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Optimizing Outcomes: The Benefits of Health Coaching for Patients and Practitioners

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Guest Bio

Monique Class, MS, APRN, BC, is a board certified family nurse practitioner and clinical nurse specialist in holistic health at The Center for Functional Medicine in Stamford, CT. She currently serves as a clinical instructor for the Yale Graduate School of Nursing and is a founding member and director of coaching development for the Functional Medicine Coaching Academy. Dr. Class holds dual board certifications in coaching from the American Holistic Nurses Credentialing Corporation and the National Board Certified Health & Wellness Coaches.

Transcript:

Kalea Wattles, ND:
On today’s episode of Pathways to Well-Being, we welcome Monique Class, director of coaching development for the Functional Medicine Coaching Academy. We’ll discuss the role of health coaching in improving both patient and practitioner outcomes.

Collaborative care teams can enhance the quality and efficacy of care delivered to patients. Leveraging the expertise of multiple healthcare providers, including nutritionists, pharmacists, psychiatrists, and health coaches, can improve long-term outcomes and keep patients engaged in the lifestyle modifications. Studies indicate that patients who work with health coaches in particular demonstrate consistently higher rates of treatment adherence, improved self-efficacy skills, and decreased recurrence of hospitalization. Working on a collaborative care team with or as a health coach has many benefits and can help reinforce several core concepts of functional medicine, including sustainable lifestyle change and facilitating the therapeutic partnership. I’m so excited to have Monique on the show today. Welcome, it’s just always a delight to be with you.

Monique Class, MS, APRN, BC:
Oh, I’m so excited to be here. This is one of my favorite topics, Kalea, so…

Kalea Wattles:
You know, I have to tell you as we get started that one of my first assignments when I first started at IFM about five years ago was to watch little 30-second and two-minute clips of IFM educators speaking on topics, things you would’ve recorded at AMFCP, so that’s really how I learned functional medicine, was, you know, in these two-minute little snippets. And one of the first films that I watched was, you were talking about health coaching, and you said, the practitioner lights the fire, but then the health coach keeps that flame lit, and that really stuck with me. I think about it all the time. Every time someone brings up coaching, I hear you saying that in my mind.

Monique Class:
Oh, well that’s how I see it. You know, we as practitioners, you know, we’re experts on the medicine, but we’re not necessarily experts on behavior change. And for transformation, our clients need both. They need an expert on the medicine, they need someone who can assess and develop really personalized care plans, and then they need someone to walk and hold their hand through that and create a care plan that has meaning for them, and that’s the key, that’s where health coaches come in. That’s where the collaboration happens. They complement each other perfectly.

Kalea Wattles:
Yeah, beautifully said, and I know you’ve worked for many years as a trained health coach and a key member of the collaborative care team in a variety of clinical settings, so I’m sure you’ve learned so much from both the practitioner’s standpoint and the health coach perspective. I’d love to know, how has that experience influenced how you practice? What impact have you seen on patient outcomes when you utilize a coach approach?

Podcast HomepageMonique Class:
Well, that’s a great question. So my coaching background informs my clinical decision tree, always. And the biggest shift happened to me internally when I really started to understand—and this is going back 20 years ago. Before coaching became cool and a thing, I was interested in coaching, and what I realized as I understood the coach approach is that we have all these great plans and ideas, but compliance isn’t getting us anywhere, so even—and patients understanding that they should change because of this number or that number, they leave your office and they’re unmotivated and uninspired. It’s not about a lack of information, it’s about a lack of motivation.And how do you motivate people? Well, it can’t be from the outside in. The motivation has to be ignited in them. That’s the fire I’m talking about. And so the coaching dynamic or the coaching conversation is about finding out and listening from the client, what gives them meaning? What gives them purpose? What can they actually do in this moment in time? There’s what the practitioner wants them to do and there’s actually what they want to do and what they can do at any given time, you know, whatever assets they have emotionally, physically, and financially to execute on the plan.

So what the coach does is sit down and unpack all of that, and kind of reconcile what the clinician wants, what the client actually wants, and what they’re capable of doing, and then co-creates plans in little bit-sized pieces to facilitate success. So it builds. It’s about momentum. I always say that changing your lifestyle’s about momentum. It’s not about an overnight success. It’s about small little changes over time that build, and you get little wins, little wins, little wins, and you win the championship. It’s taking it one moment at a time, or if you want to use the sports metaphor, one game at a time, one match at a time, and building on that. And so what I understood [was] that motivation was an internal thing, and even, and I used to, this was the old me, I used to launch into explaining all the pathways and the diagrams and, you know, the steroidogenic pathway, and I thought they’d be so excited and they’d be motivated and they’d work on their stress to change their hormonal milieu, and they were like deers in headlights, interesting information, I had a lot to say, but they walked out and weren’t making the changes.

So when I changed the languaging to finding out, well, what is it that you’re interested in changing? What is it that you’re interested in hearing more about? And just having them direct the show, and not me direct the show, by just asking those kinds of exploratory questions, letting them tell their story, finding out where the opening is, and then asking them, well what do you want to do first? What can you do? And breaking it down. So you want them to exercise. Well, that’s great. People can’t start with an hour exercise regimen or 40-minute HIIT if they’re not exercising, but they can start with five minutes, they can start with 15 seconds of planks a day, which I’ll do often with my clients with osteoporosis.

Make it small, make it available, give them a bunch of successes, and over time, they change from within, but they’re choosing, I’m not choosing. So I’m not telling them what to do, I’m asking them, what can you do? What does that look like for you? What has meaning for you? What do you think is the next step? So they’re actually, it’s a self-directive process instead of a compliance model, “I need you to do this,” right? And I’m taught, my background, I’m taught compliance, right? You’re going to do this. You’re going to take these supplements, you’re going to do this food plan, you’re going to do this amount of exercise, we’re going to do this type of testing, and I’m telling them what to do.

So that was the switch, and I think the dance is, as a clinician, how do you blend both worlds? And if you’re not trained as a coach and it’s something that doesn’t interest you to get trained as a coach, hiring one, well that’s your other hand, right? It frees you up to do whatever it is you like to do. Focus on the medicine, get a care plan, and then let the coach work with clients in this self-directed way over time towards the mutual endpoint that the client wants, not necessarily what the clinician wants. But usually there’s some overlap in what they both want. So does that answer your question? That was a long-winded answer.

Kalea Wattles:
Absolutely, that was jam-packed full of insight, and I think a couple things came up for me as I was listening. The first is, we talk a lot about collaborative care teams, and I think for—most of the time what we’re referring to is a practitioner who’s working with a nutritionist and a health coach, and there’s all these professional members of the collaboration, but what you’ve just highlighted is that the patient is actually part of a real collaboration. The patient is involved.

Monique Class:
Bingo. Bingo, it’s patient-centered care, and therefore, it needs to be self-directed, and they need to be supported in that, and they need to be brought in on the conversation in a large way. If they’re going to transform, it’s from the inside out, and that is such a key thing you said, that they’re the center of the collaborative care team. We’re spokes on that wheel. And we’re all important spokes, and to your point, we all have different backgrounds and different pieces of knowledge and ways of being with clients that are useful, and I think the dance always is, when do you hand off? I think that’s the key to collaborative care teams.

When I look at collaborative care teams that’ve been successful, people understand their scope of practice, and they know when to eclipse their own ego. And what I mean by that is, they know what they know, and when they don’t know it, they hand off to the person on the team that does know it. And so it’s very clear where the boundaries are for them, so they’re not—coaches aren’t clinicians unless they have a background—like I happen to have a background, so I’m both, but most coaches are not, so they wouldn’t be prescribing, they wouldn’t be tinkering with supplements, they wouldn’t be ordering test kits, they would be hearing what the client wanted, and then here’s the collaboration. They go back to the clinician and say, hey listen, this is what’s going on, they have a conversation with the clinician, and the clinician determines what’s the next right move, and then they go back to the client and they have another conversation. So the coaches are like the middle man, kind of reconciling what the client wants to do and what the clinician wants to do, and they’re reconciling those two things and making it happen. They’re the boots on the ground making that happen.

And you know, and like I said, it’s understanding where your role is, so coaches aren’t nutritionists either. So when there’s very complicated food plans that really need the expertise of a nutritionist, it should be handed off to a nutritionist. And so, you know what you know, and what you don’t know, know when to hand off, and collaborative care teams will work beautifully. What I love about functional medicine, it’s given all members of the collaborative care team a common language. Without a common language, you can’t communicate in a way, in a meaningful way between departments, if you want to call it departments, or between the spokes of a wheel. So functional, we’re all talking functional medicine, and so that language of functional medicine, whether it’s through functional nutrition or functional medicine coaching, or functional medicine docs, we have a common language and a common way to conceptualize health and well-being. And a common understanding, and that makes collaborative care teams more robust and more successful.

So that’s another key element, is to have really good communication and to understand how the team wants to be communicated with. Is it through notes? Is it through email? Is it through weekly meetings where you present clients? So it has to be determined by whoever is running the whole team, there’s got to be someone kind of coordinating the team, but then everybody needs to agree on the types and the methods of communication, and the charting, right? It has to be visible somewhere, when a coach sees a client, it’s got to be visible to everybody on the team what the client wants, what was revealed, what the… what happened, what was the negotiation, what was the new agreed upon first steps in all the different domains in the modifiable lifestyle factors and so that everybody knows what’s going on.

So it’s, you know, all of those things make for successful collaborative care teams, and this is what’s, I think this is what’s happening in the field, is everybody’s finding their way. People have bought on, you don’t have to sell people that collaborative care teams are the way to go. You don’t have to sell people that coaches are useful. The next iteration is, how do you do it? How do you get these collaborative care teams to flow, to work, to communicate in the best interest of the client to get these transformative, and they are transformative, outcomes? And that’s, I think, the elevated level of education and assumption now. Everybody’s on board, but how do we do it?

Kalea Wattles:
Absolutely. Something that occurred to me—it’s clear the patient benefits when they have these providers who are really focusing and leveraging their own strengths to improve their health outcomes, but I realize that there’s actually an extra benefit in addition to all of these benefits you talked about for the provider, that it actually gives you this opportunity to focus on what you love to do. If you love to just do lab reviews, you love to do functional, fancy functional tests and make those treatment plans, that gives you the space to do that.

Monique Class:
And that’s, there’s nothing wrong with that. I mean there’s some clinicians that just want to do the higher level stuff, right? They don’t want to be doing the nitty-gritty of the back and forth and figuring out the subtleties of the first step. That doesn’t interest them at all. And you’re right, if this is what you love to do, then know what you love to do and surround yourself with people that do the other pieces really, really well so that you’ve got a functioning whole system in place. You’re absolutely right.

And so it also, it takes the workload off the clinician. Then they can do what they love to do, and then hand it off and just do the communication piece, and then clients loop back around at a determined time, whether that’s a month or six weeks, but they constantly can get feedback from the coach or the nutritionist or even the pharmacist, depending on who’s on your team, as to what’s happening, so they’re always in the loop, and they can make minor adjustments if they need to. So it’s, you know, it’s shared authority as well, right? So you’ve got to trust the people on your collaborative care team, because there’s shared authority all the way around, shared authority between the coach and the clinician, shared authority between the clinician, the coach, and the patient, it’s all shared authority, and the nutritionist, who’s ever on that collaborative care team. So, those are kind of some key concepts that I see beginning to bubble up to the surface and need to be named and kind of called out for these things to flow well, for these systems to start to flow well.

Kalea Wattles:
Excellent. So many little practical implementation pieces in there, and I want to touch back on something just before I forget, because at the beginning of our conversation, you mentioned the importance of kind of giving bite-sized little treatment plans that are really approachable and realistic, and I think as a—when we’re very new in our functional medicine career, it feels like we have to give these giant treatment plans to prove that we have done our research and we’ve done our modules and we know what we’re talking about. I have certainly participated in this, of just giving these giant treatment plans, and then the patient comes back and they’ve said, “I couldn’t do all of this stuff.” So I’m just wondering if you could give some advice to the newer practitioners about taking some of the pressure off of giving these giant treatment plans, and it’s actually better if you give a couple real, actionable steps that are doable.

Monique Class:
Yeah, so absolutely. So you can have your big, lofty treatment plan, but it’s a conversation piece. So you roll it off, you have this big lofty treatment plan, roll it out, but understand that most people aren’t, you know, there’s some people that are all or nothing, meaning they’ll be all in and they’ll do everything on your list, but most people will be overwhelmed by too many supplements, too many test kits, too many changes on their lifestyle. So you can put down your overall thing, but then I reflect it back always to the client sitting in front of me. I said listen, we’ve got these four test kits. Do you want to do them all at once? Do you want to do the first two? This is what it entails. So any place I can, I give them input. You know, like I want to do food sensitivity testing, I want to do a stool analysis, I want to do a SIBO test, I want to do a NutrEval.

So you go through all the testing, and then I explain each one and we go back and forth, and they choose a step-wise approach. Or they’ll say no, I just want you to begin to treat, you know, let’s do, so a treatment plan and I want to wait on the testing ’til later. So that discussion happens, same with supplements. There may be 10 different supplements that could be useful, and again, I’ll say, well, do you want pills? Do you want powders? How many can you take at one time? And then it’s a back and forth and you prioritize, and with the lifestyle, it’s absolutely like that. I have them, where do you want to start? Do you want to start with one or two things? Do you want to start with movement, do you want to start with nutrition or both, do you want to start with stress management? Based on the story you just told me, where do you think would be the most beneficial, and what’s available to you?

They know. We’re an expert on the medicine. They’re an expert on themselves. So when you empower them and share authority with them and allow them to make their own decisions, number one, they’re participating, right? A key tenet of functional medicine is it’s participatory medicine. So we have to change the way we do it, so to participate, they have to be able to have a moment where they’re making choices, because then they’re engaged, right? Then they’re participating. Then it’s their decision. Then they’re in. It’s self-directed. So as a practitioner, anywhere you can, give them an opportunity to make a decision. And starting small and building is typically, I have found, the best way to get change over time. I just know this for myself.

What’s the hardest thing about—when I used to run, now I walk fast, and I, the hardest thing when I used to go running was putting on the running shoes. Once you get going, you can do more than you think. So it’s about getting over the barrier or the block. So if you start small, and you get people moving and say, you know, you just have to walk for seven minutes, they’ll start walking, they’re like, oh, this is okay, I’ll do another five. So it builds on itself really quickly.

You know, even with food. I’m not going to take away gluten or dairy, let’s just start by adding more phytochemicals and you work with them on what that looks like. So wherever it is, sometimes it’s just starting with taking out their diet soda, and that’s the start. And they’ll start to lose weight and feel better. So it’s wherever, whatever’s available to them, and then you build and build and build. That’s where I get my biggest success. And that’s where people, cause they can do that, and they’ll tell you what they can and cannot do.

Another key thing is I always let them know up front, this is what we mutually agreed upon. I don’t care if you’re able, I want you to be able to do it, but if you’re not, the most important thing to me is that you come back in and we can go back to the drawing board and we could have a discussion as to what it is that got in the way, what blocked you from doing this plan that we co-created that you wanted to do. Because that’s where the gold is, cause then you can re-evaluate and make different decisions and maybe scale it back, so it’s taking away the shame. Sometimes they don’t come back to us because they couldn’t follow, not because we didn’t have a good care plan, not because they didn’t want to follow, but they couldn’t follow and they’re ashamed to come back in and own that. They’re ashamed we’ll judge them, they’re failures, they failed us, whatever goes on in their mind, so taking these things off the table also takes the burnout out of the clinician. We’re not responsible for their health. We’re participating in the responsibility, it’s shared responsibility. And that takes—they’ve made the decisions. We’re working with them. So it’s different dynamics.

Kalea Wattles:
I think it’s so important that you brought up that a health coach can really help our patients or clients first identify what their barriers are to reaching their goals, because I think a lot of us don’t even understand or don’t even conceptualize what those barriers are, and then to develop strategies to overcome those barriers.

And I wanted to just share something that came up for me as you were talking is, we do an elimination diet for example with our, a group of clinicians that are going through our training, so these are people that, you know, they’re in functional medicine training, I think of them as being fairly healthy and aware of what their, what’s going on with their modifiable lifestyle factors. And recently, we’ve introduced this group that’s doing an elimination diet, they’re now utilizing health coaches, and I have found that even people who are traditionally healthy, they find areas where they could really use some support, so it’s not just for people who are really struggling with their health or have a huge list of chronic conditions. It’s even for people who maybe are in that pre-clinical stage, or even healthy individuals can really benefit from understanding how they can leverage their lifestyle factors to meet their health goals.

Monique Class:
Absolutely, and you know, also strength spotting. Coaches are really good at helping people identify, well here are your strengths, right? Here’s what’s right with you, right? You know, because when they come to us, we’re pointing out everything that’s wrong. Well, you’ve got this, you know, you’ve got a methylation problem and a COMT and all these things. We’re finding everything that’s wrong, and so what the health coach does is like, well, look at all these things you were able to accomplish in your life, this strength spotting, and just really kind of turned it on its axis and help build on possibilities and enthusiasm and potential, and look at the blocks as not a failure, but where’s the opening? Okay, this was a block, so how do I navigate this?

And me as the coach or the clinician isn’t the one figuring that out. That’s a question you ask them. How can you navigate this? What do you think you can do? What would be the best? Whatever it is, and one client the other day, I had her on the elimination diet, and the saboteur was her husband, he kept bringing all this stuff in. And so I was like, well what can you do? And she’s like, well I can engage him in the cooking with me. He likes to cook, let’s cook together and let’s cook healthy together. So she figured out her own answer, so it’s not even you having to figure out or dissolve the block. People have an innate capacity to heal and an incredible ability to understand what they need to do next if we ask them the question and we’re still enough and create enough space for them to emerge the answer.

And I think that’s the beauty of coaching, and that’s what we don’t always have the luxury to do as the clinician when we’re looking at the clock and we’ve got a full schedule and we’re responsible for looking at labs and charting on EMRs and all the other things that we do as clinicians, we don’t always have the space and the time for those wonderful conversations. But that’s where the coach can fill that particular void and really just be a great companion to clinicians. And to nutritionists. I work—in our practice, we have nutritionists, we have coaches, and we have clinicians. I mean, they all have their wonderful skillset, and it’s knowing who to send where in any one point.

Kalea Wattles:
Oh, I love the term strength spotting. I hadn’t heard that before, and I’m going to remember that, because I think the same way about even lab reviews, you know, it’s important to tell our patients or our clients where their labs could be improved, but also to say, but look at your A1C dropped two points or whatever, to show that they have made progress as well, so I love strength spotting. I’m going to use that.

You talked a little bit about building a collaborative care team and how part of that is identifying what you like to do and maybe being transparent about areas where you’re not as strong. I think clinicians who are listening to this are probably thinking, wow, I could really benefit from assembling a collaborative care team. So I want to know, what factors should a practitioner consider when they’re building their collaborative care team? What type of models have you seen to be effective? As we’re assembling this superhero team of practitioners, what should be we thinking about?

Monique Class:
Not only what the background is, but the personalities that you need around you to support you, right? So that’s important, so it’s not just a coach, it’s a coach that’s aligned with your deeply held values and beliefs and that you can resonate with. And so it’s creating a core team, and it’s an energetic thing, right? There’s energetics between it, and, you know, so it’s thinking about, first of all, I would start small, meaning I wouldn’t jump into hiring five people on your collaborative care team. Think about the first person you need, whether that’s a coach or a nutritionist or a meditation teacher. Think about your practice and what are the needs of your practice? Hire one person, get that going, and then bring in the next. Just slowly put together your team, and as I always say, hire slow, fire fast. Meaning, really take your time and get the right person that works based on knowing yourself first, right? Know what you’re good at, what you want to do, and what you need, what you want to offload on somebody else. And that’s how you bring in part of your team.

The other thing is our administrator’s part of our collaborative care team. She calls our patients, she talks to our patients, she gets our groups off the ground, OK, I mean, she’s a key part of our collaborative care team, so not to forget about your admin people, your key admin people and how they’re part of the collaborative care team, always interfacing with clients. When a client has a problem and they got the wrong supplement, or whatever it is, you know, she’s the one who gets on the phone and gets them to the right place and takes care of all the issues. So understanding all of the components of the collaborative care team, and beginning to bring people in slowly that fit in where you’re heading. And it builds over time. So we started with just Sheldon Lewis who did meditation out of our practice and we ran groups out of our practice, and then we brought in—because I was doing most of the coaching and the practitioners, and then we brought in a nutritionist and then we brought in a couple more coaches, so it built over time. It didn’t happen overnight—as our needs change, so it was knowing what we needed first.

Kalea Wattles:
This is great, and I’d love to elaborate a little bit into the group visits that you just mentioned. We talk about this all the time because that’s really how we can increase access, build a sense of community among our patients. Will you just briefly give us a little bit of background about how we might utilize health coaches as part of a group visit scenario?

Monique Class:
Yeah, yeah, so I’ve just finished with Dr. Dan Lukaczer out of his practice. We did a beta test. We ran a medical group visit where I was the coach and not the practitioner, and he was the practitioner to see how it worked. And it was, so I stayed in scope of practice as a coach, I didn’t go giving medical advice even though I knew the answers, stayed in my scope of practice, and the back and forth was amazing for the clients because we were doing different things. So there’s this synergy and this back and forth that can happen, especially in an insurance-based practice. It’s just the way to go.

And so there’d be a presentation, and then there’d be questions from the group, and then there’d be a coaching component where I was going through and coaching each person and the group together on the information that they just learned, and then everybody would leave with a personal care plan and come back next week and the curriculum built. But it was, like I said, an amazing collaboration between coach and practitioner, different skillsets, both necessary for the groups to run. And you know, this is going to be the wave of the future, especially if you’re looking at diversity, equality, and inclusion, right? Those key terms. It’s got to be accessible to all, and the group model in insurance, it’s going to be key, but you need both the practitioner and the coach to be talking the same language and to be doing their thing in their different things. Like you’d be taking people out and, so that that could be billed through insurance, and I would be doing the coaching component after he presented a lecture on the didactic, so it’s really going to be awesome.

In my practice, we spent 20 years running groups, but it wasn’t through insurance. We did fee for service, but we made it affordable and we did sliding scale. So it was, you know, and I was running them kind of with both hats as clinician and coach simultaneously, but I never did the co-facilitation as a, just putting on my coach hat solely. But I love running groups, it’s cost-effective, it’s efficient, there’s magic that happens in the group that doesn’t happen on the one-on-one. So it’s really an emerging opportunity. And it’s been around a long time, but I see it making a resurgence right now. And I think it’s going to be a really great place to work with coaches. And at the Functional Medicine Coaching Academy, we’re going to be training people on how to do this, how to run these group medical visits with a clinician.

Kalea Wattles:
Well that’s so exciting, because I’ve always thought functional medicine practitioners are uniquely well-suited to meet the group-visit model. Because community, you know, the community as medicine, that’s already part of our philosophy, so it already really honors those pillars of health that we talk about with the modifiable lifestyle factors, so I’m very excited to hear that the coaching relationship with group visits is maybe going to become more commonplace. I think that patients and practitioners will really benefit from that.

And that leads perfectly into my next question. You already mentioned a bit about how a relationship with health coaches can lessen provider burnout. And this makes perfect sense because, as you said, the shared responsibility of patient care, it allows everyone to leverage their strengths, but also to create a little bit more time for what they love. So just, what has been your experience with collaborative care and how that affects our professional outcomes, our burnout, our motivation to do good medicine and show up every day?

Monique Class:
So my experience is that it takes the workload off, right? So they did a study at a Mayo Clinic, and this is with clinicians that were coached themselves, not as part of a collaborative care team, that it, you know, six coaching sessions at the Mayo Clinic, I think they did it in 2017, 2018. Fabulous results, it was a randomized pilot with 88 clinicians where it decreased burnout when they had six sessions with a coach. So that being said, that’s physicians being coached. I don’t know the data on collaborative care teams decreasing burnout, I don’t know if they studied that specifically, but I’m sure it’s coming. My direct experience is, it does because it takes a lot of the workload off, it answers a lot of the questions.

You know, what are you looking for as a clinician? You’re looking to give really good quality care and to be able to be there for your clients and answer all your questions. But if you try to do that, you’ll be burnt out, because the magnitude of questions and the magnitude of things coming at you via email and telephone calls, you’d never be able to accomplish and see your clients. So the biggest complaint I get from people that go to functional medicine doctors is they have no way to communicate with them in between visits, so they’ll see them, they’ll get a care plan, and then they’ll be told, if they call up, well you have to make an appointment. And that appointment can be a month out or six weeks out just to get their questions answered, they can’t get some basic things. And that’s a source of frustration, and it’s because the doctors, the clinicians, are overwhelmed. It’s not cause they’re bad doctors, not cause they don’t want to answer it, it’s just there’s not enough hours in the day.

So with coaches on board, they’re answering these questions. They’re working with people. They’re working with the care plans. The way it works in our office is our coach is actually Joel’s medical assistant. She’s, so she sees clients with him, goes over the care plan, and then she follows up with them, and so they’ve always got their point person that’s taking the workload off of him. So he can be more efficient, it’s about efficiency, he can be more efficient, and clients are getting what they need, and coaches are part of a collaborative care team. And it’s the back and forth, it’s the synergy of the whole thing. So done correctly, it’ll absolutely give you what you want as a clinician. Patients are getting what they need, they’re getting their questions answered, they’re getting really good medicine, and you’re not having to answer every single question and do all the teaching on everything all the time. You know, you’re kind of insulated from that, which decreases burnout, and you can feel good about yourself.

Kalea Wattles:
Yeah, it’s really a bidirectional benefit, which is a beautiful thing. And I want to make sure that we talk about telemedicine, because we’ve really ventured into emerging practice models in this conversation, and we’ve seen so many practices transition to a telemedicine or a virtual health setting during the pandemic, not only for their consultations, but also for remote health monitoring, which I think is really exciting in terms of how that’s changing insurance billing. So how does coaching fit into the virtual or telemedicine model?

Monique Class:
Really well. Really well. You know, so I’m speaking for the Functional Medicine Coaching Academy because that’s who I’m affiliated with, the curriculum there has always been a remote curriculum. So it’s never been a, you know, they coach remotely. So it’s a mode that they’re used to. It’s been seamless transition for them to do the coaching online cause that’s how they learned, they learned everything online, they did all of their practicum online, and it’s been really easy for them to transition.

And with, I’m just telling you what we do in our practice, our coaches will come on with us on the Zoom when we’re meeting with clients so that they’re there, they’re part of the conversation, and then they can move to executing on the care plan. So they’re, you know, it makes it so everybody can be on at the same time, it’s more accessible for clients, and it’s working really well. Now the home monitoring, that’s an exciting thing, the remote monitoring. We personally haven’t gotten into it yet, but it’s an exciting field that’s going to explode. And just, you know, it’s just more information and more biofeedback on the client, which I think is motivating.

So the transformation happens person to person, but the information from numbers with devices helps to inform choices moving forward. So when you see your hemoglobin A1C looking a particular way or your blood sugar looking a particular way and you look at what you ate, it can inform the next choice. But the coach, or the person that talks you through that and helps you with those awarenesses and helps you identify, if this, then that, and what do I want to do next and what am I going to do moving forward? That’s, you need both. So the monitoring alone without the support of a coach I don’t think is going to be as effective as when you put the two together and people are allowed to, people are, or not—allowed is the wrong word, but people have the opportunity to talk it all through, talk the numbers through and see what it means for them and what they want to do next. I think that’s where the biofeedback information from the devices is going to change outcomes in a big way with the two together, so I think it’s very, very exciting.

Kalea Wattles:
Yeah, a powerful combination. I’ve heard functional medicine practitioners say that patients are more likely to change what they can measure, and what a powerful combination to have that data but then also to have this touchpoint of someone who can say, okay, here’s what we’ve got going on in your health history and your health trajectory, let’s identify any obstacles that you have to overcoming these and we’ll work on it. That’s, you know, I think the future of medicine.

We’ve talked about how health coaches can increase access to care, whether it’s utilized in the group visit model, having that touchpoint between your visits with your doc, whether you’re billing to insurance or not, we know that studies in rural and vulnerable populations show that health coaching not only improves outcomes but also improves a patient’s health literacy and their self-efficacy, even when outside of the doctor’s office. They leave with knowledge that’s very empowering. How do you see health coaches playing a role in perhaps underserved communities in terms of access to care?

Monique Class:
Oh, huge, huge. Gigantic, right? And so self-efficacy is a key tenet of coaching, is to cultivate self-efficacy in clients. And that’s what we talked about, the strength spotting and to helping them with what they can do, and helping them navigate how to, in their—whatever their situation is, how to make the best choices in whatever their situation is with food. Like what can they do, how can they make healthy meals when they’re on this kind of a budget or only have access to this kind of food, like what can they do within that? And so I think the coach’s role is always twofold. It’s not only to help them figure out and co-create a self-directed plan, but also to educate them on options and potential. So it’s education and it’s, you know, communication and support, and these co-created care plans. So I think it’s doing all of those things, which for underserved populations, they’re going to have access to medical information in a way that they have never had before, and the support to execute on it in a way that’s pertinent to their particular situation, whatever that situation is. Whether it’s where they’re living or what they’re exposed to or what they can afford, or any of those things. Which I think is an amazing, amazing opportunity.

Kalea Wattles:
Yeah, the co-creation of the treatment plan, that’s what I’m really taking away from this conversation is the importance in that co-creation and the involvement, asking the patient, what is realistic for you? What do you want to do? What do you see as the next step? That’s really what I’ll walk away from.

Monique Class:
That’s the key. That is what you should walk away with. That, those are the key things. And then supporting them in whatever decisions they can make, you know, whatever decisions they can make first, supporting them in that. And once you hear the story, you can hear parts of their lives where they’ve been resilient, where they’ve had huge successes, and it’s reminding that, it’s remembered wellness, reminding them that they have that in them, so it’s pointing that out, like I heard this in your story, you were able to do this, this, and this. You’ve got that in you. And so it’s mirroring back those qualities that they possess, in a truthful way, not manufactured, but based on what they’ve just told you. So it’s using all of those skills of deep listening and strength spotting and co-creation and just being present for people, giving them the space to design their own healthcare plan.

Kalea Wattles:
Yeah, I think you’ve really highlighted so many reasons why a health coach can be an incredibly valuable member of a collaborative care team. So for our listeners, I’m hoping you’ll share some—what resources exist for practitioners out there who are looking to add a health coach to their practice?

Monique Class:
Yeah, well, you know if you—Sandi Scheinbaum, who’s the CEO of the Functional Medicine Coaching Academy, she actually wrote a guide, an eBook that’s free. It’s The Doctor’s Guide to Health Coaching, and that may be a good place to start reading and getting some information. It’s at www.FMCAFreeBook.com. And you can email me and we’ll get you a copy of it, but it answers a lot of questions, and it helps people begin to think about, well, how can I integrate? And answers a lot of those questions. What am I looking for? What’s the, you know, how do I structure it, how do I bring them in? And then they have a matching system at Functional Medicine Coaching Academy where they’ll match up clinicians with coaches in their area or who are also interested in whatever it is, bariatric medicine or gynecology, or whatever it is, they’ll match them up. And they can begin to interview them and test out the waters, and even try the coach for themselves, maybe have six sessions with the coach they’re thinking about hiring, just so they understand their languaging and how they work, so they can test it all out. I think those are the, probably some of the best places to start.

Kalea Wattles:
That is so helpful, and I hope that many will take advantage of that resource. I think we can all agree that patients really benefit when they have a multidisciplinary team that’s supporting them. I so appreciate all of the insights that you’ve shared and giving us some guidance about how we can start to build that professional network, so it’s always such a pleasure to speak with you. And thank you so much for taking the time to be with us today.

Monique Class:
Oh, you’re welcome. Pleasure was all mine, Kalea.

Kalea Wattles:
To join the conversation on this topic, visit IFM’s pages on Facebook and Instagram. For more information about functional medicine, visit ifm.org.

Show Notes

Resources mentioned in this episode:
The Doctor’s Guide to Health Coaching: www.FMCAFreeBook.com.