Posts Tagged: health coach

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“What I Will Take With Me”

Dartmouth Health Connect, an Iora Health practice serving employees and family members of Dartmouth College, New England Carpenters Union, and King Arthur Flour, recently received a note from a patient who unfortunately was leaving the practice due to a life change. In her note, this patient described what she will be taking with her as a result of being cared for by the team at Dartmouth Health Connect:

“What I Will Take With Me

  1. I am primarily responsible for my own health with the help of a physician/Health Coach, etc. (collaborators)
  2. Mindfulness is key to addressing/mitigating health issues
  3. Sharing challenges to health issues and weight loss is helpful
  4. If you are sick, believe that you can get better and ask for help quickly
  5. Healthcare is a loving endeavor
  6. The Iora Health care model works”

This letter iterates why the Iora Health care model was created in the first place. We aim to meet people where they are so they can become advocates for themselves in their personal health journey.

Health Coaches, Cori & Audra

Medicine Coupled with Compassion

Modern medicine is incredible. We can give you a pill and lower your cholesterol, give you a pill and lower your blood pressure. We can set a broken bone. We can save lives; we can extend lives. We can fix so many problems. It’s totally amazing.

But then there are all these health problems that biomedicine doesn’t have a quick-fix pill for. There’s no pill for loneliness, and it’s a common problem that definitely affects your wellbeing. There’s no quick answer for losing weight, or getting fit. Balance is a really important issue at our clinic. So many of our patients are afraid of falling and feel unsteady. There’s often not a quick fix for improving balance. I think that most of the time, when it comes to health problems like these, patients are kind of left to go it alone. Part of the health coach role is to support patients with problems that take more time. No doubt they have to put in the legwork, but they don’t have to do it alone.

Sometimes the role of the health coach is just to hear the patient and understand what they’re going through. At the Shoreline clinic we have two patients named Dan and Mary Ann. They have been married for a long time. And it is really obvious when you meet them that there’s a lot of love. They just have a very kind way of interacting with one another.

Dan was diagnosed with Alzheimer’s disease at a fairly young age: in his mid-sixties, which was devastating for Mary Ann. And this last year was particularly hard because Dan’s condition worsened quite rapidly. And as it worsened Mary Ann had to take on more and more caregiving responsibilities.

Audra is a health coach who works in Shoreline with me: Mary Ann and Dan are on her patient panel. For any of you that have been caregivers, you know it can be really taxing work. At one point Mary Ann was sending emails to her health coach, Audra, nearly every day. Often Audra would have really solid advice for her, or something tangible to offer. With the support of Dr. Levine and Debbie Yoro, our clinical social worker, the team provided care that was so far above and beyond the status quo. But sometimes Mary Ann would come to Audra with problems that didn’t have a clear answer. When this happened Audra would just hear her out and be there with her. What resulted was really special. Mary Ann developed a very trusting relationship with Audra and the care team as a whole. It was clear that Mary Ann felt like we were on her side: that we were a team. She knew we had her best interests at heart.

There’s no cure for Alzheimer’s disease. But what is so great about the Iora model is that it recognizes that, yes there is value in fixing people’s problems, but there is also so much value in helping them cope when their problems can’t be fixed. Mary Ann sent us a note recently and it included a quote from the poem ‘Kindness’ by Naomi Shihab Nye. It read, “Then it is only kindness that makes any sense anymore; only kindness that ties your shoes and sends you out into the day.” What I love about Iora is that it’s not just medicine. It’s medicine coupled with compassion. It’s difficult to measure the value of human compassion in medicine. But when you hear stories of real human experiences, it just intuitively makes sense. The care that is provided at Iora is so exceptional partly because we recognize the value of the healing relationship and actively work to foster meaningful connections.

Scott Jacobson

One Coffee at a Time

The work we do is challenging and sometimes it is easy to succumb to feelings of doubt, thinking that all our hard work is in vain. However, there are examples that highlight the difference we make. One such example is one of our Health Coaches, Vero’s, most challenging patients.

She is a 23 year old patient. When she came to us it was clear that she was suffering. She has type 1 diabetes, difficult enough for a young adult to handle yet she also suffers from ulcerative colitis. After an extended hospital stay and major bowel surgery, she was left with an ostomy, a difficult situation for anyone and particularly debilitating for a 23 year old.

Her surgeon told her she would have to get her sugars under controlled before they would reverse the ostomy. Dealing with an ostomy bag was not only a hindrance on her social life, it limited her job opportunities.

Not surprisingly, she also suffered from major depression which became a compounding factor in managing her multiple medical problems. She tried talk therapy but never really felt comfortable opening up. Antidepressants didn’t make a dent. She was mired in despair and despite our efforts to engage her in managing her blood sugars, Vero’s texts often went unanswered. We knew she would spend days in her room, crying and isolating herself. She would frequently break down while at work. We begged her to come in to talk to us.

Finally, one day without prompting, she did. We could tell she was on the edge and didn’t know where to turn. She had decided to put her trust in us as a last resort. She opened up to us and all her emotional and physical traumas began to trickle out. It was a very emotional meeting and it was only the beginning. We offered more therapy from a professional, but she really just wanted to talk to her Health Coach. We decided that coffee with Vero every other week would be a start. She left that meeting only a step back from the edge but she was moving in the right direction.

And then, Vero received a gift of beautiful flowers.

One Coffee at a Time Vero

The note reads:

I HONESTLY WANT TO THANK YOU FOR EVERYTHING THAT YOU HAVE DONE FOR ME EVEN THOUGH I AM A PAIN IN THE BUTT I’M SO GRATEFUL THAT YOU HAVEN’T GIVEN UP ON ME YOU TRULY ARE A GODSEND

Over the past couple of months Vero’s coffee meetings have been a huge success. She has shared some of her deepest secrets that have clearly been weighing her down and blocking her from moving forward. She has felt comfortable enough to establish care with Nina, our social worker, so she can get the trained help she needs in dealing with her significant past traumas. From a medical standpoint we are still working on her sugars with the goal of reversing her ostomy. She is by no means a picture of health, but we are taking baby steps, in the right direction.

This patient has been a huge reminder to me that despite the monumental task we have in front of us, we do make a difference in people’s lives, everyday. Because of the unconventional resources we have to help us connect with our patients, we are able to continue to find creative ways to make breakthroughs and put our most challenging patients on the track to leading healthier and more fulfilling lives. I know that there are times we feel like no matter how much we try to help our most challenging patients, that they can’t or won’t change. It is so wonderful to be reminded that by showing our patients that we truly care about them and that we won’t give up on them, our positive attitude can have an impact. Great job Vero!

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Commonality: finding the common threads

Commonality is the state of sharing features or attributes. It’s an amazing thing when that is found when providing a patient care, care they deserve. In October 2013, I remember sitting around the table in room seven at the Culinary Extra Clinic, Iora Health’s first Las Vegas practice that sits in the Stratosphere’s shadow. Every stakeholder was represented at the table: a very sick patient with multiple acronyms using most letters in the alphabet, a sponsor, a primary care physician and a clinical health coach. Each was there realizing this was the most important thing they could be doing at that time.

Let’s go backwards to go forwards. This patient is under 40 years old and is trying to get their second kidney transplant. They quickly became very ill and it was determined the right course of action was to send them to the emergency department. However, an even better course of action involved a direct admission. Direct admissions need cooperation and communication with the admitting physician, all hospitalists and sometimes sponsors.

The roundtable discussion on that fall day allowed the patient to raise concerns with yet another hospitalization. It allowed the health coach, who had the closest relationship to the patient, to provide an additional voice for the patient and advocate for their needs. It allowed the physician to make a sound clinical decision. And, lastly, it allowed the sponsor to witness all of this and provide input.

Everyone at the table had a voice. While it is not uncommon for physicians and sponsors, especially if they are benefit administrators or the insurance company, to have a voice, let’s be honest, at times they may have too much of a voice, too much to say, chastising patients for poor choices and/or costing the system too much money. But what if we all started to sit around the table and voice our questions, comments and concerns. What if the common theme or commonality amongst us is cooperation and communication? How would that change things? How would that change health care and restore humanity to that end?

These are all things to think about, to contemplate. While we do that, please, let us find the common threads amongst us: the desire to be heard, to be cared for and to be respected.