Physician Well-being: Despairing to Coaching to Gratitude

“Then I sit at my workstation to document and bill for our encounter, perched at the edge of my seat, on the verge of despair.” The Doctor’s New Dilemma. Suzanne Koven, M.D., Massachusetts General Hospital. New England Journal of Medicine, February 18, 2016.

This quote on despair is the last line of Dr. Koven’s article. An unintentional victim of well-intentioned healthcare reforms is the relationship between a patient and his/her healthcare provider. What was easy and natural for physicians and nurses in past decades and generations -- to accompany with deep presence and empathy a worried soul on a journey through illness to health or otherwise -- has gotten lost in the onslaught of rules, policies, financial pressures, and technologies.

Now we find ourselves conducting research on the ROI of a warm, collaborative patient relationship because human wisdom (we used to know that relationships heal and empower) got lost in the search for evidence-based practices. Emotional intelligence, particularly empathy, are positioned as cutting-edge competencies to learn because the stress of being a doctor or nurse has numbed the inherent ability to connect and empathize. We press to create a new language on patient-centeredness because we forgot that the patient is the purpose (1).

To quote Bodenheimer and Sinsky (2):

The principal driver of physician satisfaction is the ability to provide quality care. Physician dissatisfaction, therefore, is an early warning sign of a healthcare system creating barriers to high-quality practice.

There is some good news. As the interest in patient engagement grows, so has the professionalization of coaching competencies in healthcare as a means of patient engagement and empowerment, spearheaded by the ICHWC and National Board of Medical Examiners (3). Let’s explore the experience of one of my favorite doctors, an internist in Flint, Michigan, Radhika Kakarala (4), who has transformed, in her words, from "an illness doctor to a wellness doctor” and models coaching for her residents.

Dr. Kakarala had always been passionate about empowering her patients to engage in a healthy lifestyle to prevent and reverse diseases. However, that passion became a burden because she worked harder than her patients to get them well. When patients ignored her counsel and continued to live unhealthy lifestyles, she was emotionally drained and felt helpless as she watched the adverse effects unfold beyond her reach.

In search of a more effective approach, Dr. Kakarala got trained as a health and wellness coach (5). First, as a coaching client herself she began to engage more fully in her own well-being. She then learned to spark an interest in change in her patients, while lowering their resistance, by alternating evocative questions with benevolent reflections. By exploring her patients’ intrinsic motivation and reflecting on their heartfelt values, she got her patients to open up and share what truly mattered. When considering how to apply their strengths in other life domains, her patients' confidence in change improved. In a few rich moments, meaningful improvements in motivation and confidence started her patients on a path to enjoying the fruits of healthy behaviors.

Here’s an example:

A patient came in to discuss his lab results. After he shared that his brother and Dad died prematurely of diabetes and that he is concerned about his risk, I reflected: it must have been very sad for you to lose both of them, and moreover, the loss is making you worry about your own health. He said “exactly!” After I informed him of his prediabetes, I asked if there is anything he is willing to do to decrease his risk of diabetes. He thought about it quietly and said: “I am going to give up drinking beer and smoking because I don't want to die like my brother and Dad." I calmly reflected his intention and then asked: “what needs do smoking and drinking fill for you?" He said: “they both relax me.” I asked him to share some things that helped him relax in the past, and he explained: "listening to music, mowing his lawn, and going for a walk." When I asked how confident he was in giving up smoking and drinking, he said: “I am more confident than before because I understand the reasons for those habits and what I can do to overcome them.” He thanked me several times before he left.

A few patient-centered moments.

Connect, accept, explore, spark motivation, improve confidence. Then gratitude.