The Integrator Blog
Home
Share |
about
Contact Me, Experience, Mission, Sabbatical in Central America, plus
Editorial Advisory Board
Columnists
Michael Levin
Taylor Walsh
background resources in PDF
Insurance, Integrative Clinics, Industry Summit Reports, News Files '99-'04
some organization links
Professions, Academia, Research, Policy
some CAM/IM publication links
Electronic, Peer-Reviewed, Blogs, More
Bradly Jacobs, MD, MPH, Revolution Health Blog
supported conference
Institute for Health & Productivity Management - Integrative/Complementary Healthcare
Chris Johnson, ND: "Disturbed" by the Positive View of Health Coaching in Integrative Practice PDF Print E-mail
Written by John Weeks   

Chris Johnson, ND: "Disturbed" by the Integrator Focus on Health Coaching in Integrative Medical Practice

Summary: Chris Johnson, ND writes that he is "disturbed" by the Integrator focus on health coaching "on many levels." Johnson, who practices in the Washington-DC area, then goes on to dissemble just why coaching is a misfit. He responded to an article on the Harvard/U Minnesota September 2010 summit held to begin to set national standards and certification for the field, and a follow-up report by an attendee who represented the naturopathic profession. Johnson's view is at great odds with the perspective that coaching people to health should be the center of a quality integrative medical practice. He believes physicians must create magic for patients and coaching doesn't fill the bill. Johnson questions the science behind coaching and argues that the economics of a physician practice don't support a key role for the coaching modality. I offer some comments on Johnson's perspective and hope some of you will weigh in on these philosophical-business issues about the role of health coaching relative to a physician's responsibility and his/her economic well-being.
Send your comments to
for inclusion in a future Integrator.

Chris Johnson, ND is a first-time Integrator commentator who offers a thorough opinion piece on how health coaching does not fit into an integrative medical practice. He responds to supportive views of coaching in two Integrator articles:
With Standards in the Works, Is it Time to Claim, and Certify, the Health Coach Within? and the follow-up Report on the Summit on Standards and Credentialing of Health Coaches by University of Bridgeport faculty member Jennifer Johnson, ND.

Chris Johnson, ND is the founder and owner of Thrive Naturopathic in Washington, DC. His outspoken opposition to the earlier Integrator perspectives are great fodder for engaging a discussion that is bound to be with us increasingly as the movement for national standards and credentialing of health coaches advances. Does "coaching" belong in integrative medical practice?  

___________________________

Why Health Coaching Doesn't Belong in Integrative Medical Practice

- Chris Johnson, ND
Thrive Naturopathic
Arlington, Virginia

Image
Johnson: Coaching isn't what patients want from their doctors
"I have to say that I am somewhat disturbed by the focus on health coaching. If I understand it correctly health coaching involves assisting individuals to attain their health goals with a focus on prevention of disease. Maybe I'm missing something here, but it strikes a discordant note with me on many levels.


"Prevention of disease

"Concerning the prevention of disease there are a number of problems. The first and most important of which is that we really have very little knowledge of what prevents disease and creates health. I am well aware that many claim to, but all you have to do is look back at history to see that our ideas are of very limited help. There have always been advocates for this diet, that way of living, etc and while some of these ideas have indeed helped some people, none of them represent a coherent, predictive system which helps all and harms none (or even helps many and harms few).

   
"First, we really have very little knowledge
of what prevents disease and creates health."
 

 
"Some would point to research such as that concerning diet and heart disease/cancer/etc as evidence of how lifestyle choices affect health. But the truth is this data is defective - 1) because most research on diet and lifestyle is epidemiological, and as such is highly unreliable, and 2) because the research world is significantly compromised by financial concerns of industry and individual researchers, by ideological agendae, etc. The rampant fabrication, falsification, and manipulation of data has been extensively documented by researchers such as John Ioannidis, Richard Smith, Tom Jefferson, etc,  Sure there is some legitimate stuff, but the majority of the enterprise is unhelpful to an honest practitioner who wants to do what is best for his/her patients.

"Some advocate a single mode of living for all - e.g. the idea that all should be vegan, vegetarian, eat raw foods, follow the Mediterranean diet, practice yoga, eat large meals in the morning and small meals at night, etc. But every doctor alive has seen patients who have worsened, not improved on any given regimen. The very basis of holism entails treating people as individuals, so this approach cannot be seriously considered by those in our field.

   
  "(Approaches like TCM, Ayurveda and
the Blood Type Diet) can indeed be helpful,
but these approaches are therapeutic in
nature and as such should not really be
considered preventative."
 
"Another approach is to utilize systems within which individual needs can be assessed - systems such as Ayurveda, TCM, or more recent ones such as the Blood Type Diet. These can indeed be helpful, but these approaches are therapeutic in nature and as such should not really be considered preventative - at least they were not developed and haven't proven themselves as such.

"The other option is to wing it - to somehow 'intuit' what each person needs and come up with lifestyle recommendations. Does this process work? There is no way to tell one way or the other, since the very nature of such an approach precludes meaningful scientific appraisal.

"Assisting individuals to attain their health goals

"I don't understand why this needs a special category within medicine. This is the focus of any genuine clinical encounter. Patients come into the room and know exactly what they want and it is the clinician's responsibility to deliver. So the conventional medical model doesn't achieve this? Tell me something new. They have failed at the practice of medicine. We don't need to create new language for what is simply the practice of medicine.

   
"More importantly, the emphasis on
empowering patients is in my view incorrect.
Patients are in the office because they
\need help. They can't do it by themselves."
 

 
"But more importantly, the emphasis on empowering patients is in my view incorrect. They are in the office because they need help. They can't do it by themselves. And they are not sick because they are making the wrong choices, it is the other way around - they are making the wrong choices because they are sick.

"The role of a doctor is to get people well, not tell them how to live their lives. Once well, people are completely capable of making their own decisions.

"One of my mentors at school taught me that when the correct homeopathic remedy is given the rest usually takes care of itself. Indeed this has been my experience in practice - countless times already, I have seen patients come back to my office and tell me of all the positive changes they are making in their lives now that they have their health and balance back. From this healthy and centered place, they possess a wisdom about what works and is needed in their lives I could never in a million years give them.

   
  "Conventional medicine does not have
the tools to properly treat chronic (dynamic)
diseases. We do. Modalities such as
homeopathy, acupuncture, physical manipulation,
botanical medicine, and clinical nutrition are
all capable of effecting what patients consider
to be miracles."

"This is the proper way it should work, not the other way around. This is a point clarified by the great medical mind of Samuel Hahnemann, who taught that chronic diseases (what he called ‘dynamic' diseases) are absolutely NOT due to lifestyle factors. Any physical disturbance resulting from lifestyle goes away when the lifestyle is corrected. Chronic diseases by definition do not go away unless the underlying imbalance is corrected - and this is rarely accomplished, and even if so in an unreasonably inefficient manner, by lifestyle intervention.

"Conventional medicine does not have the tools to properly treat chronic (dynamic) diseases. We do. Modalities such as homeopathy, acupuncture, physical manipulation, botanical medicine, and clinical nutrition are all capable of effecting what patients consider to be miracles. So why would we sell ourselves and our patients short by giving them less than our best?

"Economic aspects of health coaching

   
"Given its essentially non-therapeutic quality,
health coaching is less valuable than medical
 interventions.

Therefore, I consider it a disservice for ND
students to have it emphasized in their
training because it is not a solid way
to make a living.

 
"Given its essentially non-therapeutic quality, health coaching is less valuable than medical interventions. Therefore, I consider it a disservice for ND students to have it emphasized in their training because it is not a solid way to make a living. Sure, it could be a part of the clinical encounter, but I don't see how health coaching can reasonably be seen to occupy a central position.

"An ND (or similar holistic practitioner) should be making at least $150/hour, if not $200-$300/hour. This much is necessary to realistically pay down student loans and such. In tough economic times the luxury of having someone guide one in lifestyle choices will likely be the first thing people would cut from their budgets - 1) because this type of information is readily available on the internet from reliable sources, and 2) because this sort of service provides little bang for the buck.

   
  "People expect miracles and they should
get them. We in the holistic medical world
are perfectly capable of providing them.
"

"People come to doctors and pay them good money because they expect the doctor to relieve them of their pain (emotional or physical). This is what properly constitutes the practice of medicine. And that should be the practice of any doctor who expects to keep a vibrant and profitable business.

"To be a doctor who can command a good salary requires having a skill which is powerful and not obtainable outside of that doctor's office. People expect miracles and they should get them. We in the holistic medical world are perfectly capable of providing them."

Sincerely,


Chris Johnson, ND
____________________________

Comment:
I respect Johnson for speaking out. I guess that he expresses what many integrative practitioners believe. Yet I confess that I am as deeply disturbed by much of this content as Johnson was with my own views of health coaching. I look forward to your views - but will touch here on a couple of my own.

  • What coaching is  I wonder if Johnson knows the techniques, philosophy and values that are expected to eventually be part of health coaching standards. My guess is that he and many practitioners  who believe that coaching "is part of the clinical encounter" do not fully appreciate the distinctions between educating a patient, counseling a patient and coaching a patient. I worked to get representatives of Johnson's profession, of chiropractic and of AOM to the Summit in part because I believe that they have something to learn that, appropriately integrated, will be valuable to their patients.

  • Is coaching therapeutic? Johnson's judgment of health coaching as having an "essentially non-therapeutic quality" makes me wonder how much his naturopathic education was, or was not, centered around the formal self-definition of his discipline: "Naturopathic physicians treat disease by restoring health." This definition would seem to put coaching solidly in the therapeutic category.

  • "Miracles"  I have been trained by medicine's failed miracles (drugs in the 50s, the genome 50 years later, etc.) to have a jaundiced view of any practitioner whose self-image is that of a miracle worker. Certainly some healers, physicians and non-physicians, have gifts. But I have always believed that if naturopathic medicine or acupuncture and Oriental medicine or homeopathic medicine or integrative medicine were truly, routinely miracle working, the levels of adoption, cultural embrace, practice success and financial strength of the integrative practice universe would far more advanced than they are today.

Enough from me, for now. This subject will be with us, going forward. Your thoughts on this subject, please. How important is it that health coaching be in clinical education and in the practice of integrative practitioners? Is it central or peripheral?

Send your comments to
for inclusion in a future Integrator.


< Prev   Next >
Search
Advertisement
Advertisement
Sponsors
Integrative Practitioner
The Westreich Foundation
voluntary contributions
Support the work!
Archive
All Integrator Round-ups
Integrator Top 10 Lists 2006-2015
Issues #140-#142 Oct-Dec 2015
Issues #137-#139 July-Sept 2015
Issues #134-#136 April-June 2015
Issues #131-#133 Jan-March 2015
Issues #127-#130 Sept-Dec 2014
Issues #123-#126 May-Aug 2014
Issues#119-#122 Jan-April 2014
Issues #116-#118 - Oct-Dec 2013
Issues #113-#115 July-Sept 2013
Issues #110-#112 April-June 2013
Issues #108-#109 Jan-March 2013
Issue #105-#107 Oct-Dec 2012
Issues #102-#104 - July-Sept 2012
Issues #99-#101 - April-June 2012
Issues #96-#98-Jan-March 2012
Issues #94-#95 Nov-Dec 2011
Issues #92-#93 Sept-Oct 2011
Issues #90 and #91 - July-Aug 2011
Issues #88 and #89 - May-June 2011
Issues #86 and #87 - March-April 2011
Issues #84 and #85 - Jan-Feb 2011
Issues #82 and #83 - Nov-Dec 2010
Issues #80 & #81 - Sept Oct 2010
Issues #78 & #79 - July August 2010
Issues #76 & #77 - May June 2010
Issues #74 & #75 - March-April 2010
Issues #73 & #73 - Jan-Feb 2010
Issues #69, #70 & #71 - Nov-Dec 2009
Issues #67 and #68 - Sept-Oct 2009
Issues #65 and #66 - July-August 2009
Issues #63-#64 - May-June 2009
Issues #60-#62 - March-April 2009
Issues #57-#59 - Jan-Feb 2009
Issues #55-#56 - Nov-Dec 2008
Issues #51-#54 - Sept-Oct 2008
Issues #47-#50 - July-August 2008
Issues #46 & -#47 - May-June 2008
Issues #43-#45 Mar-April 2008
Issues #41 & #42 - Feb 2008
Issues #39 & #40 - Dec-Jan '08
Issues #37 & #38 - Nov 2007
Issues #35 & #36 - Oct 2007
Issues #33 & #34 - Sept 2007
Issues #30-#32 - July-Aug 2007
Issues #28 & #29 - June 2007
Issues #26 and #27 - May 2007
Issue #25 - April 2007
Issues # 23 & #24 - March 2007
Issues #21 and #22 - Feb 2007
Issues #19 and & 20 - Jan 2007
Issues #17 and #18 - Dec 2006
Issues #15 and #16 - Nov 2006
Issues #13 and #14 - Oct 2006
Issues #11 and #12- Sept 2006
Issues #9 and #10 - Aug 2006
Issues #7 and #8 - July 2006
Issues #5 and #6 - June 2006
Issues #3 and #4 - May 2006
Issues #1 and #2 - April 2006
All Articles by Subject: 2006
All Articles by Subject: Jan-June 2007
IAYT-Sponsored Series on the Future of Yoga Therapy