A collaborative approach to wellness: diet, exercise, and education to impact behavior change.

PURPOSE: The purpose of this study was to evaluate an interdisciplinary Wellness Program developed to help patients implement behavior changes necessary to begin weight reduction. DATA SOURCES: A 12-week program was developed to offer a choice of three diets, education, behavior change, and support groups that would allow participants to work through their concerns. A total of 109 participants provided feedback throughout the program and had varying degrees of change. Measures included education, food diaries, support, exercise, and anthropomorphic measurements. CONCLUSIONS: Participants who attended the exercise classes showed the most positive results with weight loss, and the greater the number of times attending the exercise classes, the more weight was lost. Readiness and willingness to change and the degree of involvement in the program also proved to be major factors in the program. IMPLICATIONS FOR PRACTICE: While obesity and overweight continue to be major healthcare issues in the United States, a real positive approach to helping patients with this problem has not been found. Continued study and support are needed to help patients deal with the impact of weight on overall health and well-being.

Physicians' emotional intelligence and patient satisfaction.

BACKGROUND AND OBJECTIVES: This study investigated the relationship between patient satisfaction and physicians' scores on a test of emotional intelligence. METHODS: Faculty and resident physicians at a southern medical school completed the Bar-On Emotional Quotient Inventory (EQi). Patient subjects were recruited at the conclusion of an office visit and completed a patient satisfaction survey. Spearman rank order correlations and t tests were used to examine the relationship between global, composite, and subscale scores on the EQi and patient satisfaction. Race, gender, and resident/faculty status were compared via t tests. RESULTS: When patient satisfaction scores were used to dichotomize physicians into two groups, those with 100% satisfied patients and those with less than 100% satisfaction, only one subscale of EQi, "happiness," was related to higher satisfaction. CONCLUSIONS: Findings suggest a limited relationship between physicians'scores on a test of emotional intelligence and patient satisfaction. Implications for physician training programs are offered in light of recent focus on physician-patient communication in medical education. Application of emotional intelligence concepts to physician skills and patient attitudes needs further research that may lead to further educational opportunities.

Medical students as health coaches.

OBJECTIVES: The purpose of this project was to teach students how to work effectively with patients in the area of health-behavior change. As part of the patient-doctor course, first-year medical students worked with diabetic patients who were selected by their primary physicians. In preparation for their patient interactions, students were taught basic communication concepts and the role of the relationship in improving patient outcomes, and continuity issues were addressed as students learned to collaboratively develop behavioral-change plans with their patients and then followed their patients' progress over the course of the year. DESCRIPTION: An educational research trial was conducted to compare the traditional community placement track (shadowing) with the health-coaches track. Students were randomly assigned to the two educational tracks. Health coaches were assigned in pairs to a family medicine patient with diabetes. Under supervision by the patient's medical provider, student pairs worked with the patient in an area of health-behavior change (i.e., weight loss, smoking cessation, exercise, or adherence to medication regimen). Students were required to have at least six patient contacts over the course of a year, consisting of at least three face-to-face visits and including one home visit. Didactic sessions with health coaches taught by either a behavioral consultant or health educator covered the basics of diabetes and behavior-change areas appropriate to respective patients. Students were also given reading assignments from communication and health-behavior change literature and handouts for patients. Behavior-change specialists were available as needed for consultation. In support of the health coaching process, students participated in eight small-group discussion sessions (eight students each) led by a behavioral change specialist. Small-group sessions lasted approximately 90 minutes each and contained didactic and experiential elements. Topics were: "Getting Started" (interviewing, the patient's story), "Fundamentals of a Home Visit," "Changing Behaviors" (stages of change, relapse prevention), "Home Visit Feedback" (report and reflections), "Challenging Patients to Change" (difficulties, challenging irrational ideas), "Giving Direct Guidance," "Non-verbal Skills," "Ending and Celebrating" (terminating the helping relationship). Evaluation methods included a pre- and post-physician belief scale completed by students, pre- and post-provider's evaluation of patient, and a patient-completed health behavior questionnaire. As available, patients' HbA1C levels were compared pre- and post-intervention. DISCUSSION: As expected, initially some health coach students complained about their perceived increased workloads compared with the workloads of students in the shadowing track. Some students also expressed reservations about their abilities to be effective with their patients, but these complaints diminished as students made contact with patients. For many, this opportunity to establish continuity relationships with patients helped students begin to understand difficulties inherent in effecting health-behavior change. Some students expressed appreciation for the opportunity to discuss their increased self-awareness about communication as well as relationship difficulties and strengths during the small-group sessions. Data analysis is under way. Lessons learned from this project influenced a major first-year curriculum revision the following year, resulting in increased emphasis on basic communication skills and the use of small groups to reach a variety of curricular objectives.