Ep. 461 Solving & Preventing Chronic Disease with Health Coaching with Dr. Sandra Scheinbaum
- Team Cynthia
- Apr 30
- 34 min read
I am thrilled to reconnect with a friend and colleague, Dr. Sandy Scheinbaum. She assists in training people to become functional medicine health coaches, and she helps practitioners and businesses hire them as she believes health coaches are the key to combating chronic disease and reducing healthcare costs. Dr. Scheinbaum is also an educator, clinical psychologist, author, and public speaker with over 50 years of experience. Her latest book is called Your Health Coach Will See You Now.
In our discussion, we dive into the limitations of allopathic medicine in addressing chronic disease and the looming shortage of over 130,000 physicians by 2030.
We explore the impact of burnout and job dissatisfaction among providers, look at what defines patient-centered care, and discuss how health coaches can improve emotional wellness, support chronic disease management, and increase patient self-efficacy. We also examine the benefits of partnering with health coaches to solve the worsening mental health crisis in the United States and the standards to consider when working with a health coach.
I believe you will find this insightful discussion with Dr. Scheinbaum particularly relevant when considering the state of primary care in our country today.
IN THIS EPISODE YOU WILL LEARN:
The limitations of our current medical model, which was designed specifically for acute care
Why lifestyle factors must be looked at when managing chronic diseases
How the shortage of primary care providers affects patients
Why so much burnout and job dissatisfaction exists among healthcare providers
How health coaches support licensed healthcare providers and improve patient care
How health coaches can help patients feel more connected and supported, and improve their overall well-being
Why a team approach, with health coaches working alongside healthcare providers, is required
How bedside manner has eroded in the current medical model
The challenges of accessing mental health care today
The importance of looking for only nationally board-certified health coaches who are licensed
Bio: Dr. Sandra Scheinbaum
Dr. Sandra Scheinbaum trains people to become Functional Medicine health coaches and helps practitioners and businesses hire them because she believes that health coaches are key to combating chronic disease and reducing healthcare costs. As Founder and CEO of the Functional Medicine Coaching Academy (FMCA), Sandra is a leader in the field of health coaching education. An educator, clinical psychologist, author, and public speaker for nearly 50 years, she founded FMCA at age 65 because, rather than retiring, she is on a mission to grow the health coaching profession so that millions of people can get the support they need to lead healthier lives. Her latest book, Your Health Coach Will See You Now: Creating a Healthier Future Together, advocates for health coaching as a critical component of primary care.
“Where do we treat chronic conditions? We treat them in the kitchen, on walking paths, and in the community. That's where the health coach comes in.”
-Dr. Sandy Scheinbaum
Connect with Cynthia Thurlow
Follow on Twitter
Check out Cynthia’s website
Submit your questions to support@cynthiathurlow.com
Connect with Dr. Sandra Scheinbaum
Your Health Coach Will See You Now, by Dr. Sandra Scheinbaum, is available on Amazon or Barnes and Noble.com
Transcript:
Cynthia Thurlow: [00:00:02] Welcome to Everyday Wellness Podcast. I'm your host, Nurse Practitioner Cynthia Thurlow. This podcast is designed to educate, empower and inspire you to achieve your health and wellness goals. My goal and intent is to provide you with the best content and conversations from leaders in the health and wellness industry each week and impact over a million lives.
[00:00:29] Today, I had the honor of reconnecting with friend and colleague Dr. Sandy Scheinbaum. She helps train people to become functional medicine health coaches and helps practitioners and businesses hire them because she believes that health coaches are key to combating not only chronic disease, but also reducing health care costs. She is also an educator, clinical psychologist, author and public speaker with over 50 years of experience. Her latest book is Your Health Coach Will See You Now.
[00:00:57] Today, we spoke about how allopathic medicine is ill equipped to deal with chronic disease and the shortfalls of physicians in particular, with a shortage of over 130,000 providers by 2030, the impact of burnout and job dissatisfaction, what helps define patient centered care? the impact of health coaches on emotional wellness as well as improving chronic disease management, increasing self-efficacy, and relevant research, how health coaches can be partnered, solutions for worsening mental health in the United States and specific standards to look for when working with a health coach. You will find this to be an invaluable conversation and one that I think will be particularly relevant given our current primary care climate.
[00:01:47] Well, welcome back Dr. Sandy. So good to see you my friend and have you back on the podcast and talk about your new book.
Dr. Sandra Scheinbaum: [00:01:54] Thank you so much. It is a joy to be here. Thank you for having me.
Cynthia Thurlow: [00:01:58] Well, I was sharing offline with Dr. Sandy that my puppy must have thought you had an especially good read because he chewed up part of your book, which I was so grateful to have a PDF to be able to read without having to read around bite marks and other things that he tore off the cover, he enjoyed it thoroughly. Anyway--
Dr. Sandra Scheinbaum: [00:02:13] I am glad it was digestible for him.
Cynthia Thurlow: [00:02:16] Yeah, and so I think this book, the themes in this book are so important. It's really talking about empowering the medical community and thinking about health coaches in a way that decompresses the current allopathic medical model, which in many ways is designed for emergencies and urgencies and is not designed right now to be able to deal with preventative health or to deal really proactively with lifestyle management unless someone is involved in a concierge medical practice or has the luxury of being able to spend an hour with each patient, which we know is really not the norm these days, how is our current medical model kind of designed, essentially, I don't want to use the word with failure in mind, but it's not designed to allow physicians, nurse practitioners, PAs to be able to offer as much to their patients as I know that they want to. There's a lot of limitations and perhaps bringing this to light will help our community better understand some of the limitations that we're seeing with our current medical model.
Dr. Sandra Scheinbaum: [00:03:20] Well, our current medical model is an acute care model. It was never, ever designed for the kind of health conditions that we're seeing. These chronic conditions are largely brought on by lifestyle. So, if you, let's say you are having, or you have, or you suspect you are having a heart attack, you want the best of that acute care system, you want to get to a trauma center, you want whatever intervention, whatever procedure would be most likely life saving for you. But what happens when you are then discharged and you go back home? Who is there to talk to you about lifestyle, how you got to that situation in the first place, which is most likely those lifestyle factors? Now what are those? Those are what you're eating. It is, are you moving or not moving throughout the day? What is your sleep like? What about the level of stress that you're experiencing, the relationships that you're having? Those are the lifestyle areas. And increasingly, what is your toxic burden as we are living in a toxic soup, who are addressing those conditions?
[00:04:31] So, my husband, about a year ago had a procedure. He needed a vascular surgeon. I wanted that vascular surgeon and so did my husband to be the best out there, and he was. And he was complimented, like, “Oh, he's the best. He's the head of the vascular surgery.” That's what I wanted. I wanted and so-- we wanted that specialist who was an expert in that procedure. And he was not the one who had the training, the time to talk to my husband about what he was eating, his need for physical activity, that's what we've lost, but there's something else that we've also lost and that is bedside manner, which I talk a lot about in the book.
[00:05:12] There is a sense of you don't have enough time with your doctor, they don't really know you. There's not a rapport that often the time they may not even know your name, and this is becoming worse and worse. So where do we treat these chronic conditions? We treat them in the kitchen, we treat them on walking paths, we treat them in the community, and that's where the health coach comes in. They are the specialists in helping you to address these lifestyle factors where we now know every estimated 70%, even up to 90% of these chronic conditions are driven by lifestyle. These are conditions like obesity, type 2 diabetes, and even cognitive decline, which is called type 3 diabetes. And so, more and more conditions we are finding are driven or exacerbated by these lifestyle factors.
Cynthia Thurlow: [00:06:06] Yeah. And it's interesting, I live in a small city inside central Virginia, and I opened up Facebook this morning or after I'd gotten up and done a few things. And what we're starting to see, and this is not unique to my area of the country, is that there are less and less primary care providers. So, there are less and less internal medicine specialists that would handle these kinds of chronic and preventative care issues. And what's interesting is it was just one women's group talking about how one primary care group has lost five providers, physicians, and nurse practitioners in a short amount of time, which to me is a red flag. I didn't want to juxtapose my opinion as I was reading this, but that seems to be a common concern expressed across social media in our group programs that we're doing, how challenging it is to find a primary care provider.
[00:06:57] And you mentioned in the book that the American Medical Association expects a shortfall of physicians, a shortage of greater than 130,000 providers by 2030. This is not that far away. And I want people to understand like the current circumstances are going to continue to worsen unless we are adding to the preventative and the comprehensive care that we're offering patients. And I think this is a really interesting discussion of how health coaches can help support licensed healthcare providers and do it in a way that it's with high integrity, high quality of care, in conjunction with a plan that's been initiated by a licensed healthcare provider and be able to provide for the resources that perhaps the overwhelmed primary care provider really isn't equipped to be able to deal with anymore.
[00:07:53] I have colleagues that tell me they are seeing 40 and 50 patients a day. When you are seeing that volume of patients, you can't get more than one. We use the term chief complaint, one complaint out of a patient before you have to be thinking about what is the plan, what is-- Then you're moving on prescription, bring them back, and you're moving on to the next patient.
[00:08:11] Now, when I was in clinical cardiology, we were maxed out at 16 patients and even that was a lot given the medical complexity. And I think about how wonderful it would have been to have had a health coach to be able to say, “I want you to see the health coach so that we can specifically talk about your carbohydrate intake, your protein intake, or let's get you in an exercise program and let's give you some resources,” or even dealing with-- So many people are dealing with loneliness, whether they've lost a spouse, they're divorced, maybe they don't have local family. I mean, we know all of these things can impact the success that we have in terms of providing care to our patients. And so, I really echo a lot of the sentiments in the book. And I think it's a book that every health care professional needs to have. They need to embrace. I think that consumers need to better understand some of the limitations of our current system so that they're perhaps coming at their provider with a sense of empathy, that understanding that no one goes into health care not wanting to provide exemplary care to their patients.
[00:09:16] I think when I speak to colleagues, many of them are frustrated by the constraints that they're currently experiencing. They want to provide the level of care to you that you are looking for. And so, I think that it just really reaffirms some of the other statistics in the book, talking about burnout, job dissatisfaction. How many of my colleagues, during the pandemic-- I had an amazing gastroenterologist. Amazing, I used to call her like a tiger woman. She was just an incredible clinician and she was not afraid to disagree. In fact, I think all the male physicians feared her because they never wanted to get on her bad side. And during the midst of the pandemic, she was like, “I know I'm still in my 50s, but I'm so tired of dealing with all the bureaucracy. Then I'm just going to retire early.” And I remember being so sad because she was an incredible clinician, but I was like-- I understand intellectually why people are starting to make some of these changes, so it becomes this domino effect. We know we have a shortage of providers the way providers that are burned out. When you're burned out, you're not delivering great care because effectively you lose that empathy. You were touching on that compassion piece, that therapeutic communication, which as a psychologist, I'm sure for you that probably is a greater concern, that people are not communicating in a fashion that is at all helpful. And in many ways, it's downright, could lead to further problems with that breakdown in communication.
Dr. Sandra Scheinbaum: [00:10:39] Absolutely. I think that the-- First of all, the shortage of physicians, nurse practitioners is real. It is getting worse. It is the perfect storm because we have the older people who are retiring, and the doctors and the healthcare practitioners from my generation, I'm in my 70s, are retiring, but they're not being replaced. And we know that medical students, residents, they are not choosing primary care because they know that it is lower paid, it's exhausting and they're attracted by specialties like Dermatology, Orthopedics, for example. And so, they're going into those specialty areas and not choosing primary care as older doctors or people are burnt out and they are retiring.
[00:11:24] At the same time, you have an aging population with more need for primary care services and the growing incidence of chronic disease where it's estimated one in two are going to be diabetic, it is 2025. In 10 years, it'll be one in two. So, it is growing. Only 7% of adult Americans are metabolically healthy.
[00:11:48] And we have doctors who are caring and they want to do the best for their patients, but they have time constraints. They are in these huge medical systems where they are feeling like cogs and wheel. They have to report how many patients, as you talked about, that they are seeing. So, they don't have the time. Even if they want to be with somebody and really care for them, they are frustrated and that's part of the burnout.
[00:12:16] And then as a patient, they are increasingly feeling like lost in the system because it is something that they are told-- Good luck, if you have a doctor who is retiring, finding a new one. I have heard so many stories, people being told, the wait list is up to a year. I talked to someone who he himself had been a cardiologist, now retired and he had an event and he needed a new cardiologist. And he said, “And I used to be on staff at this medical hospital. I still have emeritus status. I could not find a doctor. I was told it'll be an eight-month wait for an appointment as a new patient.” So, it's very, very frustrating.
[00:12:58] And then if you do have a doctor, you are given so little time and as you said, they can talk about one concern. Well, you may have other concerns. And so, you leave that appointment feeling unheard, feeling like they're just interested in refilling your prescription and lost. And so that's why we know that when health coaches on that team, it is better for everybody. It's better for patients. It's better for the medical practitioner. It's better for staff. So, this is-- I've seen this time and time again as I reviewed the research how much better people do when they have the coach. And what I talk about in the book is they're really bringing back what is lost, which is bedside manner, which we know is more therapeutic. The offering-- having this relationship, it's a therapeutic reliance, and offering that to somebody is healing. It is better than whatever somebody is going to tell you to do, which you can tune out. But it is knowing that somebody cares about you that is so critical. It's the relationship first and we've largely lost that.
[00:14:05] Now, some people say, “well, AI is going to be the future. That's our savior.” And so, the medical system will get better because of AI. And that may be true in terms of diagnostics and ability to be precise in those instances where we're relying not just on clinical judgment, but research data, as that's becoming more sophisticated with AI, but it's not going to replace that heart-centered relationship that's so critical.
Cynthia Thurlow: [00:14:37] No. And I couldn't agree more. And I reflect back on 16 years in clinical cardiology and the technology advances that came through. When I started in clinical medicine, we had paper charts. It was very different in the late 1990s than it was when I was kind of transitioning out when there were electronic medical records. And I recall being in a meeting and I was in Northern Virginia, part of a very large practice that covered seven hospitals, just to give you an idea of how large it was. And we were sitting in meetings with older physicians. And when I say older, I mean senior physicians, like people that have been in practice for 25, 30 plus years, that have enormous amount offerings that they can provide not only to patient care, but just a knowledge base of medical staff. And how frustrated they were having to be forced to use this electronic medical record.
[00:15:29] And there were some tech people that were literally assigned to these physicians to follow them around the hospital to make sure that they were comfortable implementing these new orders because it wasn't just telling the nurse, “Oh, by the way, do X, Y and Z.” You had to actually go to the computer and put it in. And so, they allotted for each physician who was feeling like they were overwhelmed with the technology they were offering them to have this tech person that would follow them around, at least initially. But I recall how many people are like, “Oh, forget it, I don't want to learn something new. I want to be-- I'm going to just retire early.” So, I think with each wave of whether it's AI, whether it's electronic medical records, I think for some people it will just push them out because they're frustrated. They don't want to learn something new, but can really help with efficiency.
[00:16:14] And I think about how health coaches in many ways can help again fill in those gaps of care that are driven by the current medical model in many, many circumstances. I think about something that you've touched on multiple times and it's this concept of therapeutic communication. And something that I think distinguishes many of us is being able to connect with our patients and develop a degree of rapport that a patient feels comfortable sharing what's going on, even though it's-- I always say the good, bad and ugly. I always say share it all because I can't help you if I don't know the full scope of the issue. But for many individuals, they have gotten out of the habit of ensuring that they have a good communication pattern with their patients. And so, I'm curious, as a psychologist, because obviously this is your area of expertise, what are some of the red flags for you as a psychologist when either patients or friends or colleagues are sharing information with you that tip you off that someone, provider, doesn't matter what their initials are after, their name, is not engaging in therapeutic or helpful communication with their patients? Now, I'm not talking about emergencies or urgencies. I'm talking about that primary care model, that internal medicine model where you're really hoping to develop a long-term relationship with this individual so that you can have shared ownership of your health over time.
Dr. Sandra Scheinbaum: [00:17:37] Yeah. So, I have seen the erosion of that. So, starting back when I was a child and my husband's experience as well, we had family doctors, I had a pediatrician, he had a family doctor. And that was the constant. So, for my husband, his name was [00:17:54] and he was a true community doctor. Everybody in the neighborhood saw him. So, he saw my husband, he saw his sister, he saw his parents. And so, he knew you, he knew your name, you would call and you knew the receptionist, you knew the nurse and they knew your history. They didn't just stare at the screen, they looked you in the eye and you could tell them anything if you were in trouble, if you had whatever issue they were there.
[00:18:24] I remember my doctor, my mother and my dad's doctor, they would make house calls, they would be there and it was a constant. And that was-- They lacked the modern equipment. They didn't have the diagnostic imaging, they didn't have the fancy technology that can be lifesaving, but I think that what they really had that we've lost is that therapeutic alliance. It was a relationship where you felt understood. They looked you in the eye. And what I hear over and over again from friends, from colleagues, from health coaches is that the doctor, they don't even know your name.
Cynthia Thurlow: [00:19:07] Mm-hmm.
Dr. Sandra Scheinbaum: [00:19:08] So, you come into the appointment and you're just an anonymous case. And they're looking at their screen and there are people who are of course very caring but the constraints of the system prevents them from going over time. They're backed up.
[00:19:26] I write about a doctor who I used to work with. He's an oncologist and he had a waiting room that was packed with people but nobody cared because they knew that he might run over even an hour because he never let somebody go without having that high level of communication. And we've lost that and that-- There's so many studies that show that when you have a practitioner who is with you, who understands you and you feel understood and heard and you feel like, “Oh, no question is too silly to ask.” That is really critical. And I'm afraid that for especially younger generation, I look at my daughters for example and they go to urgent care and that is fine. I used it about a year ago, I thought broke my foot so a robot could have been taken care of me. I got an x-ray, here's the boot. It's cut and dried. You don't need a relationship there.
[00:20:25] But when you have-- We're talking about, which is these chronic medical conditions where you need follow-up conversations, you need to not feel isolated. And that is where the health coach can be that one that is going to come into the system and be that specialist in bedside manner. And I have a friend who just had a hip replacement and she said she never saw the doctor, never once. They never came in. It was all online. She got-- The nurse came in and gave her the follow up in terms of outpatient procedure care follow up, but the actual doctor, she never met him. It was just--
[00:21:11] She was in the hospital got her hip replacement came out. She said, “I don't even know. I knew his name, but that was it never came in. Never followed up as--” So, I think that epitomizes where we have come and this is not going to be solved by better technology or AI. What we're doing is we're building these mega complexes to treat more and more people inpatient. I live near a big center and I used to be on staff there in the 1990s and it was one little building, 100 bed hospital and everybody knew-- As you talk about that system before the EMRs or electronic medical records, the nurses, the nurse practitioners, the doctors, the staff, the woman who sat at the desk for example on a unit, they all knew one another, they would talk. And this is often how good care was done. It was communicated where you'd be able to talk face to face. And I came in into that setting and it was really a true community hospital. And I was doing psychosocial oncology.
[00:22:15] Now this is a mega complex and it is quadrupled in size. And they said they just don't have enough beds. They can't keep up with the need for care. And this goes back to the rise in these chronic diseases. And so, the solution is not building more mega complex hospitals, but going back to the basics. Are people getting out in nature? Are they getting enough sleep? Are they eating whole real food? And this is, we often hear, well, the solution is doctors need to learn nutrition. Well, that would be good, but it's not a matter of an information deficit. People know what to do. They may have good intentions of wanting to change, but it is having that change talk, and that's what coaches specialize in.
Cynthia Thurlow: [00:23:00] Yeah, it's interesting as the community knows, I'm in a different part of the state for the past four years and my husband, as stubborn as he is, didn't feel that he needed to have an internal medicine specialist. And so, we had a little hiccup which you highlight in the book. And for the next two years my husband didn't need an internal medicine specialist until he got sick last fall. And by the time I realized how sick he was, I thought, I suspected initially he had pneumonia, he had to go to urgent care. And so, they sent him emergently from urgent care to the hospital. He was admitted, had a procedure, went home. And then that then led to another surgery, another hospitalization.
[00:23:41] And I remember being so grateful that I think last summer I was working on getting him in to see Dr. Aaron Hartman, who we both know and is a dear friend, works with me and the rest of my family. And I was like, “Todd, you're going to have to just accept that it's going to take a little while.” But it was so serendipitous because literally the week after he was hospitalized the second time, he finally got in to see his nurse practitioner and I could exhale a little bit. And so, I understand and appreciate when people say “I'm really struggling to find the right individual.” And so, Dr. Hartman actually has several health coaches in his practice that work with his patients.
[00:24:16] Now, I don't work with the health coach just because I-- That isn't per se what I need, but I do talk to Dr. Hartman about how helpful that is to alleviate feeling, like you have to cover everything. He can focus in on what he's best. The health coaches fill in from there. I have health coaches on my team. They meet with women separately to address specific concerns. If someone's really struggling with nutrition, someone's struggling with sleep, someone's struggling with stress. And what woman in middle age is not struggling with stress? And so, to me, I look at it as it's an additional layer of support. And, I think on so many levels that health coaches are really going to help every healthcare provider deliver better care. Better care, better communication. Things that I think in many ways are-- We're struggling as healthcare providers right now on so many different levels because we are pushed through a system where if you're still dealing with insurance, and I get it, that many people really, you know, they still have to use insurance. They're building their practices. There are constraints by insurance companies. They have only so many hours in the day to see patients.
[00:25:25] If someone has an emergency-- this is something that I remember quite well. If someone has an emergency in the office or you're in the hospital getting pulled over to the office, sometimes patients are waiting and that's not necessarily being communicated. They're stuck in a room, they're in a gown, they're cold, they're uncomfortable, and they're waiting to be seen. And no one's explaining to them, “Oh, by the way, doctor, so and so is delayed because there was an emergency. Please be patient.” And I used to actually tell my nurses, if I'm running more than five minutes behind, tell the patient so that they have set that expectation. And 99.9% of the time, that patient, knowing that will say, “Okay, I understand, if I have to wait a couple more minutes, I'm okay with that.”
[00:26:02] But when you're lying naked in a hospital gown and it's cold, you do not want to wait and not understand why you're still sitting there. Or sometimes we would give patients options. Do you want to sit in the waiting room until we know doctor so and so is back? So that you're not sitting alone in a waiting room. And we would give patients the option. And in many instances, they preferred sitting in the waiting room, they're like, “I can read a book. it's warmer out here. I'm not in a paper gown, freezing,” which for so many people is a source of contention. And it happens when you go visit your GYN, I'm sure for you visit your annual GYN exam. There's nothing worse than having to sit in there naked in a gown waiting for your doctor to come in or your nurse practitioner or PA. So, help me understand some of the existing research that's ongoing about the quality of care that we know that health coaches are providing to not only their respective patients, but also to that healthcare team as well.
Dr. Sandra Scheinbaum: [00:26:57] Sure. So, you name the condition and there will be a study. And many of them are randomized controlled trials, which is considered the gold standard in research, as you know. And there are, for example, one that just came out this past fall, and I think it's a significant one because it compares those people on GLP-1 agonist, which is a weight loss medication. Those who were on their own, maybe they got a pamphlet or a website to look at that talked about taking the medication. And then the group that was on the medication and had health coaching to focus on adjustment to medication, issues that came up, and most importantly, perhaps side effects or the need for changing their lifestyle. And taking a look at their motivation to do that. And no surprise, the group that had the health coaching did much better on all biomarkers.
[00:27:54] And what we see time and time again in that study and in others, what shows is an increase in self efficacy. That means that you feel like you matter, like you can really take charge of your health, that you're important in this process, that you don't just have to blindly follow a recommendation. And that increase in self efficacy and feeling empowered to take charge of your health shows up time and time again. It showed up in the research that we've done at our coaching school. And the studies, there's been studies on use of health coaching for weight loss, for type 2 diabetes where biomarkers like hemoglobin A1c for example, improved.
[00:28:39] There are studies with cancer, often that is quality of life and ability to feel at post treatment, for example, that you can experience resilience, post traumatic growth, studies on Parkinson's, even things like preparing for an operation, a surgical and orthopedic procedure cuts down on hospital stays, having that follow up, for example, post hospitalization, post surgery. There's been studies on pediatric populations. And so, this is more and more looking at what is research telling us, it works. And often it is a very short number of sessions, so unlike psychotherapy, this is very different. Coaches are not therapists. They do not diagnose mental disorders or provide psychotherapy, but they support emotional wellness and build upon your strengths and this is one of the reasons it is so remarkably effective.
[00:29:43] And one of the ways that I think it is most effective is in groups, which also makes it an affordable model. And in that model, the community is the medicine. I ran a group. This was one of the things that really brought me so much joy when I worked in psychosocial oncology as a psychologist, I had a group and we met in the-- It was a basement of this oncology office. It was the staff kitchen. I came in every Friday. We would clear out the pizza boxes and the food that the drug reps had left for the staff lunches. And the group went on for almost four years. And what happened? They were people who were referred by their primary care doctors, by oncologists, cardiologists.
00:30:29] And it was a group of older people primarily. And they came, it was for their-- They would not miss a session. If they couldn't drive, they had a caretaker drive them. And one of the things that was most healing and therapeutic was the ability to serve others. Whereas-- And because it was an open-ended group, people would come and go and when a newcomer came in, they would say, “Oh, I struggled at the beginning. I had a hard time. I used to have a candy dish in my living room and I would nibble on it all night. And I was able to quit that. So, if I did that, I know you can too.” And they loved being of service and supporting one another. And it was really a-- Even though I was not health coaching, because they didn't really-- At the time, health coaching was quite new, I was doing it as a health psychologist, but I was not practicing psychology. I was doing the coach approach.
Cynthia Thurlow: [00:31:23] I love it though. And the whole concept of emotional wellness, I think that is key. And I do find that group programs that we run where we have people that return over and over and over again, they do, it's just part of this rite of passage. The newbie comes in, they take them into the fold, they help me to support them. And I think that for a lot of individuals, they need that validation that someone else has gone and gone through that same process, whether it's prioritizing exercise.
[00:31:55] For a lot of people, the concept of going from being a couch potato to integrating exercise or just being more physically active feels daunting and overwhelming. And I think that it's very, very helpful and beneficial when other people have done that same walk, have been through those same-- Have experienced the same challenges whether it's limiting beliefs, whether it is, I used to call it, for there's an excuse for everything. And I used to say it in a very non-pejorative way, I would just say, well, I think all of us, I think it's human nature when we're doing something new and we're not a 100% sure we've bought into it yet, we will create excuses. I have to walk the dog, I have to go to the store, I have to run an errand, I have to call someone to avoid doing exactly what they need to be doing. And so, I love that approach because I think for a lot of individuals, they need that group support in order to actually get to a point where they're able to enact some degree of behavioral change.
Dr. Sandra Scheinbaum: [00:32:48] Yeah, it's social proof. If this person in the group could do it, well, I guess I can do it too. They're in it together and they feel these people are like me. And so, you feel like you're not alone. And so, that's why groups are so, so powerful. And it also is affordable as well.
Cynthia Thurlow: [00:33:08] Yes. And that's also important because not everyone can afford to have private one-on-one coaching. Not everyone can per se, be able to afford a concierge medicine practice. So, we really have to work within our budget and find alternatives and options that work for us. How do you think health coaches can partner with different practices for mental health? I think in particular, as a clinician, I feel like less and less psychologists, psychiatrists, mental health experts are taking insurance. And so, for a lot of individuals, they've had to make decisions, like I had a woman tell me recently, “I had to make a decision between buying groceries or taking my child to the psychiatrist.” And I was like, “That should never be the-- you should never be faced with that kind of decision really and truly, you should be able to do both. And it shouldn't be an either/or.”
Dr. Sandra Scheinbaum: [00:34:01] This is a big problem that is growing larger. And we talked earlier about the physician, nurse practitioner shortage, nursing shortage. Well, picture this on steroids with mental health professionals, there are people not going into the profession. Psychologists, social workers, people are not choosing psychiatry as a specialty. And so older people are retiring from these professions and younger populations are not going into the profession.
[00:34:29] The other issue is that by and large this field, and I was in it for 40 years and it's stuck and you're broken, you need to be fixed. The emphasis-- In fact, I would think I was a horrible diagnostician psychologist because I always focused on a strengths model and I would hear people saying, “Oh, this person is oh, such bipolar.” And I really felt like, “Oh, what's wrong with me?” I didn't find these labels easily because I looked-- I had a different perspective. And this was years before we had positive psychology, which is a natural for coaching.
[00:35:07] So, this is a real problem. People think they need and often do. But I really want to be clear that and again this comes from research as well as my own personal experience as a psychologist is that for many people health coaching can be the solution, why would that be? And research has shown that when you are experiencing coaching, your levels of depression, anxiety decrease. And this is on self-report measures. And for example, as a health coach, you might be with somebody who is encouraging you and you make a commitment to that coach, “I'm going to go out and walk every day.” Well, walking is a better antidepressant than an antidepressant medication.
[00:35:57] So health coaches have a whole person approach. They're going to be talking to you about what you're eating and your stress levels and do you have meaning and purpose in your life. And it's not the way to berate you or to pigeonhole you into a diagnosis where you think you now have a mental disorder and you need to be fixed and you have a chemical imbalance and you need medication for the rest of your life. So, you are then finding your strength and health coaches focus on your strengths, your bravery, for example, the strength of humor and character strength is a very well researched part of positive psychology.
[00:36:39] So, using a strengths model, using a resiliency model and most importantly moving away from a damaged model. Because what I have seen is too many people get stuck with, I have childhood trauma, and it's in my body and I'll never get rid of it and everything then is attributed to that. Now that may be, may have had a tough childhood, but when you use a different approach, when you are with somebody who is encouraging you to perhaps look at it wasn't 100% bad. Every waking moment of your childhood, you laughed, you maybe enjoyed riding your bike, you had a good friend, you had a teacher who believed in you, whatever it was, you can identify that it was a mixed bag. But now you're here-- in the here now, what do you want for your future? What would you like your future to look like? It is that forward thinking conversation that is therapeutic. And what happens is then, and this again is borne out by the research that levels of anxiety decrease, levels of depression change where you are feeling more optimistic.
[00:37:52] So, I want to be clear that if somebody is suicidal, if somebody can't get out of bed, they have severe depression, they have manic episodes, yes, they need psychiatric intervention. And we teach our coaches how to make those referrals. When you do need therapy, when you do need an intervention, that is beyond what a health coach can do. But for many people who are experiencing emotions that are not helping them thrive and they are feeling these emotional swings, for example, or they are waking up just feeling like not having much energy and feeling-- they jump to conclusions like, things are just awful in my life, a health coach can help them sort that out. And it's particularly powerful because they are taking into account the lifestyle factors that are most likely contributing because we know that, for example, there is a brain-gut connection. A health coach may educate people about that as they start eating better or they might refer somebody to a nutritionist to look at their nutritional status and see is supplementation perhaps helpful for them. And so that is why I think that health coaches can play a huge role in helping people that we have this mental health professional shortage. Health coaches can be part of the solution.
Cynthia Thurlow: [00:39:18] No. And I love that. And it's interesting, I just interviewed Dr. Drew Ramsey and he was talking about how 50 million Americans have faced a mental health issue in the past several years that is such an enormous number. And I think that on so many different levels, certainly hearing from people throughout the United States how challenging it is to find the support that they need, I love that health coaches can be utilized in a way that they help supplied not only support for the patient, but also support for the provider. Maybe in between appointments, they're able to meet with that patient or client to help support them. And they know, just like I always say, like even as a nurse practitioner, I know when I am in a situation where it requires sending someone to the emergency room, identifying emergencies or urgencies. And so, the coaches are also empowered to be able to look for this as well. They know when it's time to say, “Okay, these things have escalated. I think it's time to loop in the physician or the provider to give some additional support.”
Dr. Sandra Scheinbaum: [00:40:20] It is absolutely a team approach. It is not one person, the health coach, a practitioner being able to do it all. But I do want to say something that I saw so many times when I was working as a health psychologist is an over dependency on somebody meeting with their therapist. And often the therapist had some secondary gains because they didn't want to lose these paying clients. And there was a fear that was instilled and I would coach people on how to feel empowered to really get your needs met. So, they would, for example, they've been in therapy for 10, 12 years and they were feeling like it's not productive or I leave the session stirred up because that's what happens. You go to a session and you're reliving these painful memories from your past and it's never resolved. And then you leave, you feel worse than when you came in. And they start to tell the therapist, “Well, maybe it's time to terminate.” And they're often told, “Well then you're just going to have a setback, you're not cured, so to speak. You have this trauma. You're not going to be able to do it on your own.” And I’ve heard that so many times because I would be the psychologist who was doing biofeedback. I was helping them with relaxation strategies, for example, and using cognitive strategies where they were reworking their thinking. It was a very much in the here and now problem-solving approach, but they were still so tied to this therapist.
[00:41:54] In some cases afraid like the therapist would be upset at them if they terminated because it was such a long-term relationship. And that can be problematic. So, there are so many issues if you need a therapist, not being able to find one. Many are not taking insurance, it's cash pay, there's a long wait list. And then many people who are then overdependent and think that they are damaged, that they have these mental health issues, that in reality it might be tied to the lifestyle that they are choosing them.
Cynthia Thurlow: [00:42:27] I think it's such a good point. I mean I think about a family member who worked with a psychiatrist for 15 years and at the end of this individual's lifespan said to me, “I don't really think I worked on the stuff. I think I just talked and that was what I just talked to doctor so and so once a week for 15 years and we never actually got anywhere.” And that was so insightful. And I kept thinking, gosh, I mean, I think the point of therapeutic relationships is to work through things. I actually will even tell women that are in programs with us like, at some point, I want you to feel comfortable and confident to no longer need us. Of course I love all of our clients, but the goal is to get to a point where you are feeling like you've worked through X, Y and Z, whatever those issues are, and now you feel empowered, strong and confident to move forward, but we're always here, of course.
[00:43:23] But I agree with you that I think there is this gaslighting/overdependence model that some practitioners embrace. And instead of looking at it as children leaving the nest, if you will or leaving the nest or the open door that Gretchen Rubin talks about, some people like their patients being dependent on them. They feed on that they feel good with that. That's what they're looking for.
Dr. Sandra Scheinbaum: [00:43:47] Yeah. And I think that one of the beauties of working with a health coach is that it is short term and you are in the driver's seat. The coach does not have an agenda, when you have a good coach. And so, you find somebody who is where you are-- It's called client centered. And that came from humanistic psychotherapy. But the idea is that you are the expert in your own life. And the health coach asks the right questions to facilitate this change process where you have an aha moment like, “Yes, I know now what I want my health for and I'm ready to start.” And then the health coach helps you create those goals and help you be accountable for carrying out those goals that you have decided upon.
[00:44:36] But it's not the health coach. They're not the ones who are going to give you a food plan. They're not the ones who are going to give you an exercise plan, but are going to support you, provide education if needed, but they don't start out that way. And that's where I think there's a lot of confusion with health coaching and leads to the-- There's so much in the news about AI health coaching. So, Apple is going full steam ahead. They are very interested in improving their health. A part of Apple watch, for example, and your phone. And so, every company is having this version of an AI health coach, but everything I have read, I just saw one recently where it's about recommendations, and that is not what coaching is. Coaching is not giving you the information. You can access your health information. And what coaching does is have that conversation. You have a conversation with your coach where you come to the conclusion, “This is the direction that I want to go in.”
Cynthia Thurlow: [00:45:41] Yeah, I think that's really important. And how do people determine? I mean, the term health coach is so overused. And I know that your program is very detailed and really spends the right amount of time preparing individuals to be in a position where they can use motivational inquiry and/or interviewing and other specific techniques to help patients move through lifestyle changes. How do we determine if someone is trained properly? Is that the right way to explain it? Because, if it's a fly by night program where you can call yourself a health coach and you've just spent five minutes filling out a form that is not health coaching. And I say that this lovingly, but I think like many things like certifications and holding people to specific standards is really what you want to look for in a coach.
Dr. Sandra Scheinbaum: [00:46:32] Yeah. So, standards are critical. And we now have a national board for health and wellness coaching. And so, you look for somebody who is national-board certified. Just like in the medical community, you would might look for a physician who is board certified in a particular specialty, the same with health coaching. It shows that they have met those minimum requirements, that they have graduated from a coaching program where those graduates are allowed to sit for the national board exam, so that would be number one.
[00:47:03] Also, you want to focus on somebody who is not going outside of what a coach is allowed to do. Coaches are not licensed practitioners, what does that mean? Well, if they are interpreting your lab results, if they're ordering lab tests for you, they're practicing medicine without a license, that would be a huge red flag. There are many people who are attracted to becoming health coaches because they think, “Well, I want to be able to diagnose what's wrong with my patients.” They're calling them patients. They're not, they're clients because that coach does not hold a medical license. So, they should not be ordering lab tests, they should not be making interpretations of lab tests, they should not be telling you what supplements you need to be taking unless they have a prior license. So, we do have many health coaches who might have a background as a nutritionist, for example, or a nurse practitioner, and they still hold that license, that would be different.
[00:48:03] But if somebody has no medical training and some of the best health coaches do not have medical training, you don't need a prior license in healthcare to become a health coach. But what a health coach does is really be that listener. They are there for you. They can be your advocate. As we've talked earlier, the medical system is confusing and hard to navigate, they can help you through that. They're on your side to offer support, guidance, education. So, you may go to direct-to-consumer lab companies and get those tests but they can help you with the education of what was being measured. But then they can help you go to the right specialist, the right medical practitioner for follow up care. So, they are not doing that part.
Cynthia Thurlow: [00:48:52] Well, I think that's really important and I appreciate that you kind of provided that guidance. I think that-- And I had a rant in my stories today about this. Actually, it was last week and my team reshared it again this morning because I sometimes get frustrated when non-licensed people are telling patients, “Oh, your lab should between X and Y.” And I'm like, “You're not prescribing medication, therefore, you should not be the person that's providing guidance.” If you're doing it privately with your best friend, that is very different. But a lot of these individuals very large platforms where they're sharing information like that. And I'm like, “You're really not in a position to do so.”
[00:49:28] Any more than I pretend to be a cab driver, I don't own a restaurant. I mean I try to stay in my NP kind of lane and make sure that I'm practicing safely. Well, please let listeners know how to connect to with you outside of this podcast? How to purchase your amazing new book and learn more about the health coaching program that you are involved in?
Dr. Sandra Scheinbaum: [00:49:49] Thank you so much. Well, they can go to functionalmedicinecoaching.org. The book is Your Health Coach Will See You Now. That's available on Amazon, barnesandnoble.com. Personally, my Instagram is @drsandi, S-A-N-D-I or @functionalmedcoach is our school. And anybody wants to become a health coach, we need millions more. I want to see a coach in every primary care office.
Cynthia Thurlow: [00:50:16] I love it. Thank you again for your time today.
Dr. Sandra Scheinbaum: [00:50:19] Oh thank you.
Cynthia Thurlow: [00:50:22] If you love this podcast episode, please leave a rating and review, subscribe and tell a friend.
Comments