A mutually empowering patient-practitioner relationship is a key element of the Functional Medicine model. Recent studies suggest that establishing and maintaining a strong, empathic relationship with the patient may be the most crucial factor for his or her success in the long-term with lifestyle changes such as weight loss, tobacco cessation, and increased activity level.1,2
Unhealthy lifestyle behaviors are considered modifiable risk factors for many diseases, including cardiovascular disease,3 type 2 diabetes,4 cognitive decline,5 and many more. Lifestyle interventions target certain behaviors that deteriorate patient health, namely poor diet and inadequate physical activity, which impact chronic illness outcomes.
The Functional Medicine model uses treatment plans focused on modifiable lifestyle factors to cultivate a healthy balance in patients and improve disease outcomes. Often, disease occurs when fundamental lifestyle factors like diet, movement, rest, and/or sleep are lacking or imbalanced in an individual’s life. Integrating the simple strategies that help patients change these lifestyle factors into a healthcare plan can improve patient responsibility and increase overall health and well-being. What strategies can you employ to perpetuate strong patient relationships and help patients make these needed changes?
In the following video, IFM educator Patrick Hanaway, MD, talks about ways to help patients make the behavior/lifestyle changes they need for optimal health:
One strategy to improve the patient-provider relationship is by utilizing health coaching. The role of health coaches is to listen to and guide patients through a change process.6 Coaches set expectations, provide feedback, and help clients identify challenges along the way.6
Curious about health coaching? Visit the Functional Medicine Coaching Academy>
Cultivating the patient-provider relationship matters because it tends to reduce costs, increase patient loyalty, and improve long-term patient compliance and outcomes.7 Patient trust in their practitioner and commitment to the health plan are likely to improve their outcomes as well.8
When all parties buy in, the signs suggest health coaching is effective and satisfying. For instance, in a randomized controlled trial, 750 patients with complex, chronic disease received either health coaching intervention or usual care.9 Patients who received health coaching had lower re-hospitalization rates and lower average hospital costs.
After implementing six months of health coaching to patients with diabetes, another study identified multiple themes that make health coaching successful, including physician buy-in, a mutual understanding of the health coach role by both patient and provider, and the patient’s readiness to receive health coaching.10 Studies show that health coaching interventions target behavior changes aligned with self-determined goals leading to improved physical and mental health outcomes.11 Without proper management, patients with type 2 diabetes are at increased risk for complications, particularly stroke, neuropathy leading to amputation and blindness, and death.11
A 2015 study of patients with type 2 diabetes who underwent a health coaching intervention demonstrated a reduction in HbA1c, significant decreases in weight and waist circumference, and improvements in mood, satisfaction with life, and quality of life.11 A 2009 study of overweight, insulin-resistant individuals found that while weight loss and improved cardiovascular risk factors improved during a four-month intervention, more frequent monitoring for an indefinite period of time was necessary for nearly two-thirds of patients to maintain their lifestyle changes long-term.12
In practice, studies have shown that health coaching can be effectively implemented by clinicians, medical assistants, or support staff, especially in small care clinics and group visits.10,13,14 Health coaching may even reduce physician burnout by providing “a results-oriented and stigma-free method… primarily by increasing one’s internal locus of control,” one study suggested.15
Functional Medicine begins when a solid foundation is developed between the practitioner and patient. Specific tools, like the IFM Timeline, help the practitioner understand the course of the patient’s life as seen through the lens of health and disease. IFM offers a range of other tools—like the IFM Matrix, the Functional Medicine Tree, and the IFM Food Plan—to guide the practitioner in identifying the cause of disease, designing a personalized treatment plan, and helping the patient achieve an optimal outcome. Integrating modifiable lifestyle factors in a healthcare plan will improve patient responsibility and increase overall health and well-being.
Learn more about enhancing your patient relationships and implementing new tools based on cutting-edge research into your practice by attending IFM’s Applying Functional Medicine in Clinical Practice (AFMCP).
- Brandt CJ, Søgaard GI, Clemensen J, Søndergaard J, Nielsen JB. Determinants of successful eHealth coaching for consumer lifestyle changes: qualitative interview study among health care professionals. J Med Internet Res. 2018;20(7):e237. doi:10.2196/jmir.9791.
- Brandt CJ, Clemensen J, Nielsen JB, Søndergaard J. Drivers for successful long-term lifestyle change, the role of e-health: a qualitative interview study. BMJ Open. 2018;8(3):e017466. doi:10.1136/bmjopen-2017-017466.
- Shrestha R, Copenhaver M. Long-term effects of childhood risk factors on cardiovascular health during adulthood. Clin Med Rev Vasc Health. 2015;7:1-5. doi:10.4137/CMRVH.S29964.
- Van Buren D, Tibbs TL. Lifestyle interventions to reduce diabetes and cardiovascular disease risk among children. Curr Diab Rep. 2014;14(12):557. doi:10.1007/s11892-014-0557-2.
- Phillips C. Lifestyle modulators of neuroplasticity: how physical activity, mental engagement, and diet promote cognitive health during aging. Neural Plast. 2017;2017:3589271. doi:10.1155/2017/3589271.
- Hayes E, Kalmakis KA. From the sidelines: coaching as a nurse practitioner strategy for improving health outcomes. J Am Acad Nurse Pract. 2007;19(11):555-562. doi:10.1111/j.1745-7599.2007.00264.x.
- Dorr Goold S, Lipkin M Jr. The doctor-patient relationship: challenges, opportunities, and strategies. J Gen Intern Med. 1999;14(Suppl 1):S26-33. doi:10.1046/j.1525-1497.1999.00267.x.
- Berry LL, Parish JT, Janakiraman R, et al. Patients’ commitment to their primary physician and why it matters. Ann Fam Med. 2008:6(1):6-13. doi:10.1370/afm.757.
- Coleman EA, Parry C, Chalmers S, Min SJ. The care transitions intervention: results of a randomized controlled trial. Arch Intern Med. 2006;166(17):1822-1828. doi:10.1001/archinte.166.17.1822.
- Liddy C, Johnston S, Nash K, Ward N, Irving H. Health coaching in primary care: a feasibility model for diabetes care. BMC Fam Pract. 2014;15:60. doi:10.1186/1471-2296-15-60.
- Wayne N, Perez DF, Kaplan DM, Ritvo P. Health coaching reduces HbA1c in type 2 diabetic patients from a lower-socioeconomic status community: a randomized controlled trial. J Med Internet Res. 2015;17(10):e224. doi:10.2196/jmir.4871.
- Dale KS, Mann JI, McAuley KA, Williams SM, Farmer VL. Sustainability of lifestyle changes following an intensive lifestyle intervention in insulin resistant adults: follow-up at 2-years. Asia Pac J Clin Nutr. 2009;18(1):114-120.
- Willard-Grace R, DeVore D, Chen EH, Hessler D, Bodenheimer T, Thom DH. The effectiveness of medical assistant health coaching for low-income patients with uncontrolled diabetes, hypertension, and hyperlipidemia: protocol for a randomized controlled trial and baseline characteristics of the study population. BMC Fam Pract. 2013;14:27. doi:10.1186/1471-2296-14-27.
- Sang MJ, Benavente V. Health coaching in nurse practitioner-led group visits for chronic care. J Nurse Pract. 2016;12(4):258-264. doi:10.1016/j.nurpra.2015.11.015.
- Gazelle G, Liebschutz JM, Riess H. Physican burnout: coaching a way out. J Gen Intern Med. 2015;30(4):508-513. doi:10.1007/s11606-014-3144-y.
“Whole Health is an approach to health care that both empowers and equips patients to really take charge of their health and well-being. For what purpose? [For patients] to live their life to the fullest. What does that look like? The person is at the center—their mission, their aspiration, their purpose—is at the very center of this model… It addresses areas of self-care together with clinical care.” – Tracy Gaudet, MDRead More
In an IFM video, Elizabeth Boham, MD, talks about how she combined an undergraduate degree in nutritional chemistry with a degree in family medicine and Functional Medicine certification so that she could help patients navigate chronic disease. Dr. Boham is also a registered dietitian.Read More