Archive for the ‘Motivational Interviewing’ Category

Meet Health Coach Shelley Wroth, M.D. – “Health Happens Mostly Outside the Doctor’s Office”

February 8th, 2013 by Cheryl Miller

This month’s inside look at a health coach, the choices she made on the road to success, and the challenges ahead.

Shelley Wroth, MD, Instructor for the Integrative Health Coach Professional Training at Duke Integrative Medicine

HIN: Can you tell us a little about your first job after college and how you got into health coaching?

(Shelley Wroth, M.D.) My first job after college was working for a company writing grant proposals for a non-profit agency, Helen Keller International, that does blindness prevention and rehabilitation work globally. Just writing about this life-changing work became frustrating; I wanted to be doing it! I returned to school to finish medical school requirements and began medical school at Columbia University College of Physicians and Surgeons. I became a health coach after practicing first as a general OB/GYN for seven years, then completing a fellowship in integrative medicine through the University of Arizona and shifting my practice to integrative women’s care.

Even with a much broader approach to treatment options after my integrative training, people still didn’t always do what I told them to do! I realized I was missing the tools to find out what people actually wanted for their lives and health, and to partner with them first to create a customized health plan to meet that big picture, and next break it down into concrete steps to put into place. Health coaching training provided me those skills and radically changed my practice and view of truly patient-centered care.

Have you received any health coaching certifications? If so, please list them.

I received my health coaching training through the Duke Integrative Health Coach Professional Training.

Has there been a defining moment in your career? Perhaps when you knew you were on the right road?

I think the defining moment was when I was reminded in both my integrative medicine training and health coaching training that people’s health is their own, and happens mostly outside of the doctor’s office. People’s bodies heal themselves, even after a needed surgery or medication, and people decide how they want to approach their health based on their personal goals and values, and the most important things that support their health happen through their food, movement and relationships. In my medical training, I had truly forgotten that. To not only be reminded, but to learn a process, skills and strategies to work skillfully with people to discover what makes sense for them for their health, changed everything and let me know I was on the right path.

In brief, describe your organization.

Duke Integrative Medicine has a mission to transform medicine in the 21st century. Our professional training in integrative health coaching is a primary pillar of this mission, in addition to our clinical and research work. In order to transform medicine into a care system that is focused on supporting health, preventing disease and treating it at the earliest signs, and that supports each person to create and implement a plan that is based on best practices and is customized to their values and needs, we need providers with new skills in effective health behavior change. Our Integrative Health Coach Professional Training is designed to train a new professional on the healthcare to meet this need.

What are two or three important concepts or rules you follow in health coaching?

  • Start and stay curious. I may have a lot of information and even passion about different options to support health for my clients. However, I know nothing about what they already know about their health, how they work best, what is most important to them, and most realistic to put in place unless I ask. My favorite question is: What else? There is always more for a client to discover to increase learning and enact successful action.
  • Mindful awareness. At Duke, we view cultivating mindful awareness as a foundation to effective coaching and partnership. With mindful awareness, I am paying attention to the present moment, just as it is. This supports my ability to hear my client, be aware of my own thoughts without needing to automatically react to them, and notice changes in voice tone, or energy level, or emotion with my client, and follow up on them to see where it might expand client learning.
  • Work from research and neuroscience-based models. No one has cornered the market on effective behavior change; if they had, our country would not be in the healthcare crisis due to preventable chronic diseases that it currently is. However, we are learning more and more about how the brain prioritizes information and builds new neural pathways that are required for change. I believe in using health coaching strategies that take advantage of the amazing plasticity of the brain for sustainable behavior change.

What is the single most successful thing that your company is doing now?

We are focused on increasing the accessibility of integrative health coaching training to interested providers through the healthcare system, including nurses, nurse practitioners, physician assistants, physicians, psychologists, massage therapists, nutritionists, and exercise physiologists, in order to more effectively engage people in planning for their own health and making sustainable health behavior changes.

What is the single most effective workflow, process, tool or form that you are using in coaching today?

I believe there is no single most effective process or tool in coaching, as every person’s brain is unique based on their own experiences and decisions. Therefore the most effective process or tool will be unique for each client. The key is to listen to the client, have established a trusting working relationship, and as a coach be familiar with a clear process for exploring change that offers multiple strategies to try and see what helps the client make the greatest insight and implement new action.

Do you see a trend or path that you have to lock onto for 2013?

The questions about whether or not we will implement healthcare reform have been answered with the presidential election. It is now time for action. The old system will not work to provide the truly patient-centered, preventive care needed for reform. Integrative health coaches will be at the forefront of new systems and delivery methods for healthcare that make sense to promote and incentivize health.

What is the most satisfying thing about being a health coach?

For me it is when I am teaching health coaching and a coaching student sees the impact of asking the client a question that elicits the client’s own knowledge and solution instead of the coach offering advice. That is when everything changes in the neurochemistry of possibilities for the client and coach.

What is the greatest challenge of health coaching, and how are you working to overcome this challenge?

My greatest challenge is patience as the healthcare system moves to incorporate the position of health coaching. The need for expertise in health behavior change is so great and immediate, it is both an amazing opportunity and a personal source of great frustration with the gap in our current care.

Where did you grow up?

I grew up in Santa Barbara, Calif., though I have lived longer in my current home of Durham, N.C. I feel lucky to have lived in such beautiful university towns, with amazing resources for outdoor activities, music, food and arts.

What college did you attend? Is there a moment from that time that stands out?

I went to Yale University as an undergraduate. I loved being on the women’s rowing team and spending a junior semester living in London, studying and going to plays.

Are you married? Do you have children?

I have a partner who is an acupuncturist. I have learned a great deal from her about Chinese medicine’s approach to whole person care and healing. I have two children, one getting ready to drive and the other busy with Ultimate Frisbee. Life is full and always interesting!

What is your favorite hobby and how did it develop in your life?

My favorite hobby is yoga. I discovered yoga during my integrative medicine training about eight years ago. It has been part of my life ever since, supporting my physical and mental flexibility, stamina and strength.

Is there a book you recently read or a movie you saw that you would recommend?

Two books that I recently read and loved were The Power of Habit by Charles Duhigg and Escape Fire: Designs for the Future of Health Care by Donald Berwick. The Power of Habit has a great discussion of how we set behavior patterns as individuals, businesses, and societies, as well as how we can recognize those patterns and change them. Escape Fire: Designs for the Future of Health Care is an inspirational series of talks given by Don Berwick, the founder of the Institute for Healthcare Improvement, over 10 years, detailing the gaps in the current healthcare system and outlining the framework of the solution and what our future healthcare system will evolve into. Absolutely masterful.