This entry is the fourth in a series on health professionals who work in the author’s primary care clinic.
As a Health and Wellness Coach, Ryan Sherman takes his skills from bench (press) to bedside.
In grade school, he spent much of his free time either in the midst of football and basketball seasons or training for these sports at the gym. So it wasn’t a stretch for him to major in kinesiology - the study of human movement - while attending the University of New Hampshire. For his athletic training requirement, he spent a semester with the women’s field hockey team and found that he grew impatient “waiting till they [were] injured and then helping them.” Why not tackle the problem before it became one? His itch for prevention kept nagging at him as the years went on.
Ryan signed up for Wellcoaches, a 14 week distance course on topics like motivational interviewing and appreciative inquiry. By the end, he’d earned the title of Health and Wellness Coach as certified by the American College of Sports Medicine. Health coaching is a young field that originated with efforts in the 1980s to treat alcohol addiction with motivational interviewing. Many of the training programs, like Ryan's, offer online or weekend certification courses.
In kind, Medicare has started to pay doctors, nurse practitioners (NPs), and physician assistants (PAs) for intensive behavioral counseling to stem cardiovascular risk factors and obesity in particular. Insurance companies still don’t reimburse for health coaches. The point is well-illustrated by the fact that in Boston, with its glut of doctors, Ryan knows of only one other health coach besides himself who works in primary care. But he’s confident that his chosen profession is a growing one.
Ryan joined the Ambulatory Practice of the Future soon after becoming a health coach and quickly picked up patients referred by doctors and the NP at our practice. Typically, during the first meeting, he’ll ask the patient to imagine her ideal self (what is she eating, what is she doing for exercise, how does she spend her day?), identify her motivations for becoming that person, and come up with strategies to get there. For the next three months, Ryan will call her every two weeks to check in and will chart her progress, sharing the results with the patient and with her other providers.
Doctors might give advice about losing weight but we don’t have the time or skills to follow through, Ryan tells me. “You send them out the door, [they] see you in six months or a year usually. People are motivated for a few weeks. I provide that structure on how to get going plus that accountability.”
Ryan has started to tag-team with our registered nurse Mary Ann: after she teaches a patient about their diabetes, for example, Ryan helps him or her mitigate contributing factors like obesity and stress. Since July, through our IMPACT project, he has worked with a primary care doc and a psychiatrist to coordinate care and track progress for patients with depression. Through this work, Ryan has found joy in delivering something our health system seems to need: a powerful, targeted dose of common sense.
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