Maria Goldsmith (Diploma in Wellness Coaching Skills)
This assignment will look at how I show attention and use exploration, understanding and action skills currently. The Gibb’s cycle will guide the process which incorporates scenario description, feelings, evaluation, analysis, conclusions and action plan (Gibbs 1988).
Patient A has a diagnosis of type 2 diabetes, he is in his 40s with a secondary diagnosis of a severe orthopaedic condition called Charcot Arthropathy which causes irreversible damage to the joints and bones of the foot. In a recent consultation my medic colleague suggested that there could be a possibility that he could have late-onset Type 1 diabetes and asked for him to have some specialist blood tests to assess for this.
Demonstrating attention and interest
Table 1 outlines the background of the scenario I will discuss. The suggestion that there could be a possibility of Patient A having late- onset Type 1 diabetes in addition to his other diagnoses came as a complete shock for him. I could see him shutting down from any further engagement, his posture ‘shrank’ but he was also rigid with his arms crossed and his face dropped. I noted this shift in body language and when my colleague left the room, I angled my chair towards him and asked him to tell me what he was thinking.
He had my complete attention, in a private and calm clinic room where we were in chairs that were the same height. I am mindful that this is not always the case as often we consult with the patient sat in the middle of the room with the patient on a plinth, which is not a natural and equal situation for the individual. I tried to demonstrate open and relaxed body language with my arms in front of me and eye contact towards him. A challenge for me here was not coming across too sympathetic which is unhelpful as it can imply that the person is a ‘victim’ (Starr 2016). This patient is a smart, professional man, who has struggled with his diagnosis which has changed his family and professional role and he has previously stated he does “not want to be seen as disabled”.
Demonstrating exploration skills
During this scenario, I was trying to use open questions to him and reflective statements. I think I used a phrase along the lines of “I sense that the suggestion that you could have type 1 diabetes has come as a shock to you.” He had concerns for the future, as if this was the case, he reported to be afraid of the possibly of requiring insulin injections. My colleague wanted him to have some specialist blood tests, I asked him about his feelings towards having these taken, I feel my use of questioning was useful to get a lot of information from him. On reflection of my use of open questions generally in my consults, although I would use open questions with my patients during history taking, I think over time I have learnt to limit open questions in consults because this ‘can open a can of worms’. Often I have either felt I don’t have the time or I haven’t had the skill set or knowledge to address/sign- post effectively.
Demonstrating understanding skills
To demonstrate understanding to an individual is to show that you are interested, sympathetic and curious about their behaviour, feelings or situation (Oxford Dictionary 2020). I appreciate that sometimes it can be very difficult to demonstrate understanding and our own individual bias and assumptions can influence our behaviour, as well as the assumptions of others. With patient A, I have spent many months providing continuity of care, clearly explaining each step, answering questions, and ultimately trying not being judgemental when at times he has not performed agreed health strategies. From doing this, he now quite openly discloses how he is feeling, and what he has been doing during his week. With this particular scenario the understanding skills I demonstrated were reflecting my observations back to him, and asked him to tell me how it felt when my colleague was talking about the possibility of a different diabetes diagnosis.
I think my ability to read him, is an element that I have done well, and I hope to work on this further, by truly active listening to people to tune into the subtle behaviour changes. A challenge in the NHS environment is always going to be time, and patients particularly are aware of this too when they see the waiting room of other patients. To develop going forward, I think it would be possible to put aside some consult for allowing time for the patient to speak about lifestyle goal setting, to assist my patients to use their own skills and resources to help sustain lifestyle choices that support diabetes management.
Demonstrating action skills
During this scenario, I feel that through affirmations and a collaborative approach for developing next steps I was able to raise his self-esteem to turn this potentially very negative consult, to a more positive one with clear steps going forward. I aimed to give him options regarding the timing of the blood tests that my colleague had asked for, and also some flexibility for him to work on his healthy eating behaviours. Shared decision making is a central aspect, advocated by the National Institute for Health and Care Excellence (NICE 2020) and offering choices emphasises patient autonomy. From this consult we had a time specific action plan that he could commit and be accountable to. Hopefully at the next consultation when I see him we can then revisit some the themes we had discussed during this scenario and then work together again collaboratively to make a new action plan for the following consult interval.
On reflection it was a good feeling for me that I was able to support him after receiving potentially bad news that he could have a different diagnosis. I chose to utilise to use the skills that I had been learning about during this course, and it was helpful in this particular case. It has made me reflect that although there are times when I have to give more direct advice to patients, there is also a substantial role for using coaching techniques in my daily podiatry practice.
I would like to continue to work on tuning in to emotion, body language and tone and pace of people’s voices to help aid my understanding of my patients concerns. This will hopefully allow me to reflect back feelings and then use questioning effectively to explore what the patient is going through. Through reflection of this scenario it has also highlighted how different coaching techniques are highly interlinked with current government health policy and have use in managing my patients with diabetes foot disease.
- Gibbs, G. 1988. Learning by Doing: A guide to teaching and learning methods. Further Education Unit. Oxford: Oxford Polytechnic.
- National Institute for Health and Social Excellence 2020. Shared decision making. [Accessed: 10 May 2020].
- Oxford Dictionary 2020. Meaning of understanding in English: Understanding. [Accessed: 29 April 2020].
- Starr, J. 2016. The Coaching Manual. 4th Edition. UK: Pearson.