The Doctor as a Coach

In adult education (andragogy), the learning process is inclusive, based on previous experiences, seeking problem solving, immediate applicability and social relevance.

Malcolm Shepherd Knowles

(1913 – 1997)

Alex's clinical report

(Fictional narrative)*

Alex was still very young when he was diagnosed with non-Hodgkin's lymphoma. Since his first consultation, he expressed himself as a communicative and cooperative patient. He was married to Sue, a Philippine lady. They used to have a close relationship, sharing everything in life. Alex was an athlete and projected the internalized figure of a coach in the relationship with the doctor, who felt expanded his professional responsibility. A coach not only communicates technical information, but follows the learning process, promoting behavioral modulation.

Abstract 

Overview of the emotional flow and decisive moments in the care of a young cooperative patient, who elect the doctor as a coach, requiring a cognitive intervention based on Knowles' adult education approach.  Respecting Alex's attitude, the doctor had to find an inventive strategy to communicate with the patient. Here you will find the segmentation of the plot, describing how the doctor dealt with the challenges presented by Alex's clinical case: The exposition (PLOT 1) took place at doctor’s office. Alex and Sue were surprised and very concerned with the diagnosis of cancer in a very young patient. During raising action (PLOT 2) Alex identified the doctor's image with that of a coach and requested for a tutorial. The conflict (PLOT 3) was characterized by Alex and Sue running the tutorial and becoming familiar with the medical language. The climax (PLOT 4) was reached when the couple master the tutorial and began to exercise shared decision making. The falling action (PLOT 5) was entirely dedicated to the assessment of the risk-benefit ratio of the treatment. The resolution (PLOT 6) will be presented by the storyteller in a comprehensive biopsychosocial approach.

Emotional Flow

The graph presented below is a simplified depiction of Alex's emotional flow. At each PLOT element the patient-physician relationship leads to emotions that occur along distinct time intervals (△t). The interventions are responsible for the emotional flow, which is unique to each story. The continuous sinuous blue line represents the oscillating patient’s emotional status, with the larger inflection representing the “turning point”.

Author's perception of the patient's emotional flow and turning points 

*James Fleck, MD, PhD is a full professor of medicine at UFRGS, Brazil

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