Have you ever had a client who you suspect needs some medical help/advice/tests? Or wonder what to do when a client demonstrates serious symptoms and does nothing about it?

A health coach wrote to me about this scenario and it's a good one to discuss as we'll all likely encounter this at some point.

She felt that the client was confiding in her about medical issues that she hadn't discussed with her GP or husband and wasn't getting the medical support the coach felt the client needed.

On the one hand it's great that the client has the coach to confide in, the trust and rapport was there. But on the other hand, the coach felt she needed to tell the client to get medical help but this felt was too directive.

The coach discussed scope of practice and felt like the client did not appear to want to get medical advice for fear of being a hypochondriac. The coach found it hard to sit by and watch without expressing an opinion, being concerned and getting too involved.

What do we do in this situation?

1. Discuss scope of practice. If the client is talking about medical symptoms, issues, etc we always start with the fact that we aren't doctors so we can't diagnose, prescribe or treat. Start here and if anything is outside scope you should discuss a referral or how the client will get additional support.

2. Watch for endangering behaviours. It is in our scope of practice, and ethically our responsibility, to step in if we see the client engaging in endangering behaviours such as overexercising, exercising when injured, not following a doctor's prescription, sharing medication, following extreme or unhealthy diets, remaining in high stress situations and if they have symptoms that require medical attention.

For the NBHWC exam you do have to know many biometric numbers - the lows, normals and the highs for things like blood pressure, diabetes, heart disease, metabolic syndrome etc, and also be aware of signs and symptoms of stroke and heart attack. This is so we can watch for red flags and direct the client to medical attention if we feel they need it.

In these cases, it isn't about the client making their own decisions and being non-directive, if they are at risk and need medical attention.

3. When in doubt refer out. If you feel the client is at risk, demonstrating signs and symptoms, then yes you suggest they seek medical attention.

"This is outside my scope of practice based on my knowledge of risk factors, signs and symptoms I believe you need to see a doctor or specialist."

Work with the client to develop a plan for a commitment around making the medical appointment. In extreme cases, if the client is having a medical event/emergency you would call an ambulance, or direct them to go to the emergency.

4. Ending the coaching relationship. If you see the client demonstrating endangering behaviours, you've addressed it, tried to coach them and made recommendations to seek medical help or a referral, and they don't take your advice, then you may have to end the coaching relationship for both your benefits.

Positive Outcome: I've had an update from the health coach - after having some frank conversations and good coaching, the client did finally get the medical attention she needed. The coach was also able to help her client work through her fears around getting medical help. The coach persevered, she didn't give up. She asked powerful questions and did a lot of reflecting back to the client about what she was noticing. She also invited the client to look ahead to the future and explored motivation. Since then the client has renewed for an additional six months with the coach. Well done!

What an awesome example of great health coaching in action!

Over to you: Have you had a situation like this? What did you do? Tell me in the comments...

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