Date: Sun, 21 Oct 2007 12:22:34 -0400

From: Don Ardell <donardell@KNOLOGY.NET>

Subject: Wellness coach, health educator, health promoter, etc. - What's in a name?

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From: "Don Ardell" <donardell@KNOLOGY.NET>

To: <HEDIR-L@listserv.siu.edu>

Sent: 10/21/2007 12:22 PM

Subject: Wellness coach, health educator, health promoter, etc. - What's in a name?

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Cheryl J Dye describes a training program for "wellness coaches" and notes other efforts or plans being made (Duke) to train (and certify for profit) those who would promote effective lifestyles leading to improved health status and higher enhance quality of life.

It is the nature of the beast (us) to be territorial - to mark the boundaries of our turf and protect it from intruders. After all, we have been here for some time, ergo, we must be more entitled and best qualified to maintain said turf. Alas, this might inhibit innovations, different models for doing the same things better and other desirable advances. The name attached to those who promote wise health habits is not so important as how well efforts to do this work succeed, that is, the extent to which people on the receiving end benefit from the services rendered.

It was George Bernard Shaw who said that professions were a conspiracy against the laity.

Health educators, wellness promoters and all the rest would best serve the public by welcoming and, if possible, assisting any and all who seek to do the important work noted by Ms. Dye as part of the wellness coaching skill set.

Last week, I spoke to a medical society in Iowa and encouraged the family practice physicians to be health educators, wellness coaches or quality of life consultants. I offered a dozen suggestions, as follows. Maybe some of these might be of interest. Be well.

Don

Introduction

Here are a dozen suggestions for expanding the doctor role. Yes, I am aware that physicians are already overloaded with medical duties. However, I think the add-on wellness mission will enable Iowa doctors to help patients seize teachable moments. The latter are inherent in illness encounters. Physician efforts at wellness education might spark reforms in the attitudes, expectations and consequent behaviors of patients -- if the doctors add a few (or all) of my dozen suggestions to their regular agendas. The results, I believe, can lead to advances in quality of life, happiness, health status and all the positive outcomes we associate with wiser lifestyle choices.

An Aside

After I had identified and organized these suggestions, I got quite enthused if not carried away about this new doctor role I was about to unveil. In fact, I got so enthused I decided it might be really cool to become one, that is, a real doctor, as in MD. I'm thinking of applying to medical school Given that I'm nearly 70, however, it is clear I don't have a lot of time to fool around with preliminaries. I can't spend days on applications, weeks on campus visits or months preparing for tests or taking perquisite courses to buff up thin background in chemistry, math, biology and other sciences.

Instead, I might have to ask the Iowa Academy of Family Practitioners to waive all these and other preliminaries and requirements, plus tuition and other barriers to fast tracking of my new career. I'll let you know if this works out.

Caveats

This presentation summary identifies the broad nature of my dozen suggestions. What follows, please remember, is but a humble essay, not the stand-up performance the good doctors will experience. All memorable, meaningful images that will be projected while I speak are absent here, as are references to the costumes I'll wear, the set design, the fireworks, the magic tricks and the varied dances, songs, wellness healings and doctor testimonials planned. Space limitations, you know.

I'll even mention a few caveats at the beginning, all designed to ensure reasonable expectations.

For example, I'll admit that while all dozen suggestions seem sensible, desirable, doable and consequential to me, I could be mistaken. Some may not appeal to everyone. Few of them can be implemented overnight. Templates do not exist -- the best ways to actually carry out my ideas will have to be determined in relation to local conditions, barriers, characters and opportunities. Finally, although the list of caveats could be longer, I'll mention the obvious fact that some tips might be a piece of cake to implement and afford quick payoffs, others will take time. A lot of time, in some cases.

Of course, the biggest caveat of all is to acknowledge that there would be no need for doctors to attempt to make personal responsibility more appealing to patients if everyone acted sensibly, that is, did not pursue lifestyles that have made America the fattest nation on earth with the most expensive medical system. But, that's how it is. People are not taking much responsibility to stay well in the first place, and while that might be good for your sickness care business, it has placed the nation in a fix where we are improvising on the edge of catastrophe.

That's it - no more caveats. It's good to cover your butt with sensible expectations but one must not go too far. I hope this won't overdo it.

And now, no more folderol. Here are the dozen suggestions I'll offer for doctors who might want to try making personal responsibility more appealing to patients, in addition, of course, to still providing quality medical care efficiently and effectively.

The Suggestions

# 1. Dazzle patients - and get to the heart of their problems. You can do this in the first 30 seconds of initial encounters. Ask everyone a question that goes beyond symptoms, one that is non-threatening, not difficult to answer, though seemingly nonsensical - at first. Soon, the question will make perfect sense and the patients will enjoy a good laugh and be thinking in terms of the big picture, not only a physical complaint. With this question and the explanation that you provide, you will have set in motion a line of thinking that will enable the patient's to forget, if just for a moment, his pain, worries or malaise. And, most important, be better positioned to hear your first message about personal responsibility.

Simply ask patients if they are experiencing enough DBRU equivalents!

Evaluating patients DBRU daily intake at the start of clinical history- taking can open them up to all manner of insights beyond the usual history.

Readers of the E-AWR are quite familiar with the DBRU equivalent concept. No need to explain it here, as I will to the Iowa doctors. I don't suppose any will already know of this important assessment tool. However, I'm hoping that not many will soon forget it! For a refresher on the DBRU idea, go to SeekWellness.com.

# 2. From illness to life enrichment. Broaden your scope. Think of ways to segue your current practice from something scary (illness, disease and delay of death) to something exciting, like health enrichment or life enhancement.

This is another way of getting at that much overworked idea of the so- called total patient, meaning that you should go beyond an isolated overemphasis on his or her medical problems. Yes, of course - the latter must always be fully attended.

It would not surprise me if many, if not most, of you have already began to make such a transition. Dentists have been at it for years. By broaden your scope, I'm suggesting you consider that your career puts you in the field of life enrichment, rather than the business of medicine. A broad- based perspective and definition of the business you are in will facilitate transitions in times of change and lead to more opportunities to serve and profit as the health system evolves.

In the mid-70's at the Stanford University School of Business, I learned from case studies that the most successful railroad owners were visionaries who understood and acted upon the realization that they were in the transportation business, not just railroads. It made all the difference when roads became freeways, the economy changed and alternatives to traditional ways of moving freight rendered other approaches highly lucrative while many railroads went out of favor.

# 3. Promote planning for personal responsibility. Becoming sovereign for one's health does not come easily for most people. It is too easy to excuse, blame or avoid accountability. To counter this hazard, invite everyone, regardless of complaints, to develop a business plan - for their own well-being. Offer to guide the process. A personal plan can be quite simple, yet remarkably effective, both for communicating the message that each person is ultimately responsible for his or her own health and for facilitating organized, successful change efforts.

Doctors can do amazing things to promote healing, but patients must be the ones who take responsibility for making healthy choices to become weller. To paraphrase JFK, you could even sound presidential in making this suggestion to your patients: Ask not what your doctor can do for you, ask what you can do for yourself.

A personal wellness plan can be composed on a single page with key elements including a goal or two, a few objectives, sources for support, a list of barriers anticipated and brief strategies about how the obstacles will be overcome and payoffs for success. Ask patients about plan progress at every visit and offer suggestions, encouragement and guidance along the way. Of course, you should provide the forms for doing this planning -- it won't take you more than half an hour to design a personal plan process on a single sheet that all patients can modify if they wish and then utilize. (Or just copy the form that I provided to the IAFP Executive Director.)

# 4. Develop a wellness specialty - or two. Develop one of more special interest areas that fall in the category of quality of life enhancement.

Another term for life enhancement might be REAL wellness, which is a celebration of personal responsibility based on reason, exuberance and liberty or freedom. Specialty areas might be lifestyle skill dimensions, such as exercise and fitness, nutrition, resilience-building (a positive term for stress management) or a life stage. The latter would be my first recommendation, specifically the entire area of aging well. Who would NOT be eligible for your aging beyond belief-type messages, sooner or later?

# 5. Assign homework! Conclude all patient encounters with a modest assignment that promotes personal responsibility in a subtle fashion. Call these learning adventures or something positive like that. You can pass along self-care and other wellness- related information in the form of articles, books, Internet site recommendations and much more. The resource base for such counseling is extraordinary, but patients are far more likely to avail themselves of it if given such direction, almost as a prescription, by their doctor. Happily, no pharmacy visit is required to learn more about the payoffs for taking greater responsibility for one's own help. But, it helps that it's doctor recommended.

# 6. Consider an image makeover, if necessary. The doctor's image is not as important as his or her performance, manner and a few other qualities, but it is consequential when encouraging patients to take more responsibility for their own health, unlike when the practice is restricted to treatments for chronic and acute illnesses. Doctors can assume patients will view them as role models, whether they seek to be such or not. Remember Charles Barkeley? He once complained, when asked about what message his bad behavior might be sending to his young fans, I never wanted to be no role model. It's not an option. The fact that, to your patients you ARE a role model, like it or not, might be reason enough to shape a healthy lifestyle. If personal responsibility is a good idea, it will be evident in your presence, not just your words. One principle expressed in my first book, written in the mid-seventies, was Examine your doctor before you allow him or her to examine you. By examine, I meant be attentive to the doctor lifestyle and appearance, not just what he or she expressed verbally. You know the old story illustrating the difference in effectiveness in preaching a sermon versus living a sermon's moral. No need to be a slim, super-fit marathon runner or other paragon of healthy living -- just let it be evident that you are making the effort consistent with your promotions. A chain-smoking physician, for example, is not likely to inspire healthier lifestyle choices no matter what advice he/she offers. Patients surely assume that a doctor who tries to stay fit, seems cheerful and appears happily engaged and so on is more likely to be supportive of personal responsibility by others.

# 7. Increase your presence in the lives of patients. Explore a variety of communication technologies that facilitate and encourage prevention, wellness and a better quality of life. Send out a stream of personalized wellness-related material on a regular basis. This will keep patient motivation high and assist all who want to assume more responsibility. A website is highly useful for this purpose, as are electronic newsletters, public lectures (free for patients) and giving interviews/writing columns for community media outlets.

# 8. Keep things light and positive, when possible. Humor, a playful spirit and an informal environment will render change easier to manage. Go out of your way to address popular misconceptions in attention-getting, creative and memorable ways. Examples include having fun with signature expressions that involve doctor/patient relationships, such as:

* Get your doctor's approval if you decide NOT to exercise. This is the reverse of the lawyer-like warnings we have all seen that imply exercise is dangerous. The latter message paints exercise as a health risk - and states that a physician's clearance is appropriate before engaging in such hazardous activity. The truth is just the opposite: It is so dangerous to live without a daily exercise regimen that nobody should consider such a perilous course without an estimate, from a qualified doctor, about how long he might last in this perilous condition.

* No medicine is good medicine, as a bendable rule. Most people are overmedicated and rely excessively on meds to cope with life. Of course drugs are great, if properly used, by there is enormous abuse in all developed nations. * Modern medicine is a wonderful thing but there are two

problems: People expect too much of it and too little of themselves. This is self-explanatory but unrecognized by most people who place too much responsibility in getting fixed rather than avoiding problems. Better to promote responsible behavior that minimizes the need for much medical attention in order that resources can go to difficulties that are unavoidable.

An entire industry has come into being to help doctors do this, featuring humor consultants to business and medical institutions, popular books on humor applications in medical settings and conferences and training programs targeted to use by the health professions. Make a habit of conducting frequent celebrations. Create occasions and rituals that honor the successes of patients. Successes are easy to identify, and patients are never shy at self-reporting, if given a little encouragement. Whoop it up for patients who are coping well with difficulties, or who have realized wellness plan goals or overcome difficulties or otherwise made quality of life advances through conscientious efforts.

# 9. Assist patients to think more clearly. This is a biggie. If I were ranking the dozen suggestions (I'm not), this one would be way up there. Be an advocate for science, reason, empirical evidence and free inquiry.

Consider the influence of modern advertising. Your patients are bombarded with ads daily for quick fix solutions for whatever ails them. The message is always the same Ask your doctor about one drug after another. Well, when they ask, give them an earful of good counsel instead of a handful of pills Encourage patients become a lot more skeptical.

The sad fact is that large numbers of people believe in really crazy things, from tooth fairies to elves, astrology, UFO abductions, conspiracies, quack remedies and, of course, demented politicians. I'll skip some of the more colorful and blindingly irrational supernatural beliefs, the better to avoid a holy war. Check out the level of insanity for yourself -- go to Snopes.com or any urban legend website. Peruse the variety of mind-boggling stories people believe, and circulate, as gospel truth, which in itself is suspect.

Ooops, there I go again.

Offer an incredible personal responsibility service not usually considered a part of the practice of medicine, namely, encourage folks to develop, however late in life, better critical thinking skills. Not what to think, but rather how to think. A good starting point might be to distribute copies of Carl Sagan's Balon ey Detection Kit to all patients.

# 10. Reach out to healthy people. Just because someone is not at your door complaining of one misery or another does not mean she is a well- camper. Au contraire - normal is a sorry state of physical and psychological mediocrity Create a welcome mat and varied opportunities for those in your community who recognize that while they are not sick, they are a long way from being hale and hearty. Most people do realize that their lifestyle is nowhere near as developed as it could be with more care, attention and guidance. Many who think they have no reason to see a doctor for symptoms or check ups nevertheless know that reducing risks of illness is not the same as enhancing prospects for well being. You could be functioning nicely at both ends of the illness/wellness continuum by promoting the embrace of personal responsibility.

Thirty years ago I wrote a couple articles in Prevention Magazine about a family doctor who created a practice exclusively for healthy people! That's right. He opened a center in Mill Valley, California that catered to healthy people who wanted to get healthier. He refused to see sick people, referring them to other doctors.

You surely won't want to go that far, I suspect, but you might wish to consider some of the assessments, principles, modalities and tools that are applicable and attractive to seemingly healthy as well as truly ill patients Unlike the good doctor in California three decades ago, you need not think in either/or terms. Both sick and well people need your guidance.

# 11. Think big. Promote good health for patients as noble and logical.

Recall the immortal words of the Hippocrates of urban planning. I have forgotten most of what I learned in the early sixties at UNC in Chapel Hill studying for a master's degree in city planning. However, I well remember what the patron saint of planning, Daniel Burnham, recommended: Make no little plans; they have no magic to stir men's blood and probably will themselves not be realized. Make big plans; aim high in hope and work, remembering that a noble, logical diagram once recorded will not die.

Don't write anyone off. You never know who will turn out to be a success story as an enthusiast for healthy living. Many who have high-risk habits (e g., habituated to being sedentary) are surprisingly aware and supportive of the wisdom of pursuing higher quality of life behavior patterns, but have not yet found the necessary support or otherwise resolved to initiate changes. In my experience, many people whom you would not mistake for positive lifestyle enthusiasts are quite supportive of others who seek healthy changes. This was true of several of my own mentors over the years.

From a cursory look, they did not seem likely enthusiasts for wellness but they were, in their own fashion. Bottom line - encourage everyone you encounter to consider adopting more responsibility for changes toward healthier choices. You might find more receptivity than you expect.

While thinking big, go all the way, at least in your own mind. Attempt bold, big plan changes ala Daniel Burnham. Personally, I'm going for the Nobel Prize for these dozen suggestions. You've heard people say, If we can go to the moon, we ought to be able to (fill in the blanks). Well, my attitude is, If Al Gore can win the Nobel Prize, why not me? Make no little plans.

# 12. Raise big picture topics. Ask an existential question or two, perhaps about the meaning of life or the nature of enlightenment. Last weekend in New York City at Radio City Music Hall, another recent Nobel Peace Prize winner, the Dalai Lama, called for a path to enlightenment that entails such wellness-friendly tendencies as giving more and seeking less, peace, cultivating tolerance and compassion for all living things (even veracious

humans) and striving to free the heart from hatred, the mind from worries and society from suffering. That sounds like a wellness message to me. Maybe you can work some of these notions into your expanding medical practice.

Well, that's it - A dozen suggestions for Iowa doctors who wish to make personal responsibility more appealing to patients. I hope it works out. Be well - look on the bright side of life.

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#732

Date: Sun, 21 Oct 2007 14:22:35 -0400

From: Keneth Packer <packer18@EARTHLINK.NET>

Subject: Re: Wellness coach, health educator, health promoter, etc. - What's in a name?

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Don,

What an amazing idea, you being a physician. Back in the 1970's you were

one of my teachers and role models. That still holds today. But you are

right, at 70 you don't have much time. By the time you are done with medical school and an internship, you will be 80. If you make it, sign me up as one of your patients.

But here is a better idea, instead of becoming a physician, why not teach at a medical school and instill your ideas in many young physicians, who have a lifetime to be great doctors, based on your ideas. I am sure there is a major medical school out there, that would love to have your contribution.

Then there will be hundreds of you instead of just one physician as you envisioned.

Be well,

Ken Packer

--

Kenneth L. Packer

41 Cardinal Dr., Washingtonville, NY 10992

(Work) 845-496-8698 (Home) 845-496-3708 (Fax) 845-496-0453

(E-mail) packer18@earthlink.net

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#733

Date: Sun, 21 Oct 2007 15:35:05 -0500

From: "Mark J. Kittleson, PhD, FAAHB" <kittle@SIU.EDU>

Subject: Health Coach

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I'm interested in the comments by Doug McLaughlin. First, I don't know if it's a step forward for the profession to use the term 'coach'.perhaps it's just my skepticism but it's taken decades to break away from the physical education/coaching mentality. But more seriously, my main question is, based on what Doug said, is how is this different than regular counseling (other than the obvious 'stigma' attached to counseling)? The profession of health education has a basis in health counseling. We have numerous textbooks with the same name and we have a number of experts in health counseling (first to come to my mind is Joseph Donnelly at Montclair State).

So again, how is this different?

Mark J. Kittleson, PhD, FAAHB

Southern Illinois University

Professor, Health Education

Director of Graduate Studies

Health Education & Recreation

618-453-1841 Office

618-453-1829 FAX

SKYPE ID: mark.j.kittleson

618-912-4445 SKYPE Phone

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