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Wellness Coaching for a Real-Time Payoff

(Robert M. Duggan, M.A., M.Ac.) -- The new Healthy Howard Plan will provide health and wellness services for the uninsured of Howard County. I believe it is a major public policy initiative that in the long-term may have a significant national impact.  Here I will focus on one aspect of the proposed plan: every enrolled member will be required to devise a health and wellness action plan with a health coach.

For over 60 years, Americans have heard the mantra: "Your doctor is an expert on your health. Consult your doctor about every symptom. Check with your dentist. Check with your doctor."  While protecting people, this mind-set also has taken away people’s sense of their own ability to enhance and maintain their own wellness.

A recent Wharton School of Business report (Traditional vs. Western Medicine: Which One is Easier for Chinese Consumers to Swallow? Knowledge@ Wharton) raises interesting perspectives:

The authors (Lisa Bolton, Wenbo Wang and Hean Tat Keh) begin with a Chinese proverb: "He who takes medicine and neglects to diet wastes the skills of his doctors." They note that in China, "consumers perceive Traditional Chinese Medicine versus Western Medicine to have slower action and milder side effects and a greater focus on treating the underlying illness versus alleviating the symptoms." Moreover, when a consumer is uncertain about his/her condition and not in a hurry for a resolution, traditional remedies are preferred.

On the other hand, "If you want a quick fix, you go for the Western medicine." For instance, a person may want quick relief from insomnia and choose to take a sleeping pill if he has to go on a long drive several days from now, instead of seeking a slower-acting remedy (stress reduction techniques, for example), which eventually may address what’s causing the sleeplessness.

According to the researchers, generally Western medicine (as compared to Traditional Chinese Medicine) "reduces the perceived importance of, and motivation to engage in, complementary health-protective behavior, thereby undermining a healthy lifestyle." For example, patients taking pills for their high blood pressure may be less apt to see the need to exercise, watch their diet, or lose weight. Or, Bolton notes, people taking cholesterol drugs may figure they don’t need to cut fat from their diet because the pills are protecting them from heart disease.

Bolton has documented this "boomerang" effect in other instances.  She has researched how the marketing of products such as nicotine replacement patches, debt consolidation loans, and identity theft products influence consumer perceptions and risky behavior. The attitude becomes, "Well, the risk is manageable, so I don’t need to worry about it."

Health Coaching must reach deeper inside the individual to be effective in real time and not simply a form of risk management. At Tai Sophia Institute, we have learned over 30 years that people come to Tai Sophia to pay for an understanding of how their bodies function — a sense of meaning about their symptoms, both small and large. In fact, they are buying the ability to understand the relationship between small and large symptoms, with awareness of the smaller symptoms as teachers of right living.

A number of studies have documented this understanding of what happens during treatment at Tai Sophia Institute. Recently Professor Lawrence Wissow from Johns Hopkins and Professor Mark Stibich from the University of California, San Diego School of Medicine (Alternative Therapies Mar/Apr 2006, vol.12, no.2), analyzed more than 600 letters written by patients at Tai Sophia. The authors indicate that "five main meaning shifts were identified in the data: (1) from a goal of fixing the problem to a goal of increasing health; (2) from symptoms as problems to symptoms as teachers; (3) from healing as passive to healing as active; (4) from being dominated by illness to moving beyond the illness; and (5) from regarding the practitioner as a technician to regarding the practitioner as a healer or friend." 

The authors add: "Patients suffer not only from their primary symptoms, but also from the results and effects of their illnesses, such as depression and changes in their relationships. For the patient, symptoms often hold much meaning beyond physical sensation. A recurrence of symptoms can have other unpleasant results, such as additional trips to doctors, paying for medications, time off from work, not being able to play with children, or changes in relationships with family members. In many cases, the anxiety and depression surrounding the symptoms causes suffering that is greater than the suffering caused by the physical symptoms directly."

This data points to the importance of understanding the full implications of the "boomerang effect" highlighted by the Wharton study.  The Healthy Howard Plan involves development of a health action plan with the guidance of a nurse, a dietician, an exercise specialist, or a wellness specialist. This coaching will attend the major issues individuals face in preventing disease and maximizing wellness.  Tai Sophia’s role will be to train the wellness coaches to become the real-time observers of the meaning of symptoms that our patients say is so significant and valuable.