Imagine a world where individuals are empowered to achieve their best health, supported by a trained professional to fulfill a holistic goal of well-being. That’s the way Heidi Duskey, a health coach with Harvard Vanguard Medical Associates, envisions an ideal healthcare future.
At the center of this blissful picture is a health coach – a trained professional whose sole aim is to empower individuals (and patients) to attain health goals and high levels of wellness.
Dorland Health sits down with Duskey, ACC, CHFS, to explore the potential inherent in health coaching and its ability to transform individual wellness and collective health and well-being.
Dorland Health: What is health coaching’s place in modern healthcare?
Heidi Duskey: I see health coaching as a value-added service to modern healthcare. I say this because a coach’s expertise – that of guiding patients through lifestyle changes – is something that primary care clinicians aren’t trained to do and don’t have capacity for. Although many physicians are empathetic and compassionate, a busy practice would want them working at the top of their license. So it is also more cost-effective to provide patients with a professional trained to help them examine their lifestyle choices between visits, in the “real world” where they actually live their lives. This is what coaches do. Lastly, the data collected by Harvard Vanguard Medical Associates during the past three-plus years indicate that coaching results in improved patient outcomes, providing our practices with a valuable mechanism for improving the quality of care.
DH: How does health coaching fit in with new models of care like the medical home?
Heidi Duskey: The medical home provides integrated care to patients, and coaching fits in beautifully for the reasons I’ve cited above. For example, imagine a patient informing their clinician that they are ready to quit smoking or improve management of their diabetes. Both of these outcomes require behavioral changes that are sustainable and, furthermore, work best when they are tailored to the patient’s life. Because coaching is patient-centered and built on a partnership between coach and patient, the methodologies provide a powerful platform for conversations about behavior change, learning and personal growth. I know it is a boon to the clinicians I work with to be able to respond to a patient’s expressed desire with a referral to the coaching program.
As an aside, I often see the words “patient engagement” used in the literature. Engagement occurs when patients have the autonomy to direct their own health, both in their daily choices and as a lifelong process. Because coaching is process-oriented (one of my mentors used to say that everything was process!), we are able help our clients elevate their awareness to see pattern and opportunity for change.
DH: Do you expect to see more health coaches in the future? Will every healthcare consumer have a coach?
Heidi Duskey: Yes and yes. I believe that coaching within a clinical environment is in its infancy and is poised to grow. For me, the reasons are straightforward and obvious: much of disease today (I’ve seen estimates as high as 70 percent) could be eliminated through lifestyle changes, and this is what coaches do. I’m confident that when a patient expresses the desire to improve their health, any clinician wants to do everything they can to support this goal. To me, it’s a no-brainer that a piece of this support is best delivered by a trained health coach. Further, I believe that as data collected by coaching programs continue to show efficacy, this service will eventually become reimbursable through insurance.
DH: How can health coaches support the work of physicians and other team members?
Heidi Duskey: In short, we provide needed content expertise and expand capacity. I would say this statement is true for everyone on a patient’s team, including nursing staff and various medical specialties. For example, in addition to our internal medicine staff I work closely with our nutritionists, behavior health staff and sometimes cardiology and endocrinology. I also receive referrals from these clinicians and I sometimes refer clients to nutrition or behavioral health. Our goal at Harvard Vanguard is to provide seamless service to our patients. Communication is the key and I am very fortunate that I have wonderful access to colleagues through our electronic medical record and, in person, if dialogue is the appropriate activity.
DH: What example or story can you share to highlight the power of health coaching?
Heidi Duskey: On April 26, 2011, I began work with a 39-year-old woman whom I’ll call Mary. On this date she weighed 358 pounds on our practice scale. Below are direct quotations from my chart notes as Mary began her journey to lose weight, change her relationship to both food and her body, and regain her health. Please note that most of Mary’s weights are on her home scale because she usually calls in to the practice for her coaching sessions.
5/25/11 – Regarding her health goals, Mary stated, "I don't want to be the person who gets home and sits down to watch TV. Maybe I'll do a load of laundry or make my bed. I can remember what it feels like to feel good and I want to get there again. I smiled a lot then."
12/07/11 – Weight of 299 lbs on Mary’s home scale. “I used to feel deprived. Now I feel empowered. I'm just living my life now, but I'm living it in a different way."
01/18/12 – Weight of 297 lbs on Mary’s home scale. “I’ve learned that I never feel bad about what I do anymore unless I don't follow my own rules…I feel so good! I've had a lot of ‘a-ha’ moments over the last six months. I know it's going to be amazing whenever I get to wherever it is I'm going!...This was one of the best holidays I've had in a long time! It was happier because I'm happier!"
2/29/12 – Weight of 293 lbs on Mary’s home scale. “If I could have dreamed how it [losing weight] would go, this is how it would go. The guilt kept me paralyzed. The guilt was like a fog over me. It was crippling. Now it's lifted."
3/28/12 – Weight of 288 lbs on Mary’s home scale. Mary had hit a plateau in January. Regarding this she stated, “I never felt like what I was doing wasn't worth it or giving up. I was afraid that I wouldn't be able to adapt further. It feels like I've just been born. There were so many things I never did when I was younger and now I feel like I can do them all."
5/11/12 – Weight on practice scale at last physical: 282 lbs., a weight loss of 76 lbs.
And to this day, Mary’s journey continues.