Critical Reflection on Learnings
The Intrinsic Coach® Development Series provided me with several new learnings. For example, I used to believe that everyone who works in the healthcare industry does so because they have a desire to help people. I had never thought that “helping” people could be a bad thing. Learning how “helping” rather than serving can cause a person to feel broken was a real eye opener for me. The distinction of serving versus helping versus fixing was very valuable to me, and was not a learning that I had ever been exposed to before. I understand that sometimes people do need help, but it was good for me to learn how to make sure that the intrinsic does not get lost in the process. I now think that those of us in the healthcare industry truly desire to serve people, but a lot of us do not know how.
Contrary to what many people may think, for those of us in the “outpatient” setting who deal with patients who have chronic diseases, the work can become just as draining as for those who work in the inpatient setting. We put forth our best efforts every day to help our patients only to end up many times feeling under appreciated and disrespected by the very people we are trying to serve because they do not do what we tell them to, even though they know if they did, it would improve their health. As if that is not bad enough, we also have to deal with the “business” side of things, meaning increasing our productivity (as in the number of patients we see) and decreasing health care costs (meaning improving our patients’ health so that they do not need as many medications and/or so that they do not need to go to the emergency room). Because of this, we are always searching for ways to improve all aspects of the clinic system.
In an effort to improve the healthcare we provide, the clinic system I work in is participating in several national “collaborative” models. The primary goal of these models is to improve patients’ overall health in relation to diabetes, cardiovascular disease, asthma, and depression. There are certain extrinsic patient outcome measures for each collaborative that we are judged on, such as laboratory values, particular medications being used, number of visits for nutrition education, etc. As a team member of the diabetes and depression collaboratives, I have been searching for ways to “get” my patients to set realistic goals and achieve those goals (in other words, to get my patients to become “compliant” with the health care plan agreed to by all the team members, including the patient). While I think those of us in the collaboratives know that we really cannot “make” our patients do anything, many of us still approach our jobs with the thought that if we provide several suggestions for goals and our patients “choose” one, they may actually act on it.
As I myself became closer and closer to burning out, I thought, “There has to be a better way.” In my search for ways to improve my skills at helping my patients achieve better outcomes, I came across the Totally Coached, Inc. and the ICDS. The methodology of Intrinsic Coaching® was completely foreign to me, but it was highly recommended by several dietitians who post regularly on a bulletin board I frequent, so I thought it was worth a shot.
Learning what intrinsic means was a welcome confirmation to me of my view of myself and others as “unique” individuals. I have always disliked taking “personality” tests or using other similar tools because I feel like those questionnaires pigeon-hole people and do not truly reflect how a person is going to act in any given situation. I understand the intent of those tests, but too often they are misused and do not actually improve interactions among people. Intuitively, viewing people as unique and preventing extrinsic and systemic thinking from dominating intrinsic thinking made sense to me. However, initially I was not sure how viewing people with that perspective would help me in my interactions with my patients.
The other 2 core elements of Intrinsic Coaching® were more difficult for me to grasp. Learning what “intrinsic goals” are was a concept that was hard to wrap my brain around; identifying intrinsic goals was definitely a completely new learning for me. Learning to listen intrinsically more than extrinsically was also a completely new concept for me. I think people in my profession, in general, have dominating extrinsic listening skills. It is an expectation that we ask questions to determine what kind of dietary and lifestyle factors may be effecting a person’s health (e.g. identify the problem or problems), evaluate those factors/problems, then come up with a plan to “fix” the problem(s). Now I realize that while this type of listening is still a necessary skill, I cannot let it dominate. Through this ICDS, I have been able to develop “intrinsic” skills that I did not have before, such as eliciting true goals, enabling the patient to do their best thinking, and the ability to listen with a spirit of service.
Of the three core elements of Intrinsic Coaching®, listening with a spirit of service has been the hardest, as well as the most important, for me to master. I have always thought of myself as a “good listener,” but I now realize there is much more to listening than just hearing what a person is saying and being able to repeat it. In my work, because I had a habit of listening “extrinsically,” I had a tendency to want to listen for the solution, for how I could apply my “expertise” to help my patients. Learning how to listen intrinsically and listen for a person’s true goal has really helped me to better serve my patients. While it is still a challenge, it is a skill I know I will always have and can continue to improve.
I also now have the ability to regard people as fully capable, creative, and complete. I have always tried to keep in mind that people have different learning styles and things going on in their life that I could not possibly know, but sometimes some of the decisions my patients chose to make made it difficult for me to regard them as “fully capable.” Knowing that this is a skill to master, not a “fact” that is true for everyone all of the time, has made making this choice a lot easier.
I have always been confident in my most of my abilities, and have had very few issues with low self esteem in my life, so I often have a tendency to become impatient with people who do not view themselves as fully capable. Because of this, making the choice and continuing to make the choice was initially very challenging for me when it came to interactions with people who lack self-confidence. There are still so many people that I meet who have very low self esteem and such little intrinsic capacity that it is often very hard for me to have an Intrinsic Coaching® conversation with them. I want to become so skilled at Intrinsic Coaching® that I do not become frustrated with these types of people. I know that we cannot “make” someone increase their intrinsic capacity, but I hope that by increasing my own intrinsic capacity, when I interact with others who have very little self-worth, they too will be able to increase their intrinsic capacity on their own.
In my work in the past I also rarely asked the person I was working with what was most important to them. I usually worked from the perspective that because they were referred to me for a specific health condition that that condition would be the most important thing for them to talk to me about. If they did not want to talk about that condition or were not receptive to learning about it, I assumed that meant they just did not care or were not “ready” to work on that aspect of their life. In fact, those were the appointments that I felt like were a waste of my time, or that I should not have to deal with! Those were the appointments where I thought to myself “you need to see the behavioral health counselor, not me!” Making the choice and asking people what they want has really opened up doors for me in my interactions with my patients. I am now able to assist them in improving their lives in ways I never thought possible. Even when I do need to refer them to a behavioral health counselor, because we have already developed a sense of trust between us they are generally more agreeable to seeing that specialist.
I really hope to be able to improve my practice of all aspects of Intrinsic Coaching® so that eventually it feels “easy” all of the time. Right now, I still have moments when it is hard work for me, not just the coachee, because I have so much internal dialogue and because there are so many things that my patients “need” to know, eventually, in order to take care of their health. I want to get to the point where I can have an Intrinsic Coaching® conversation with anyone at any time and be able to do it with ease. I want my intrinsic questions to be the first questions that pop into my mind.
Now that I have become an Intrinsic Coach®, I believe I am in a much better position to serve my patients while at the same time eventually helping my organization achieve its own goals with respect to the extrinsic outcome measures we are required to meet. I understand now that while I may still need to do some identifying and evaluating, I will also be “coaching” so that the actual plan comes from the coachee. That plan may not be what I have in mind or am used to, but it will continue to evolve and serve the patient in the best way possible.
Because I have had the opportunity to experience Intrinsic Coaching®, as well as to learn how to become an Intrinsic Coach®, I want everyone who works in the healthcare industry to experience it as well. It is so freeing, and it enables our coachees to really take charge of their lives and improve their health without draining those of us who are serving them.
The really nice thing about becoming an Intrinsic Coach® is that I also now have the benefit of being able to use this methodology in my personal life as well. Because it is applicable in so many ways, I believe I have tremendous potential to improve my practice of Intrinsic Coaching® for the simple fact that I will have many opportunities to use it. I want to get to the point that whenever an opportunity presents itself, whether I am at work or at home, I remember to use Intrinsic Coaching®. In the end, what I really want for all of us (for the world), is to be able to make good decisions, improve our health and well being, and to feel fully alive.
-Christine E. Marquette, RD, LD: Concordia OMC 299 Reflection on Learning Intrinsic Coaching®
