical students on the exercise prescription and health coaching.

35 Conclusion Summarize with a Wellness Plan

36 The Vision Healthcare providers and Health Coaches will work side by side to help people modify their behaviors and create lasting lifestyle changes that will propel them to their optimal level of health and wellness.

37 Motivator We all see people suffering because of their lifestyle behaviors including being physically inactive, making poor food choices, neglecting self-care and relaxation, and continuing to smoke.

38 Obstacles Lack of knowledge about health coaching. Lack of published, established evidence that coaching creates results. Lack of physician buy in.

39 Strengths Powerful coaches empowering clients everyday and helping clients make lasting behavior changes. Clients who have benefited from coaching.

40 Strengths Physician coaches working to bridge the gap between healthcare providers and health coaches. Healthcare providers who are frustrated with the current healthcare system.

41 Strategies Educate healthcare providers about coaching. Perform and publish more coaching research studies. Market coaching to healthcare providers. Offer coaching to healthcare providers. Build relationships between healthcare providers and coaches.

42 Long Term Goals Primary Care Physicians referring appropriate patients to coaches. Healthcare providers and coaches engaged g in researching lifestyle behaviors and reporting their results in medical journals. Healthcare providers and coaches working together to help people modify their behaviors and reduce morbidity and mortality caused by lifestyle related diseases.

43 Short Term Goals Communicate with a healthcare provider about coaching. Research different CME opportunities that coaches and healthcare providers can attend together. Consider publishing a case report about one of your coach-client client relationships that produced lasting change.

44 Short Term Goals Research ways to create an online survey that asks healthcare providers about coaching. Attend a lecture at a local hospital on a topic relevant to coaching, such as stroke prevention, and make a point to discuss coaching with the presenter at the end of the talk. Consider conducting an original research project.

45 THANK YOU.

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