The Value of Coaching in Health Care Delivery

A recent Annals of Internal Medicine special article (1) presents the activities from a summit organized by the American College of Physicians and its Council of Subspecialty Societies. The summit proceedings paint a picture of a new paradigm to tackle the growing multifaceted problem of obesity. The article precisely details the dimensions of the problem, including social determinants of health, access to care, and the need for better policies. The article also underscores the need to synthesize knowledge and advocacy to empower clinicians and patients through high-value care delivery. As I reflect on such expansile problems that arise out of unhealthy lifestyles, I think of the urgent need to empower clinicians with simple yet effective coaching techniques to combat obesity and other lifestyle problems. 

There are many coaching techniques that can assist clinicians in empowering patients by insourcing their lifestyle problems. Once patients regain their executive power and receive a practical plan of action from their provider, they can achieve positive outcomes. In this article, I want to share a relatable story with coaching techniques that can be applied in everyday practice. 

The story. Years ago, I admitted a middle-aged female veteran with a medical history of obesity and occasional alcohol use. She had been struggling with what appeared—on face value—to be advanced liver fibrosis due to metabolic dysfunction-associated steatohepatitis. The reason for admission was “alcohol intoxication” following an argument with her partner and teenaged son. She did not report depression and was not suicidal. 

In the fast-paced world of hospital medicine, these admissions are typically observed for about 3 days before discharge. 

But when I looked at this patient, I felt compelled to advocate for her. I had 3 days to do so. 

The role of silver lining technique. As the name suggests, we use “silver lining technique” in coaching to take a crack at a cognitive cloud filled with negativity. This technique can be effective when patients mention previous successes in adopting a healthy lifestyle. The technique has been shown (2) to improve coping, enhance mental engagement, and support the accomplishment of goals. In my patient’s case, I had to shift her attention to her established identity as a veteran who can muster discipline and make a commitment to victory. It worked; she was receptive. 

The impact of double reflexive listening. On day 2, it was time for “double reflexive listening.” This technique is fundamental to motivational interviewing (3). It hinges on the listener’s ability to motivate empathetically by pointing out a cognitive gap the speaker may not yet recognize. The key is to motivate the speaker by helping them discover a gap that needs to be bridged. This technique relies a lot on the listener’s ability to be gentle, and to be very comfortable with pausing in silence. 

In her case, I had to gently point out the gap between the intense anger she felt out of love for her son and the act of drinking and mismanaging her lifestyle to the point where she might jeopardize her life and no longer be present for him. 

The impact of treating patients holistically and leveraging health numeracy. After the patient switched into a positive and motivated mindset, the next step was to guide her toward weight loss and healthier drinking habits using realistic scientific data, numbers, and timelines tailored to her lifestyle. Ignoring health numeracy has been linked to poorer health results (4). On the contrary, sharing and committing patients to targets for numbers like body mass index, hemoglobin A1c, and caloric intake is associated with better outcomes (5). 

A few months later, I saw the patient during a routine clinic visit. She had lost a significant amount of weight, and I barely recognized her. I was humbled when she told me she had written my name on her phone screen as a deterrent to prevent relapses and to stick to the plans we made. Most importantly, she had rekindled her relationships with her son, his girlfriend, and her husband. The lesson imparted was clear: Advocacy works! 

References

1. Wee CC, Arbaje AI, Bering H, et al. Unifying efforts to empower equitable obesity care: synopsis of an American College of Physicians and Council of Subspecialty Societies summit. Ann Intern Med. 2025;178:725-736. [PMID: 40163876] doi:10.7326/ANNALS-25-00675
2. Barr EA, Raybin JL, Bennett CR, et al. Silver linings: a principle-based concept analysis examining the emergence of positive changes that accompany adversity. Int J Nurs Stud Adv. 2024;7:100243. [PMID: 40226228] doi:10.1016/j.ijnsa.2024.100243
3. Katz D, Singh A. Motivational interviewing. StatPearls; 2023.
4. Mann BK, De Ycaza Singh SA, Dabas R, et al. Evaluation of effects of health literacy, numeracy skills, and English proficiency on health outcomes in the population of people with diabetes in East Harlem. Clin Diabetes. 2019;37:172-175. [PMID: 31057224] doi:10.2337/cd18-0068
5. Petrova D, Garcia-Retamero R, Catena A, et al. Numeracy predicts risk of pre-hospital decision delay: a retrospective study of acute coronary syndrome survival. Ann Behav Med. 2017;51:292-306. [PMID: 27830362] doi:10.1007/s12160-016-9853-1

Mohamad Saad, MD, MBA

Dr. Saad is an Internal Medicine Residency Program Director and a polymathic coach who leverages coaching to establish human connections, build human capital, and deliver better outcomes.