Coaching doctors requires nuanced understanding of healthcare
Published in Coaching Life Magazine April 2019
For many years I have worked as a psychologist. Often my clients have been experiencing a health crisis, so I have listened to lots of stories about healthcare, many of which have been distressing and disappointing. Eleven years ago, I had my own close encounter with the health system, when my husband Tim was diagnosed with cancer.
There have been enough lessons from this experience to fill a proverbial book. Unfortunately, after four years of the cancer rollercoaster, Tim passed away. One of the outcomes from my personal experience and by witnessing other people’s stories, has been that I have spent the last four years coaching health professionals, specifically doctors.
Health executives in the C-suite have known and used coaching and whilst doctors and nurses in America and the UK have also been using coaching for several years, it is a new concept for most health professionals in Australia.
Most health professionals have learnt and refined their skills on the job watching others perform the same tasks, via mentoring and occasionally through formal supervision. All health professions in Australia are mandated through the regulatory body, AHPRA to attend regular training and updates to maintain their technical skills and registration. Contrary to what we might expect, there is minimal training and specific processes that teach doctors people skills.
Doctors are qualified through medical school, internships and specialty training, ensuring they are extremely resilient people; they have to be to keep going. The process of becoming a doctor can be harrowing for many and can take 10 – 15 years or more of formal training, before the doctor is fully accredited in their specific area of care. Now I am generalising when I say that as a result of this long, arduous and costly training process, doctors mostly consider themselves tough and feel like they have proven themselves. To reach accreditation they justifiably feel like they have earned it. Some doctors do experience persistent imposter syndrome, in spite of the evidence that they have reached their goal through years of effort.
Healthcare is a technical business and is delivered by a complex system. At the heart of it though it is a people’s business, delivered by people, for people. This means care exists in the relationships between caregiver and patient, between teams of colleagues and during the interactions with communities and families. Skills in relationship building, effective communication, emotional intelligence, navigating complex systems, accessing information and interpreting it from many different sources, allow the health care system to operate effectively. Where these skills are lacking health care is suboptimal, medical errors are higher and patients are placed at risk, conflict occurs more often between all the parties, providers of care burnout and their own health suffers seriously. This suboptimal healthcare is not able to meet the needs of the community it seeks to serve.
Medical school focuses on anatomy, pharmacology, differential diagnosis and risk assessment. Emotional intelligence, communication and those other ‘soft skills’ need to be learnt incidentally. In my limited experience, it is a totally random event if a doctor has learnt these skills at medical school or in the early years of their career. It certainly has not actively been given a priority and embedded into the curriculum. (There has been some significant work to teach mindfulness skills to medical students, most notably led by A/Prof. Craig Hassed at Monash University.) Truly effective caregiving requires both an understanding of the scientific evidence and a compassionate intention to understand the needs of each person. Head, heart and gut play a role in human connection.
This is the reason we feel uncomfortable about AI (artificial intelligence) and this is the place where coaching can have the most impact. Helping doctors think, reflect, learn and practice the skills they have not learnt in traditional medical training in a psychologically safe place away from the hierarchical, competitive medical culture that exists in healthcare.
Doctor wellbeing is a front of mind issue and often in the media now. As recently as last month we learnt of Dr Yumiko Kadota’s ordeal as she trained to be a hand surgeon in a Sydney hospital, quitting after deciding she could not achieve her goals, as her concerns were left unheard by a culture that was eating its young. (A phrase often used by my doctor clients when referencing working in medicine). The rates of suicide, depression, anxiety and drug abuse in the doctor community are frighteningly high, higher than the general population and higher than any other healthcare profession (e.g. nurses, allied health). (Beyond Blue, 2013). Coaches should not underestimate this reality.
In addition, until early 2018 if doctors disclosed that they were suffering from depression or other mental health concerns, they were reported to the registering body and lived in fear of being deregistered. Fortunately, this situation was rectified in 2018 and doctors are now better equipped to receive support for a mental health issue and in many cases continue to practice.
As coaches we need to be very clear about what we are offering and how it is different to counselling. Coaches also need to educate clients, so they understand how to obtain this support, what is expected and how this will help. By following ethical guidelines and opening up about our own training and experiences, coaches will demonstrate their expertise and build trustworthy relationships with their clients.
Doctors are considered the experts in health however; the statistics show that they compromise their own health and these devastating stories are now being disclosed to the public. Hospitals and colleges are attempting to devise a strategy that will change the culture, but these processes are slow.
The doctors who contact me sometimes need referring to counselling and I am grateful for my experience working with people suffering from trauma, because I can clarify what the doctor specifically needs. These doctors are asking me to help them build their skills to protect them from the system because they want to be successful in their career. They recognise that coaching could be the best way to build skills, develop perspective and emotional intelligence, make a plan about priorities and be held accountable. They want to be seen to care, be allowed to truly connect with their patients and families and have long sustainable careers after all the work they have put into their learning.
Even though psychological training is not compulsory for coaches, research undertaken in Australia and Israel suggests that coaches who have an academic background in psychology are more effective (Ritchie 2001). When treating doctors, there are advantages for coaches to have experience within the healthcare system. Doctors traditionally learn from other doctors, which may be the reason people skills and emotional intelligence are being overlooked. Working with a coach who has experience in healthcare but is not solely inculcated by the medical curriculum, can help cultivate alternative thinking, which is what coaching is all about.
I am grateful to those who have shared this journey to coaching health professionals with me and I look forward to the continued privilege of coaching doctors. It is a legacy of Tim’s life that I find myself working with doctors as coach and immersion facilitator.
References:
Bozer, G, Sarros, J.C. and Santora, J.C. Academic background and credibility executive coaching effectiveness. Personnel Review Vol. 43 No. 6, 2014 p.881-897
Correction note: The reference quoted in the original article published in The Coaching Life (Edition 19, March 2019) is incorrect, please use the above reference. (updated 5/11/2021)