Hippocrates said: “it’s more important to know what sort of person has a disease than to know what sort of disease a person has” Being a doctor is an art, which helps to unravel the complexities of the medical science that explains why we become sick or even why we die. Learning about the origins of disease enables the doctor to make the right diagnosis and treat a disease, more often than not, using pharmacological approaches or surgical interventions. There is a missing link in this challenging battle against diseases and the link is the person who is the subject of our treatments. The complexities of the individual human intellect which determines how humans receive, process, perceive and respond to clinical information can play a key role in people following the prescribed treatment plan, responding to treatment and ultimately, getting back to good health. But is it that simple? Having a disease is very different to being ill, the latter can be felt by people without the presence of a disease, which is defined by a formal diagnosis. Illness can be a subjective state that a patient perceives as real and important and which cannot be ignored by the doctor. Although there may be no drug or surgical intervention available to treat the illness, we still need to address the root causes, heal people and enable them to return to their optimal state of health. The risk of ignoring illness in the absence of disease is the loss of a person’s agency and power to make change, in order to get back to a state of health and wellbeing. What also gets lost along the way is the trusting and partnering relationship that a doctor should have with patients, which can nurture and coach patients to a better state of health. Person’s values, cultural and spiritual beliefs as well as people’s expectations, need to be explored and understood by doctors during their consultation with ill patients, because those will help shape the proposed healing (rather than treatment = disease) plan for patients and is more likely for the plan to be followed by ill patients. The World Health Organisation has defined people-centred care as follows: “Care that is focused and organized around the health needs and expectations of people and communities rather than on diseases” Whereas patient-centred care focuses on the individual patient, people-centred care considers the patient’s environment in their holistic healing or treatment plan. Patients do not live in isolation and their health and illness or disease state impacts their families, carers and the community they live in. If a patient develops a cancer for example which could have been prevented through regular screening, then the patient’s family and the community where the patient and their families live need to be studied and appropriate education provided on the importance of cancer screening. Developing an open and trusting doctor-patient relationship needs a lot of work, which is doctor-led primarily and this work is worth investing the time and effort in. Patients who have greater trust in their doctor, have less anxiety and better clinical outcomes. When it comes to serious illnesses such as cancer, patients treated by doctors who are good listeners, do not judge and focus on the whole person by optimising their body and mind, have better treatment outcomes and further disease can be prevented. The use of the coaching approach in a clinical consultation means that the doctor is totally focused on the patient, their needs and wants, respecting that patient choices may well differ to the choices the doctor would otherwise make. Going back to the illness model I mentioned at the start, the human intellect complexities and the values that determine people’s actions and choices, dealing with illness and disease is really multidimensional and needs a combination of good medical knowledge and the connecting power between the doctor and the patient. Asking open questions to patients about ‘what matters to them’ and ‘what brings them joy’ can reveal a wealth of information which needs to be incorporated into the treatment or healing plan. How has my coaching training impacted on my medical practice? It has certainly transformed myself into a more mindful doctor and one that puts the needs of the people above my own opinion of what the right treatment for them should be. The outcome is usually transformational on both sides, with patients changing their illness behaviours into health-focused behaviours and advocating for their own self-management. For doctors, they are rewarded by seeing their patients living better lives, which reduces their workload to enable them to deal with other sicker patients. Imagine if we all used a similar approach in clinic, the benefits for our individual patients and their families as well as the populations we serve would be equally transformational.
