| ||Health Coaching: Sheila Quinn and Jamey Dyson, DC Challenge Naysayer on Role in Integrative Practices||
Summary: The Integrator has closely followed the work to set standards and national certification in health coaching led by professionals from Harvard and U Minnesota. The coverage stimulated Chris Johnson, ND to write a column in which be noted that he was "disturbed" by the focus. He shared his reasons: scientific, philosophical and economic. His comments provoked these two response columns. One is from Sheila Quinn, a 30+ year veteran of significant educational and policy initiatives in integrative care. The second is from Oregon chiropractor and Certified Chiropractic Wellness Practitioner. Dyson wonders, among other things, how widespread are Chris Johnson's views in the naturopathic community.
Prior Integrator articles on health coaching:
The Integrator coverage of the invitational summit to set national standards and certification for health coaching, and health coaches, stimulated a strong, antagonistic response from integrative clinician Chris Johnson, ND.
Johnson found the Integrator support for this movement "disturbing."
His reasons ranged from questions about science to views on the role of a
physician and what he views are the economic challenges coaching can put on
a successful physician-level integrative practice. Johnson's
perspective stimulated these responses from integrative care consumer,
editor and policy leader Sheila Quinn, and from Oregon chiropractor
Jamey Dyson, DC.
1. Sheila Quinn: "The physician's role is not to take over the healing process ..."
work in holistic health care, naturopathic medicine, functional medical
and integrative practice extends over 40 years. Her positions have
included senior editor at the Institute for Functional Medicine,
founding chair of the Integrated Healthcare Policy Consortium,
a kitchen-cabinet crafter of language used in the NIH NCCAM
legislation and co-founder of Bastyr University. Quinn, an Integrator adviser, was last seen commenting on the not-unrelated topic of employer incentives for habit change.
"My response to Dr. Chris Johnson's opposition to coaching as
part of an integrative medical team:
Comment: Quinn shows diplomacy in her choice of language. I second her note about the tendency of all clinicians to recall their successes. (This is also true of journalist-organizers.) I tend to think few spend enough time truly wrestling with habit change in their patients and clients at the level that the contributions of lifestyle choices warrants. In the best of all worlds, a coaching perspective would be embedded in the thinking and approach of the integrative clinician, whether or not the services were delivered via the clinician or a staff member.
"I disagree that the scientific literature is of
little or no value in helping clinicians understand how to guide their patients
toward healthier lives. I have read widely in the literature and written
extensively on this subject. I believe there is indisputable evidence that the
effects of environmental exposures and lifestyle choices on genetic
vulnerabilities are responsible for most chronic disease. True, the literature
is heavily epidemiological, but there are many excellent clinical studies as
well, and the evidence base grows stronger over time.
|"The idea that people make poor
decisions because they
are sick seems ludicrous to me.
- "The idea that people make poor lifestyle
decisions because they are sick seems ludicrous to me. Not that illness
doesn't affect our abilities-certainly it does, and it can be difficult to
self-activate when one is ill (even nearly impossible if one is very ill). But
we don't become sick and then choose unhealthy lives! Each of us has a unique
response to lifelong exposures to toxins, poor diet, sedentary jobs, chronic
stress, and other unhealthy influences that, over time and conditioned by our
genetics and epigenetics, create our own personal trajectory toward disease;
our therapies need to address those influences in order to create lasting
"The role of a physician or other health
practitioner is to help the patient-not to take over the whole healing process.
As patients, we are more effective on our own behalf if we are partners in our
care. We need to be educated and supported in making healthy changes. The
clinician is vital, of course, not only to identify our underlying problems but
to help us understand how we got there, and to recommend appropriate
interventions and monitor their effects. Some therapies are as straightforward
as taking a pill or avoiding a certain food. Others are far more difficult; a
good coach-taking the time that most physicians cannot-can provide expertise,
encouragement, and feedback, all extremely helpful factors in the struggle to
achieve lasting change.
| "The role of a physician or other
practitioner is to help the
patient-not to take over the
whole healing process."
"I do agree that there's no one right answer to
most health problems. However, there's nothing inherent in the coaching
discipline that dictates a uniform approach to all patients! On the contrary,
clinicians and coaches (at least the best ones) do not take a
one-size-fits-all approach; they individualize the therapeutic regime to the
particular patient, taking into account their genetics, environment, lifestyle,
and readiness/ability to change. As one who has struggled to make healthy
changes, I can say unequivocally that a well-trained integrated team with
health coaching available would be a tremendous boon!
"I am glad that Dr. Johnson's approach has helped so many
patients. However, ALL clinicians tend to overestimate their successes and
underestimate their failures-perhaps accounting for the fact that most primary
care practitioners in ANY field report seeing a lot of other people's failures!
Just because Dr. Johnson doesn't appear to need an integrative team (including
coaching) for his own patients doesn't mean that many other practices and
patients wouldn't reap great benefit from these services. I think there is very
convincing evidence that most of us would benefit enormously."
Freelance medical Writing and Services
Gig Harbor, Washington
2. Jamey Dyson, DC: "Patients just don't know how to get themselves to be healthy ..."
Jamey Dyson, DC, CCWP
The website for the practice of Jamey Dyson is titled Advanced Chiropractic: A Licensed Eat Well, Move Well, Think Well Center. The clinic's name pretty well announces Dyson's view of the importance of health coaching which he describes here. Dyson is also a Certified Chiropractic Wellness Practitioner (CCWP), a program of the International Chiropractic Association.
opinions of Chris Johnson, ND are quite disturbing to me also. I wonder
if he represents a large part of the naturopathic profession. His
opinions appear to be rooted in a lack of understanding of the cause of disease,
a lack of understanding in the power of lifestyle change, and a lack of
understanding how to deliver coaching services in a profitable way.
Comment: My instinct is to answer "no" to Dyson's query about whether Chris Johnson, ND's views are widely held in the naturopathic profession. That said, portions of the naturopathic medical profession's practitioners are certainly aptly characterized as "green allopaths." In addition, the crushing debt load of many new naturopathic graduates is an incentive to wring as many dollars as possible out of an hour of practice.
opinions of Chris Johnson, ND
are quite disturbing to me also.
if he represents a large
part of the naturopathic profession."
of all, it should be well known among most health care providers that the cause
of disease and illness is STRESS. This concept was developed by the late
Hans Seyle, MD in the 1940s and describes how any living organism will enter
pathological states of function when under prolonged stress. What is
stress? We can say that stress comes in 2 forms: toxicity and deficiency.
Simply too much or too little of something. It is easy to think of
toxicity/deficiency examples relating to nutrition, but this concept applied
holistically, must also include the areas of movement and thought patterns.
we can say that stress in the form of toxicity and deficiency in the way we
eat, move and think, is the primary cause of most states of human pathology.
The research is clear that 8 out of 10 deaths in western society are
being caused by genetically incongruent lifestyle choices. Industrialized
humans are not living according to their genetic needs and it has everything to
do with lifestyle.
human body has an amazing ability to heal and regenerate with the proper
changes in lifestyle. Dean Ornish, MD has shown us with his research that
it is possible to reverse not only heart disease, but also prostate cancer with
simple lifestyle change. In fact, the literature shows that the simple
effects of eating more fruits & veggies and walking 30 mins a day are more
powerful than any drug on the planet for preventing heart disease and cancer.
Why wouldn't a physician want to focus on helping his patients develop
lifestyle change we need should be based on what our species requires for
health. Very simple. All wild animals on the planet innately act
out the lifestyles they require for health. Humans are the only animals
who have the ability to choose a lifestyle which differs from our innate
genetic requirements for health. When we live an incongruent lifestyle,
it acts as a chronic stressor, gradually pushing us into varying pathological
states of chronic illness. Herein lies the problem of chronic disease in
industrialized and developing countries.
have found that the ONLY effective way to help a person change their lifestyle
is through coaching. Yes, they can look up how to eat and exercise on the
internet, but they still don't know how to get themselves to change. This
is a new, emerging science - the science of human lifestyle change. We
have to effectively work with the complex nature of the human mind if we are
going to have any hope. We know that to effectively change a person's
behaviors, we must first change their belief systems at a deep enough level.
If you do not change belief systems, there will be no long-term behavior
have found that the ONLY
effective way to help a person
change their lifestyle
"Yes, they can look up how to
eat and exercise on the
but they still don't know how
to get themselves to change."
patient wants to be healthier... they just don't know what to do, why to do it,
how to do it, and most importantly - how to get themselves to do it. They
need coaching by a lifestyle wellness expert. They need someone to hold
their hand through the process of learning about healthy lifestyle and learning
how to change their belief systems about lifestyle, which will result in their
behaviors changing for a lifetime.
hope other practitioners out there agree with what I have written here."
Jamey Dyson, DC, CCWP
Eat Well Move Well Think Well® Center
Salem, OR 97304
Johnson is right that there are challenges with integration of health coaching in any physician-level practice. One that one doesn't hear discussed much is that, while life-style change may be central to health and disease prevention in patient, referring a patient to an ancillary provider - whether nutritionist or health coach or exercise physiologist - makes this central pursuit appear, well, ancillary. That's not the message. My instinct is that the primary practitioner - whether MD, nurse, naturopathic, chiropractor or some other professional - makes a profound statement when he or she is actually involved. I am not sure, honestly, on what literature there is on this. Any of you?
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