When it comes to buying a household appliance, car, or home, consumers study their options carefully. The customer is conditioned to consider all options when making these major purchases; benefits and costs are mapped out clearly by manufacturers and reality checked by consumer product journalists and other customers who have purchased similar products. 

But what happens when people are confronting cancer, diabetes, or heart disease treatment or prevention? Then, they’re not so sure in their decisions as they confront a lack of authoritative information and a web of conflicting studies and recommendations.

Talya Miron- Shatz, PhD, an expert in medical decision making, and author of a new book titled “Your Life Depends on It: What You Can Do to Make Better Choices About Your Health,” takes a new approach to why physicians and patients need to abandon old behavior patterns that no longer work and learn to help each other make better collaborative choices. 

Dr. Miron-Shatz maintains that consumers must learn to express what they want and become part of the decision-making process as a partner or informed participant.

It’s an intriguing idea whose time, very frankly, is overdue. Doctors can no longer assume treatment decisions are all “their call.” Dr. Miron-Shatz maintains that both doctors and patients must explore what will work best toward the desired outcome and, as an outgrowth of this exploration, health system leaders must recognize that their processes for approvals, prior authorizations, and formulary baffle patients and cloud their understanding of potential outcomes and must change.

The System Rules Itself — Not Patient Input or Outcomes

We make a mistake if we assume that patient care is the system’s priority. When the decision pathway is murky and the consumer’s voice is absent, the system jockeys to make sure “house rules” win. Consumers not only need clarity of information, but they also need to build up their ability to make informed choices. As Dr. Miron-Shatz writes:

“We all make health and medical choices every single day. We choose to take a vitamin supplement, go for a run despite a sore tendon, forgo birth control pills, or have chemotherapy after cancer surgery. The more important these decisions are, the more vulnerable we are, and the tougher choosing becomes. This is why we need to build up skills to deal with these choices.”

It’s a simple yet powerful concept. For years, we in the healthcare ecosystem have heard the seemingly sensible call to “invite patients to the table.” Epidemiologist and decentralized clinical trials leader Craig Lipset, himself a patient with a rare disease, recognizes that assumption is flawed. “It’s their table in the first place,” Lipset says. “Too many fear ‘I don’t know’ as a sign of weakness, rather than a signal of confidence and honesty.” 

Though a response of “I don’t know” from a physician to a patient’s question may not inspire confidence, a provider’s willingness to explore questions with the patient — working as a team — is the foundation for a patient-physician relationship that is a positive force for inspired and trusting care and likely better outcomes.

Time for Shared Decision Making

It’s this working partnership that Dr. Miron-Shatz believes to be foundational for systemic change. However, with payers often making the care decisions, it often seems that the system serves itself. The patient is an afterthought with little influence in the conversation — at best a “junior partner” in their own care decisions. 

Payers often reject medical technologies for reimbursement as “investigational.” They cut physical therapy short, either because “it’s working” or “it’s not working.” Doctors are forced to battle the system, until, exhausted, they follow the path of least resistance. Physicians and patients need to hone their shared decision-making abilities in order to align and direct their combined voice toward better care choices.

Dr. Miron-Shatz knows this must happen. Consumer-patients need to have a larger say in the direction of their care, and they need allies to help them make smart decisions. Sy Syms, the menswear mogul and health philanthropist who founded the SYMS clothing chain in New York City, coined the expression, “An educated consumer is our best customer.” 

It’s a concept that transcends its advertising tagline as it applies to just about every interaction a consumer, even a health consumer, may find themselves in. Consumers entering the health system as patients should remember it, and physicians should listen to their charges. Perhaps the will and needs of the educated (health) consumer can be the foundation of a new alliance that helps healers, too often swimming upstream against the flow of the system, to be better partners and advocates for their patients.

Healthcare professionals that master the patient-care decision-making partnership draw upon emotional intelligence to communicate effectively, empathize with their patients’ struggles, and call upon medical knowledge and research to be better providers. 

But, most physicians are not sufficiently trained to speak with patients and are overwhelmed with the expectations of the system struggling to digitize and integrate technologies to ease their administrative burden. It’s a recipe for making decisions in isolation.

Physicians are Dedicated to Patient Advocacy

Allyson Ocean, MD, a medical oncologist and Associate Professor of Clinical Medicine at Weill Cornell Medicine, is among the founders of a pancreatic cancer health professional and patient advocacy community called Let’s Win for Pancreatic Cancer, that encourages shared decision making, says she is on the phone with insurance companies nearly every day trying to make sure her patients can get the treatment they need, and get it paid for.

“My best advice to work around the system of whether or not drugs or tests can be covered for cancer is to make sure you have an advocate in your field working for you,” says Dr. Allyson Ocean. “The frustrating part for me is that sometimes we even have to educate the insurance companies and say, ‘There’s a reason why I want to use this medicine.’”

In medical school, doctors do not learn how to navigate the medical system. They expect to help patients, to tackle disease — but not how to collaborate to tackle obstacles thrown up by the very system in which they’re preparing to work. Dr. Miron-Shatz, a “medical decision-making scientist,” has researched how doctors, consumers, and health systems need to learn how to collaborate and make better medical choices. 

Her new book is the long-needed guide for physicians, patients, and payers that will help them better navigate today’s care realities and rising consumer expectations. Dr. Miron-Shatz recognizes that what is essential to innovation’s success is having a knowledgeable and engaged customer — the consumer voice — as part of the decision-making conversation. She sums up the challenge facing caregivers and patients in this fragmented health ecosystem:

“Making better health and medical choices is neither intuitive nor easy, especially in the face of a life-threatening decision or despite medical jargon and confusing probabilities. Expecting us to handle these flawlessly is unrealistic and ignores issues of cultural background, a whole slew of cognitive barriers, lack of professional training in how to convey medical information, time constraints, and health-system deficiencies.”

Consumers and providers are at a disadvantage. Patients often feel that medicine employs a secret language requiring a skilled translator, and the range of treatment protocols and care options appear to change constantly. The outlook is daunting; to better make informed decisions, Dr. Miron-Shatz prescribes collaboration. 

That’s the key from her point of view, and ensuring patients sit at the head of the medical decision-making table must become the norm. It’s central to better, informed choices that drive care delivery, and will also influence future drug development and regulatory processes. Our lives depend on it.

[Special thanks to Dr. Elinor D. Bashe and John Bianchi for their contributions and input.]

The post A Reference Manual Toward Better Care for Patients and Physicians in 2021 appeared first on Medika Life.

As a third-year Psychotherapist-In-Training, I’m increasingly aware of the overwhelming amount of Life Coaches popping up all over social media, predominantly LinkedIn and Instagram. From all intensive purposes, it appears anyone can become an “Insta-Coach,” promising all sorts of pathways to prosperity, happiness, and wellness. The lack of experience, credentials, and governing ethical body may cause more harm to clients than good. In addressing my concerns, I am coming from a place of genuine curiosity instead of condemnation. Please help me understand the Life Coach phenomenon and whether there is a hint of accuracy to my following observations.

The Current Climate

I believe we are living in desperate times, and one with two converging issues. First, we have an overwhelming societal need for mental health care providers to supply the increasing demand. How do I know this? Our Toronto Gestalt Psychotherapy Student Clinic is beyond capacity, to the point where I will begin to see clients through a mentoring process in October 2021, at least six months earlier than what was planned pre-Covid. Our expertise is needed in the field.

Second, Covid has driven up to record unemployment levels. To illustrate this point, as of Feb 5, 2021, The Statistics Canada website reports:

Unemployment rate increases to highest level since August 2020. The unemployment rate rose 0.6 percentage points to 9.4%, the highest rate since August 2020.

In January 2021, Statistica demonstrates the United States showing a rate of 6.3%, double from the year prior.

We have the perfect environment where there is a high demand for mental health services and a skyrocketed percentage of the population seeking employment. To address this need, the Life Coaching industry is taking notice and helping to fill in the gap. In a LinkedIn article from 2019, author Umesh Venkatesh reports:

The estimated market size of the Coaching Industry is $15 billion in 2019 with a total of $7.5 billion worth of market value in the US alone. I expect the market value to reach $20 billion by 2022 with a 6.7% average yearly growth rate from 2019 to 2022. Moreover, according to PwC, the Coaching Industry was the second fastest-growing sector in the world.

People require mental health services more than ever before, particularly as the stigma disappears and the topic is at the forefront of the national conversation. While I believe our shift in belief systems is positive, what concerns is the number of Coaches flooding the market who are not trained to work with people in the mental health space. And knowing human nature, I believe many clients are seeking a quick fix to problems and may be attracted to the promises some Coaches offer when the reality is deep personal change requires hard work, time, and perseverance.

Life Coaching — An Unregulated Profession

One of the fundamental challenges I have with Life Coaching as a profession is its unregulated nature. If I am a client of a Life Coach and receive improper or questionable care, who can I speak with to ensure the individual’s practice is investigated? No one.

For example, what if a Life Coach is working with someone who experiences anxiety, yet the Coach doesn’t possess in-depth clinical knowledge of the symptoms and underlying issues. Here, we may have a recipe for lousy guidance with the possibility of harming the client. Without a governing body, the Coach can continue to practice and unintentionally make a situation worse. Umesh Venkatesh shares how the consequences can be dire:

The biggest challenge facing coaches today is that untrained and incompetent Coaches are damaging the reputation of the industry. The coaching field is unregulated. No license is required. Consequently, anyone can call themselves a Coach. The profession is painfully aware that inept coaching makes the field look bad.

Speaking from a Canadian perspective, registered Psychotherapists, Psychologists, and Psychiatrists are accountable to governing bodies with established codes of ethics and represent and protect the public interest. For example, the College of Registered Psychotherapists of Ontario, whom I will soon become a member of:

investigates and addresses complaints and reports. If you have a concern about care you received from your Registered Psychotherapist, we want to hear from you.

In the 2019 Inc.com article, 7 Ways to Know if a Business or Life Coach is Legit or an Imposter, author Andrew Thomas summed it up best:

There are dangers present with this new dynamic. If you fake-it-till-you-make-it as a coach, you’re not just being an imposter, you are misleading people at best, and potentially harming their lives at worst.

If you are a current Life Coach, I’m curious to learn your opinion on the unregulated profession and hear about your personal experience.

Wait? What Is The Role Of A Coach?

The present dangers lead to my next challenge with Life Coaching — the unclarity of the role. Let’s take a look at three different definitions:

1. Oprahmag.com — a Coach is an action-oriented mentor who can help you reach your goals. Life coaching focuses on what’s happening right now, what a person wants next, and how that gap can be bridged.
2. Verywellmind.com — A life coach is a type of wellness professional who helps people progress in their lives to attain greater fulfillment. Life coaches help their clients in improving their relationships, careers, and day-to-day lives.
3. tonyrobbins.com — The life coach definition is someone professionally trained to help you maximize your full potential and reach your desired results. They are like a supportive friend and trusted advisers rolled into one. They’re someone who will push you to identify your goals, hold you accountable, and encourage your journey to become a better version of yourself.

The profession is vague and open-ended in terms of the level of deep personal work a Life Coach can enter into with a client, one that can head into dangerous territory if the Coach is untrained. Let’s return to anxiety. Take a moment and open up the Coach.me and you will find a plethora of Life Coaches who are seeking clients in this area. Yet anxiety is a medical condition, and as the Mayo Clinic reports:

Sometimes anxiety results from a medical condition that needs treatment.

Life Coaches need to be extremely careful to “stay in their lane” and leave the diagnosis and treatment of anxiety to the psychologists and psychiatrists who are trained, medical professionals. Once again, certain Life Coaches may not understand where the line exists and too easily provide the wrong kind of care to their clients without proper training.

Global Recognized Accredited Coaching Programs

When I scroll through the sea of Life Coach and Multi-Level Marketing (MLM) Success Coach social media profiles, I am fascinated to see what certifications support their career endeavor. 90% of the profiles I have come across lately have limited to no education or experience.

While I recognize certifications are not a defining factor of an individual’s competency, it shows me that this person has invested time and money to learn a specific framework or modality and may possess the qualifications to aid clients in their journey. When I see an international certified Coach, I feel a greater sense of confidence in their abilities.

Two globally recognized accredited coaching programs are the International Coaching Federation (ICF) and CoActive Coaching — the latter certification I will be embarking upon this year. I appreciate ICF and CoActive’s individual Code of Ethics and the requirement to spend hundreds of hours in the Coaches chair practicing the methodologies before entering into the public domain with clients. When I see either of these certifications on a person’s profile, I know the Coach is serious, given the vast time commitment and thousands of dollars spent.

While there are other Coaching programs on the market, taking a weekend crash course does not prepare a person to start a coaching business and begin immediate work. Unfortunately, the current practice can lead to misrepresentation of credentials and experience, ultimately harming the client and the industry as a whole.

My Social Strategy And MLM Life Coach Challenge

In my twenty-plus-year technology career, I’ve been fortunate to work alongside some super-savvy social media marketers. While I do not claim to be amongst the sharpest social strategists, I am well attuned that being a Psychotherapist and Coach is not enough — for me. I will market my capabilities and personal brand through original, practical, and purpose-driven content.

My strategy is a delicious cocktail of combining Gestalt Psychotherapy, CoActive Coaching, and gaining the Digital Marketing Institute certification to learn SEO and implement a successful social media strategy to build a client network.

However, not everyone is as passionate about social media marketing as I am and may quickly seek the guidance of a “Success Coach,” a souped-up term for a Multi-Level Marketing or MLM Marketer. MLM Success Coaches are distinct yet related to Life Coaches. Austerityhealth.org defines the role as:

An MLM coach is a unique subset of a business-focused life coach. They take many of the foundational life coaching skills and target them specifically to the entrepreneurial business world of network marketing to help their clients meet their goals for optimal success within their chosen company.

Based on my above observation, if an MLM Success Coach promises advanced marketing techniques to secure clients yet has zero previous lead generation, sales, or marketing experience on their LinkedIn profile — buyer beware! And there is an enormous and ever-growing presence of people entering the MLM Marketing space during our time of Covid.

How the COVID-19 Pandemic Has Fueled a Network Marketing SurgeThe heartache resulting from the coronavirus pandemic is seemingly without end. In the United States alone, millions…thriveglobal.com

A limited number of lucrative MLM Success Coaches exist, and for every person, there are a thousand who are not. In my observation, I strongly recommend accredited professionals in the mental health and wellness field to seek alternative, organic methods to grow your client base and will dedicate a post to this topic in the coming month.

Let me make myself clear in our hypersensitive age — I am not against the Life Coach profession. However, I have some legitimate questions and concerns over the rise of “Insta-Coaches” and people practicing who have limited to no credentials or experience. The last thing we want to do is make our clients’ lives worse off than when they started the Coach-Coachee relational process.

In Canada, we have a shortage of mental health care workers coupled with rising demand for services. We are also experiencing a high employment rate lending itself to the rise of people gravitating towards Life Coaching. And to make matters worse, the Life Coaching profession is unregulated — it’s evident to me we have a severe problem on our hands, and I hope to see a governing ethical body established to ensure clients’ safety and well-being.

While there are well-established and globally recognized coaching certifications such as the IFC and Co-Active, most Life Coaches I’ve encountered on social media platforms do not possess credentials.

And finally, I expressed concern over the rise of MLM Success Coaches and, in particular, people entering the profession with little to no experience yet offering big promises for established professionals to grow their client base exponentially. There are other, cheaper ways to reach the right audience without spending a lot of time and money.

If you are passionate about this topic as much as I am or have an opposing view, feel free to share your thoughts. While the above post is based on personal experience and observations, I remain curious and open to a healthy dialog to better understand the Life Coach profession.

Resources:

• Life coaching and network marketing. No thanks.
• Why I’m Quitting Compass Coaching
• 7 Ways to Know if a Business or Life Coach is Legit or an Imposter
• Success Help From An MLM Coach
• The MLM Syndrome
• Reddit — Life coach new MLM?

The post Life Coaches, Let’s Talk About Credentials appeared first on Medika Life.

One patient may view success as meeting their goal of running a 5K pain-free in under 25 minutes. Anything less is a failure. Another patient may view success as simply finishing the race, even if walking breaks were required.

We don’t all live by the Ricky Bobby mantra of “If you ain’t first, you’re last.” How does everyone else in healthcare measure success?

If you ask a researcher, success may be exceeding the minimally clinically important difference (MCID) or achieving a greater level of change relative to a control (with acceptable p-values and confidence intervals of course).

If you ask Medicare, success is determined when a patient is “functional” (because that isn’t muddy at all…). If you ask a therapist, it may be 0/10 pain, full range of motion, 0% on the Oswestry Disability Index, or a beautiful single leg pistol squat with absolutely no compensation, pain, or difficulty.

But what if the patient doesn’t care about any of those things. How do we juggle the markers of “success” for all relevant stakeholders?

There is not a simple one size fits all answer. What I will try to untangle are the factors that influence how satisfied a patient is with physical therapy.

Why does this matter? Patient satisfaction has a substantial impact on both current and future performance. How a patient perceives their care can dictate the success of interventions, their compliance with care, how they speak about their providers in public, and potentially future reimbursement.

So, patient satisfaction is kind of a big deal.

THE DOMAINS OF PATIENT SATISFACTION

Patient satisfaction questionnaires target many different domains. At PT Solutions, the practice I work for, we ask patients their satisfaction with the treatment they received, the information provided about their condition, their input on goal settings, access to the physical therapy facility, and the availability of convenient appointments. I then receive a scorecard containing all individual scores and the overall satisfaction — an average of the five questions.

This provides us a substantial amount of information and allows us to tease out potential issues and highlight areas of strength.

Quick note, patient satisfaction scores are only valuable if we act on the data. Treating data as a “fun fact” is essentially useless and does not allow us to grow as clinicians. Of course, the data must be accurate.

Ulterior motives and biases can impact the answers patients provide and when the clinician provides the surveys. For example, if a clinician asks a patient how satisfied they are with face to face, they are more likely to receive a positive report. Most people do not like confrontation. This is different for outcome measures.

Outcome measures are designed to highlight functional areas of difficulty. These are best completed with the clinician present. Incorporating Patient-Reported Outcome Measures (PROM) throughout a plan of care has the potential to promote shared decision making between patients, their families, and clinicians.

PROM assessment heightens the provider’s awareness of patients’ health concerns and facilitates communication regarding available medical evidence for optimal treatment options. Geroge et al found patients who were satisfied with symptoms reported higher physical function, lower pain intensity, and less symptom bothersomeness (great word chosen by the authors) at six months.

The two strongest absolute and unique predictors of patient satisfaction with symptoms at six months were whether treatment expectations were met and change in symptom bothersomeness.

Patient satisfaction is most associated with items that reflected a high-quality interaction with the therapist — such as time, adequate explanations, and instructions to patients.

Environmental factors such as clinic location, parking, time spent waiting for the therapist, and type of equipment used are not strongly correlated with overall satisfaction with care.

HOW DO WE GET ACCURATE SATISFACTION DATA?

Clinicians work on their craft daily. They take courses, read the research, engage in clinical conversations, and reflect on past treatments to improve their care. All of these strategies certainly improve the care provided to patients, but they don’t guarantee satisfaction, and outcome scores will improve.

There is an art to administering outcome and satisfaction measures. Here are the strategies I have learned over the past few years as the National Director of Quality and Research for PT Solutions.

A quick caveat, this is not meant to artificially inflate your scores. Furthermore, the goal of obtaining outcomes and satisfaction scores is not simply to inflate the ego and display your awesomeness to everyone.

The purpose is to objectively assess your quality of care and make the necessary adjustments. You may apply guideline adherent care and have mastered your exercise prescription and manual therapy techniques, but if the patients are unhappy and prematurely ending the plan of care then the quality is not high.

Strategy #1: Obtain timely scores.

Patient evaluation worsens as the gap between encounter and completing the measure increases. Our memories become less clear as time passes. I would argue the most important indicator of whether your outcome data is accurate is the ‘days between status and discharge’.

This number represents how many days you treated a patient after obtaining their final outcome measure. The larger the number, the more days you treated and helped a patient without obtaining credit for the improvement. Additionally, patients (and clinicians) have poor long-term memory for our subjective experiences.

The longer a patient goes without a survey, the more they are guessing at how they previously felt.

Clinicians have to decide whether in-person or email surveys will provide more value. They both have benefits and drawbacks. In-person provides more immediate ratings and a larger volume of data, while emails rely on the patient open and answering the survey. However, a patient may feel less pressured to convey disappointment over email.

Strategy #2: Complete the specific actions from the outcome tool on the day a survey is administered.

If a questionnaire asks how difficult it is to walk a quarter-mile, then have the patient walk a quarter mile on the treadmill the day they complete the questionnaire.

Again, this limits the guesswork and provides a more updated assessment.

Strategy #3: Prep the patient but do not hover or bias them.

This strategy falls under ‘obtaining accurate scores’ not ‘maximizing your score, even if it is artificial’. If you hover over a patient during the survey, your body language or the way you ask a question (or your mere presence) may cause scores to be artificially high.

Patients are reluctant to disclose negative attitudes toward a health care provider because of a sense of dependency on patient-provider communication. This doesn’t benefit anyone. Instead, fully explain the survey and be available for questions.

FROM THEORY TO PRACTICE

Ok, your NVBs are top-notch, you are providing evidence-based care, and you are a master at collecting the data appropriately, what can go wrong? In many cases, it will be smooth sailing to world-class outcomes and satisfaction, but there are a few remaining barriers.

The malalignment of therapist and patient goals can be detrimental to satisfaction. It is imperative you are both on the same page with the goals and the methods for obtaining them. This is where motivational interviewing comes into play as this alignment may take weeks to obtain.

Another barrier is understanding what the patient values. They lack the knowledge to assess accurately the technical competence of health care personnel and therefore may only judge satisfaction on outcomes.

Others, however, may care far more about the ‘experience’ and weigh NVBs and the interaction with employees much higher. It is important to recognize these differences and assess them all.

A final thought on this topic is the impact the scores can have on our treatment choices. It can be tempting to provide whatever treatment a patient wants, regardless of the efficacy, to simply satisfy them. This can be a major driver of continued use of treatment with poor efficacy and limits both our progression as a profession and the long-term outcomes of a patient.

Patient satisfaction and outcome measures are by no means the pinnacle of assessment tools. However, they do carry immense value and can help guide improvement for the benefit of our patients and ourselves.

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