Kathy Hare was disillusioned three years ago when her doctor entered the exam room and delivered, with dubious bedside manner, the diagnosis. "'The good news,' he told me, 'is you don't have cancer. The bad news is that you have arthritis.'" Go see an orthopedic surgeon, he told her.
She became even more disillusioned when the orthopedic surgeon said, with no discussion of options, that she needed a hip replacement. Hare was only 46 at the time and aware that she could easily outlive a new hip.
"I walked out really disappointed and kind of depressed, really," recalls Hare, who lives in Greensboro.
She also wasn't eager to have surgery, so she began looking into alternatives. While thumbing through an issue of Body & Soul magazine, a Martha Stewart publication on clean, green living, she spotted an add for Duke Integrative Medicine, a relatively new offering from the Duke University Health System.
The idea of having access to a variety of medical alternatives under one roof -- from a physician, to physical therapist, to nutritionist and acupuncturist -- was appealing. And she was particularly curious about something the center offered called "health coaching."
"I've always been open to the whole mind, body and soul thing," she says. So she signed up.
Soon she was learning more about the various options for dealing with her arth ritis, options she says her physician and orthopedic surgeon never mentioned. Guiding her through this period of discovery was a medical professional that she had never heard of until picking up that copy of Body & Soul.
A health coach.
Emphasis on prevention
Dr. Tracy Gaudet, a traditionally trained physician who graduated from Duke School of Medicine in 1991, describes our current system of medicine as disease-based.
"We were trained to first diagnose the disease, to treat the disease and to cure the disease," says Gaudet, Duke Integrative Medicine's executive director. "That's important, but it leaves out how do you actually improve health?"
It's also important, she says, because of roughly $2 trillion spent in the U.S. each year on health care, about 70 percent of that is devoted to chronic conditions -- heart disease, diabetes, etc. Head off these conditions before they become chronic and you not only improve a person's health, you help get a handle on the nation's runaway health care costs, which now consume about 16 percent of the nation's gross domestic product, according to the Kaiser Family Foundation.
The integrative health approach grew out of Duke's efforts beginning in 2000 to address this flaw in the system. A key component of the integrative approach: a trained individual familiar with the system and what it has to offer who is also in tune with a patient's goals for healthy living. Someone who could provide direction, motivation and support in reaching that goal.
A health coach.
"We start with basic things like listening skills," says Julie Kosey, Duke's integrative health coaching manager, who also was Kathy Hare's coach. "We teach how to be present with a person, to listen deeply and understand their goals and motivation. We let the client hold the agenda."
Also critical to helping people adapt a healthier lifestyle, says Linda Smith, director of programs for Duke Integrative Medicine, is understanding and appreciating the patient's idea of an ideal lifestyle -- be it walking three miles a day or simply being able to perform basic household chores -- rather than telling the patient to lose 30 pounds or lower his or her cholesterol 50 points.
"The goal is about their value system," says Smith, "not about some medical number."
Duke's health coaching training program, one of the first in the country, began last year. Trainees attend four three-day modules, learning everything from listening skills to coaching techniques to the components that contribute to a healthy lifestyle, including nutrition, dealing with stress and exercise.
Aspiring coaches are expected to have some exposure to the health-care realm, though there are no firm requirements. Nurses, physical therapists, psychotherapists, an oncologist and a fireman with emergency medical technician training have been among the first to take the class, which was first offered last year. Six coaches work through Duke Integrative Medicine; many others coach on the side as a supplement to their day jobs.
There's usually an initial face-to-face session in which coach and client get to know each other. Subsequent sessions are done over the phone. How effective the coaching is boils down to one thing, says Smith: "The client has to be ready to change."
Motivated to try
Hare was more than ready to change. Over a six-year period, her arthritis had progressed to the point that she couldn't cross her legs and she had to sleep with a pillow between her knees.
She signed up in March 2008 for a one-year membership to Duke Integrative Medicine. She began her sessions with Kosey and immediately found out things she hadn't heard from her doctor: Trim the wheat and dairy from your diet, because they can cause inflammation and aggravate your arthritis.
"She helped me with pain reduction, with calming the inflammation, with learning good exercises," says Hare. "I felt mentally better.
"I didn't feel so bad, so lethargic."
In the end, after assessing her options, Hare opted to have her right hip replaced in January. She says Kosey played a key role in helping her make that decision, prepare mentally for the surgery and cope with the post-surgery depression that followed.
"I didn't envision how long it would take to get back on my feet," says Hare. Kosey's assurance that what she was going through was normal helped.
"Those kinds of things are what a health coach brings to the party," says Hare.
How quickly the concept of health-coaching spreads could depend on how quickly insurers help cover the tab. Through Duke Integrative Medicine, the service ranges from $590 for six sessions to $1,090 for 12. As Duke Integrative Medicine's Gaudet notes, "Innovative models are often paid out-of-pocket" -- at least at first.
Blue Cross and Blue Shield of North Carolina has offered health coaching for several years, though most of its programs have been geared to helping patients get through existing conditions. The insurer more recently has explored the kind of pre-problem coaching that Duke advocates, and it is pleased with the results.
"We've seen a good return on investment," says Debra MacClennan, the insurer's vice president of member health partnerships. (Putting a firm number on that return is difficult, she said, because its various coaching services are combined as one.)
To Hare, the expense was well worth it. (She paid for her Duke membership through her flex spending program at work.)
"My right side feels great," says Hare. "Now I have to stop and think, 'Which was my bad hip?'"
