Physician’s Dilemma

Welcome back, Coach Alan!  It has been a while since I last blogged about coaching.  I took a summer break to focus on a book I am writing about General Motors (GM).  I am writing this book with a remarkable top GM executive (now retired) who was personally responsible for not only saving a large GM plant from closure but also for changing the plant’s culture to allow it to flourish.  He was a masterful coach, long before coaching was popular.

Physician’s Dilemma

My blog today was presented by a physician coachee who was faced with a dilemma.  He is a member of a university-based surgical practice.  As part of this practice, he has developed a pre-operative weight-loss program to help patients become better surgical candidates.  He would like to train one of his office medical assistants to coach patients through this weight-loss program.  The medical assistant, a woman, would go through the program, allowing her a firsthand understanding of what the patients will experience.  Like many of the patients, she is overweight. The dilemma is that she wants the new opportunity but is not willing to go through the nutritional program.

What is the physician to do?

First, it is not clear whether the medical assistant is coachable on this matter. Although she has expressed a strong interest in this new role, it is unclear as to why she will not go through the program.  From a rational sense, it seems like an easy decision.  By accepting the physician’s request to go through the program, she demonstrates initiative in expanding her professional career, gets to go through the weight-loss program as a benefit of employment, loses weight, establishes credibility with patients, and becomes a healthier person.

Easy decision, right?

Let’s take a look at other possible explanations for her decision not to participate. She may have a fear she will not be able to complete the program, letting the physician down.  She may also be comfortable with her current weight and see no reason (tension) to lose weight.  Or she may be thinking of the cost of new or refitted clothing.  In short, she may have her own valid reasons for not participating

Coaching the physician on how to resolve this dilemma may not lead to the outcome he prefers. What he needs to do from a coaching perspective is to create tension between the medical assistant’s job requirements and her willingness to meet them.  She must decide on which course of action to take.  If she really wants this role and her motivation is strong enough to overcome her reluctance to take on the program, she will be on her way to closing the gap and reducing tension.  If this gap is not strong enough to overcome her reluctance, she will likely pass on the new role.  It is possible that she will reframe the situation and accuse the physician of demanding a condition that is unrelated to the success of a weight-loss coach.  Here, the physician needs to justify the job requirement as reasonable and necessary for a successful patient coach.

This raises an ethical question.  If the assistant in question were not overweight, would the weight loss program still be required?  If the answer is yes, there is no ethical issue; in this case, the program would need to be modified to maintain the assistant’s health.

In sum, we can’t always have what we want.  In the case described above, the physician must create tension, but he does not control how this tension will be perceived by the medical assistant in question.  We can predict, however, that the assistant will either go through the program, or our physician will be hiring another person to coach his patients. In either case, creating tension will bring about a timely resolution to our physician’s dilemma