Post-doc playbook
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Post-doc playbook

A doctor works primarily to pinpoint the causes of symptoms and how to fix them – whether it's by taking medication or changing diet. But after one or two appointments, the rest is up to you. To help create and execute long-term plans outside the office, more doctors are turning to health coaches who work closely with them (some even sit in on physicals) to develop specific regimens and goals. Using physical exams, tests, blood work, and medication orders, health coaches then keep in touch regularly to ensure patients hit those targets.

"Most of the problems people go to their doctors for are chronic, lifestyle-related questions, and doctors don't have the time to treat them," says Dr. Frank Lipman, a New York physician who uses six health coaches in his practice. "Health coaches can give patients specific recipes and hold their hands. I don't have the time to do that."

Health coaches are not doctors or nurses. They can't conduct medical procedures, prescribe meds, or order blood work, and they leave medication questions to the doctors – like whether supplements conflict with a pill or whether a patient can stop taking a medication early. Because of this, they aren't required to have the usual medical degree. Duke Integrative Medicine instituted a health-coach training program in 2008 that involves a three-month course and has so far graduated 575 coaches. The Institute for Integrative Nutrition in New York, another prominent training center for health coaches, offers an online course that takes a year.

Most coaches help with the simple things: exercise, following specific instructions from doctors, and eating. "Health and lifestyle behaviors are difficult to change," says Linda Smith, director of professional and public programs at Duke Integrative Medicine. "Most of us know we need to exercise more, eat better, and work more effectively with stress. But it takes a partnership to walk this walk to activate these medical recommendations."

Like many of her colleagues, Kerry Bajaj, a New York–based health coach, stays in regular contact with her patients – checking in monthly, weekly, or daily, depending on the need, often by e-mail but sometimes by phone and during follow-up visits to a doctor. Given the time spent with patients, bad habits that would have otherwise gone unreported can be spotted. Bajaj saw that one male patient with a low sperm count was always balancing a cell phone on his lap; she suggested keeping the phone on a nearby surface instead, since even the low levels of radiation from a cell phone can reduce sperm production.

Everyday nutrition usually plays the biggest role in health coaching. "People think they're eating healthy. But we throw out a lot of what they eat," says Bajaj, who usually suggests a purge of the standard diet: junking gluten, sugar, dairy, caffeine, and alcohol and shifting to a diet heavy on fruits and veggies, quinoa, beans, nuts, and salads.

While coaching isn't usually covered by insurance, some companies like Humana, which insures more than 12 million people, have begun including in-house health coaches in their benefits packages. For everyone else, a coach's rates are comparable to those of a personal trainer – about $100 a full session, although they check up frequently and free of charge. A long-term plan will end up costing somewhere in the ballpark of $1,000 with regular visits over the course of about four months.

The most important role for health coaches may be as the alternative to the speedy follow-up appointment that leaves some patients wondering what to do next. "The traditional treatment is not to ask questions like 'What might have caused this?' " says chef Seamus Mullen, who saw a health coach to help him deal with own case of rheumatoid arthritis. "That's one of the greatest things about health coaches. They say, 'What are the myriad possibilities that could lead to this?' This is like having an advocate for your well-being."