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  • When I first became a doctor

  • in Benin City, Nigeria,

  • some 30-odd years ago,

  • I was drawn to help people live full lives.

  • But often, I found myself feeling impotent.

  • Here I was, a brand-new doctor with all these skills,

  • but I couldn't cure my patients who had chronic diseases --

  • illnesses like heart disease, asthma, diabetes --

  • and needed more than just handing them a prescription

  • or providing grief counseling in the office to get the job done.

  • Fast-forward 15 years later:

  • I'm in Atlanta, Georgia;

  • it's a different world,

  • but it was déjà vu all over again.

  • As doctors, we see our patients who have chronic illnesses

  • in an episodic way.

  • In between,

  • the patients have to learn how to make a lot of decisions for themselves.

  • I'll give you examples.

  • If you have medications you're supposed to take every day,

  • what do you do when you're sick?

  • Are you still supposed to take it?

  • How do you recognize a complication when it happens?

  • How do you recognize a side effect when it happens?

  • What do you do with it?

  • In addition to all of this,

  • they're dealing with the inevitable loneliness, isolation and anxiety

  • that people who have chronic illnesses deal with.

  • In the US alone, six in 10 adults have a chronic illness.

  • That's 125 million people.

  • A recent report from the Robert Wood Johnson Foundation

  • showed that health habits account for 50 percent

  • of the health outcomes that people experience,

  • while medical care only accounts for 20 percent.

  • In fact, the Centers for Disease Control

  • says that if we could eliminate smoking,

  • physical inactivity and poor nutrition,

  • that we can prevent 80 percent of heart disease,

  • 80 percent of type 2 diabetes

  • and 40 percent of cancer.

  • But we also know

  • that changing health behaviors is very difficult.

  • So we asked the question:

  • What if we could create a resource

  • that could motivate people to change health behavior?

  • The truth is, there are a lot of these resources out there

  • that help people acquire these so-called self-management skills.

  • But many a time, they're not easily accessible or relatable,

  • particularly to individuals within minority and underserved communities,

  • who face bias in addition to barriers like language and culture

  • and inadequate health insurance coverage.

  • And so in the last 12 years,

  • my colleagues and I at Morehouse School of Medicine

  • have created a technology-based application

  • to assist with chronic illness care.

  • It's freely available on the web

  • and as an app.

  • And what we do is get people to track variables --

  • blood pressure, blood sugar --

  • and then report it back to them in a color-coded format.

  • So green would indicate a healthy range,

  • and red would indicate a problem that needs something done about it.

  • We link these stats to a curriculum.

  • The curriculum helps the individual learn about their health condition,

  • whatever the chronic illness is.

  • They also work with a health coach

  • to learn self-management skills,

  • skills that'll help them prevent complications of their illness.

  • In order for the coach to be successful,

  • they have to be able to gain the trust

  • of the individual that they're working with.

  • We tested this application

  • in clinics, where the health coaches were medical assistants,

  • and in a large urban church,

  • where the health coaches were volunteers from the health ministry.

  • A year later, a third of the participants

  • were able to acquire three new self-management skills

  • and maintain them to the extent that it was able to improve

  • their blood pressures, their blood sugar

  • and their exercise.

  • Now, what was simple yet fascinating to us

  • was that the group from the church did just as well or even better

  • than the group that were under purely medical care.

  • And we wanted to learn why that was.

  • So we looked a little further into the research --

  • 400 hours of recorded conversation --

  • and what we learned was that the coaches from the church

  • did have more time to spend with the patients,

  • they had access to the patients' families,

  • and so they could figure out what people needed

  • and provide those resources for them.

  • My team and I call this "culturally congruent coaching."

  • To illustrate this concept of culturally congruent coaching,

  • I want to tell you about one of our patients.

  • I'll call her Ms. Bertha.

  • So Ms. Bertha is an 83-year-old lady with diabetes and hypertension.

  • She was assigned to Anne, her health coach in the church.

  • Anne also happened to be a family friend to Ms. Bertha for many years,

  • and they were fellow congregants.

  • Anne observed after the first few visits

  • that even though Ms. Bertha faithfully recorded her stats,

  • they were all showing up as red.

  • So she probed a little deeper

  • to try to understand what was going on with Ms. Bertha,

  • and Ms. Bertha gave her the real-real.

  • (Laughter)

  • She told her that there were times

  • when her medications made her feel weird,

  • and she wouldn't take them the way they were prescribed,

  • because she thought it was due to the medicines

  • but she didn't tell her doctor that.

  • She also skipped out on some doctor appointments

  • for a variety of reasons,

  • but one of them was she wasn't doing better

  • and she didn't want to make her doctor mad,

  • so she just didn't go.

  • So Anne talked to Ms. Bertha

  • and asked her to bring her daughter in for the next visit, which she did.

  • And at that visit,

  • Anne was able to print out a log of all these stats

  • that Ms. Bertha had been collecting,

  • gave them to her and encouraged them to go see the doctor together,

  • which they did.

  • With that information,

  • the doctor was able to make changes to Ms. Bertha's treatment.

  • Within three months, Ms. Bertha's numbers were all in the green.

  • No one was more excited or surprised than Ms. Bertha herself.

  • Now, Anne was successful as a health coach

  • because she cared enough to go below the surface

  • and probe Ms. Bertha's deep culture

  • and was able to reach her at that level.

  • She knew how to listen,

  • and she knew how to ask the right questions

  • to get to what was needed.

  • We all have deep unconscious rules

  • that drive the way we make our health decisions.

  • That's our culture.

  • The relationship and the conversation between Anne and Ms. Bertha

  • illustrates what's possible

  • when we have conversations with our patients,

  • our friends and our neighbors

  • on a deep cultural level.

  • And personally, I'm beyond excited

  • to think that with this simple concept of culturally congruent coaching,

  • we could change the lives of 125 million Americans

  • and many others across the world

  • that are living with chronic diseases.

  • Thank you.

  • (Applause)

When I first became a doctor

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慢性疾患を持つ人のためのパーソナル・ヘルス・コーチ|プリシラ・ペム (A personal health coach for those living with chronic diseases | Priscilla Pemu)

  • 28 2
    林宜悉 に公開 2021 年 01 月 14 日
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