Transcription
Welcome back to Health Coach Radio. I'm your host, Aaron Power, and today I've got a conversation with you, an unscripted riff on a topic that I'm going to call symptomatology, but you might know it as symptomology. Same same. Uh, I know that sounds boring, but I want to tell you what it is first of all, and why I think it's actually a very, very useful tool for health coaches who, per our scope of practice, cannot be diagnostic. But how we can use a symptomatology self-assessment with our clients to help them uncover how they're feeling and how we can help them feel better.
Let's start with the definition. The definition of symptomatology is the cluster of symptoms or a set of symptoms that characterize a condition. Could be a medical condition or a psychological condition. It's a set of symptoms that characterize some kind of diagnosable state. Okay.
Now, I learned about symptomatology when I was in, uh, school getting my registered holistic nutritionist designation, and it became a tool that we, as unlicensed nutritionists, were able to use to figure out how our clients were feeling and how we could help them to feel better. This is powerful for health coaches. I would be remiss if I didn't hammer on the one topic that I am so bullish about, and that is health coaching scope of practice. So, please stay with me while I once again remind you of our scope of practice as health coaches.
We are not permitted to send clients for tests. We are not permitted to decipher their tests or make recommendations based on diagnosis from tests that we've done. We can encourage the client to go get further testing with their doctor. That is a coach encouraging the client to go have a conversation with the doctor. We're going to talk about self-advocacy in the medical system today. That's one of my points. But we, as health coaches, cannot send our clients for blood testing. It doesn't matter what your credential is called. If your credential has the word "functional" in the title, it doesn't give you an advanced scope of practice. You are a health coach. You should not be sending people for blood tests or urine tests or hair trace mineral analysis tests or saliva tests. Lab testing is not in scope of practice for health coaches. Symptomatology is.
So, I'm going to give you four use cases for symptomatology and why I love it for health coaches. Right off the dome, unscripted riff, I have handwritten notes. In the age of ChatGPT, I'm very proud to say that I scribbled down some talking points, and I'm going to walk you through them right now.
Number one, scope of practice. Sorry to say it again, but we are in scope of practice when we help clients identify how they're feeling in their bodies, how they want to feel, and identifying the barriers between the two. So, let me just share a little anecdote with you.
When I went to the doctor 15 years ago, I went to the doctor because I felt tired. My brain didn't work. I was lethargic. I had insane sugar cravings and blood sugar crashes that took me out. I was gaining abdominal fat rapidly. I was losing muscle mass rapidly. I was in bad shape. And I was in my mid-30s. I went to the doctor because of all of those symptoms. I went to the doctor and said, "Doc, what's going on? Here's what I feel. Here's what I feel." She said, "You know what? Let's send you for some blood tests." Cuz a doctor can do that. A doctor is a licensed healthcare practitioner. They can send you for blood tests, which she did. And my HBA1C was off the charts. I was pre-diabetic. The blood test offered the diagnosis of pre-diabetes. But before we went for the blood test, you know what the doctor said? She said, "This sounds like pre-diabetes or insulin resistance. Let's send you for a blood test to confirm." By coming in with my symptoms, she already kind of knew what we were aiming for, and that's why she could direct the blood testing appropriately, a full comprehensive medical panel. She wasn't concerned that I had a brain tumor or a cancer. She right away knew this was something metabolic, probably a good bet based on the symptomatology that I came in with. And she sent me for the appropriate test, and I got the diagnosis.
But here's the deal. If I had gone to a health coach and said, "Health coach, I'm tired. My brain doesn't work. I'm having like crazy cravings and blood sugar crashes. I'm gaining a lot of abdominal fat." The health coach could say, "You know what? This sounds like it's a bit of a metabolic dysfunction. We can send you to the doctor. Let's get you set up with the doctor to run a blood test just to make sure. In the meantime, here's some ways to support good metabolic health. Here's some ways to support energy and mood and sleep and weight loss. Here's some things we can do to maybe start helping you feel better." This keeps us in scope of practice because the way the client self-reports their feelings is the client telling us what's wrong. It's not us diagnosing what's wrong. We cannot diagnose. But the client can say, "I feel tired. I feel lethargic. I'm achy. I'm getting fat around my midsection." It could be any. I have a skin rash. My eyes are dry. I get headaches. Now, we can't diagnose. We can't even offer. We can't offer to cure these things, but we can say, "You're not feeling good right now. Let's get you set up potentially with some further medical testing if that sounds appropriate. And in the meantime, let's work together to support you through some basic health and wellness behaviors that can support your metabolic health, can support your thyroid health, can support your liver health."
So, based on what you've told me, it sounds to me like you could use some help with understanding a way of eating that's going to keep your energy level throughout the day. Or maybe we can work on some sleep hygiene so you can get a good night's sleep and wake up feeling rested in the morning. And potentially, in the meantime, this client might need to go for some additional medical testing. And they might go get a medical test, and they might get a diagnosis, and there might be some medication involved or a procedure involved. At the end of the day, the client comes to the medical professional because they don't feel well. There's some symptom.
I'm reflecting back on all the times I did first aid training, which I had to do a lot because for various jobs. I've worked in gyms forever, but also I was in the army as a medic, so I had to do CPR and first aid constantly. And maybe this rings a bell for you, but there are signs and there are symptoms. So, the signs are the things that the outsider can physically see. I'm seeing a nose bleed. I'm seeing a contusion. I'm seeing an unconscious person on the ground. That's a sign. A symptom is a self-reported feeling. When the client self-reports, that keeps us in scope. We can collect client self-reported symptoms in effort to help our clients feel better. Then, how we help the client feel better is by staying in our scope of practice. We have an amazing scope of practice. We get to help clients eat differently, sleep differently, move differently, live differently. We get to help them understand the minutia of behavior change. These little behavior changes that make a big difference in how you feel. And if there happens to be some diagnosable disease state, that's in the purview of the licensed medical practitioner, not a health coach.
So, I love symptomatology because it keeps us in scope of practice and it feels productive because the client comes to you not feeling well. That's why a client would seek out a health coach, quite frankly. If you're a health coach that helps busy moms feel less tired, well, that's what she's feeling. She's feeling tired, and she's like, "I found this health coach who helps busy moms who feel tired, makes them feel less tired." Maybe you do that by helping the mom with some great nutrition support. And, um, maybe you help that mom set boundaries and get help in the family, right, in the household. Maybe you help the mom sleep better. That's in the purview of the health coach. So, we get to help people feel better, and there's a million tools we have in our toolkit to help them do that. How lucky are we? We have an amazing scope of practice. We don't have to put on the imaginary lab coat here, my friends. Please don't do that. By the way, I'm begging you as a health coaching educator and somebody who's been in the industry for a long time and has watched the industry grow and change. And I have a line of sight on where the industry is going as a health coach educator and a thought leader in the health coaching space. And I don't want us to become regulated. And I don't want us to get shut down because too many of us are overstepping our scope of practice. So please, you have an amazing scope of practice as a health coach. We get to help people feel better. That's their symptomatology, the way they feel.
Second on my list is symptomatology becomes very, it's a very client-led experience. The way you would typically do this, the way you would typically operate utilizing symptomatology inside of your health coaching practice is by some kind of self-assessment questionnaire or evaluation where the client is given a list of symptoms and they are asked to rate the symptoms in terms of frequency and severity. Again, when I went to nutrition school, I was given kind of a clunky Excel spreadsheet. Quite honestly, it was just a giant list of symptoms that I was supposed to give to my client and have them rank one, two, or three in terms of frequency and severity. And when I would see things that were rated three, most frequent, most severe, I would highlight them and say, "Here's some sort of front burner activities. These are mission critical. We have to get you feeling better here." And you know, there was some deeper programming there. For example, I was trained if there were many signs pointing to say, for example, a brain disorder or heart disorder or some kind of major dysfunction, then my next action was to help the client find a licensed healthcare practitioner to take the next step with them medically. There's a really nice boundary that it sets for health coaches in terms of scope of practice. I'm not going to go back to scope of practice. I've definitely covered it.
But what I want to talk about in this point is the client getting to self-report. This is very client-led. We want to be client-led health coaches. That's honestly one of the foundational pillars of health coaching. We are client-led. We are not the boss of the client. We are not in the boss position. The client's in the subordinate position. A lot of times clients are in subordinate positions in the health and wellness and medical world. Unfortunately, the client feels really disempowered in that relationship, and this is an empowering move for them. Tell me how you feel. Hey, guess what, client Sally? You've got a lot of symptoms here that are making you feel pretty bad. So, I can understand why you're looking for help today. How about you and I work together on getting some of these three out of three or five out of five or 10 out of 10 symptoms feeling better? We're going to start with some basics, some food, some lifestyle, some sleep, some stress management. Talk to me about your life. We have so much room to help people feel better. And what's really amazing is we get to ask the client how they're not feeling their best and how they'd like to feel. That's values-based. The client who comes in who rates a lot of symptoms with a high frequency and severity wants to feel better. Ask them about that. What would it feel like if these symptoms weren't rated five out of five, 10 out of 10, three out of three, whatever rating scale you're using? How do you think that would feel? Why would that be important to you? Get them thinking and connecting how they feel to the outcome they want.
Sometimes I do think we can get a little too data-driven. This is maybe my, uh, my recent bias because I'm kind of nervous about advancements in technology generally speaking, but also I'm a little unquantified right now. I'm kind of unquantified. I don't have an Oura ring. I don't have a Whoop strap. I'm trying to just come back home to my body and trust the ancient wisdom. I know it sounds kooky when I say stuff like that, but I like it. You know, I'm trying to take some of the technology out of my home, and I'm trying to be more analog. Anybody else trying to be more analog? So, there's nothing more analog than the client telling you how they feel and how it would feel if they could resolve some of these feelings. That's so inspiring.
Sometimes we encourage clients, maybe on an intake form. You might have a client do an exercise called their vision of health. I do this on my intake form. And to be completely honest with you, a lot of clients don't really love it. They don't really complete the exercise the way I would like them to, but some clients lean in. The way I like this vision of health exercise to go is basically write a paragraph as though we have solved the problem that you'd like to solve in your health and happiness. So imagine we've solved it. What is your life like? How do you wake up? How do you feel? What do you put on? Where do you go? What do you do? Who are you with? And some people really, again, they really anchor to that activity. It's an imagination experiment. What if you could feel better? For example, when I went to my doctor, if she said, "Aaron, what if your brain could start working again?" I would have done anything she said. I would have done anything she said. Now, my doctor didn't because my doctor was not a health coach. So, she gave me a blood test, diagnosed me pre-diabetic, and then said, "So, there you go. There's your diagnosis." And actually, not to disparage her because she was in a hurry, but didn't give me much else to do. She did say, you know, sometimes stress can cause it, sometimes diet can cause it. So, maybe take a look at those things in your life. So, I did. I quit my job. Anyway, what I'm getting at is when I went to the doctor's cuz I was feeling at a rock bottom level of poor health, and all I wanted was to feel a little better. And I could imagine what it would be like if I could get my brain back. And it was like I'd get a new job. I'm stuck in this crappy job I don't like. If I, if my brain worked, oh my gosh, the sky's the limit for me. That kind of thing, right? So that's really client-led. That's very values-oriented. And those phrases are so, so beautifully in the purview of the health coach. That's what we do.
That's another reason why I love symptomatology. My third reason is because it actually enables and encourages client self-advocacy inside the medical system. So again, I'm going to reference that if you ran a symptomatology questionnaire. Let's say you fold this kind of, uh, tool into your intake process. So maybe you have your client complete an intake form, and maybe they complete a symptom self-assessment. So you can create one of these, or you can probably find one. There's some tools, digital tools that exist for this. So you have your client complete a symptom self-assessment. Then maybe the client comes back with a bunch of symptoms that are highly rated. And for you, as the trained health coach, you might recognize that this raises a bit of a red flag. And you'll say, "You know, Sally, according to my symptom self-assessment, the one that you and I completed together, it looks like you've got, um, pretty unbalanced thyroid gland. There's something going on with your thyroid. Just symptomatically, you have a lot of strong thyroid symptoms. So, what about if you and I, let's, let's open up a browser tab. Let's start Googling to see if we can find a great doctor in your area that specializes in, you know, midlife women's thyroid. It's probably pretty common. Probably not, you know, maybe not nothing to worry about. We'd really want to make sure you get that tested, though, so you know what's going on. You don't feel good. These thyroid symptoms are really holding you back from feeling great. And we can go into imagine how life would be like if you didn't have all these thyroid symptoms holding you back. Let's get you a doctor that you can have a conversation with about this and start to get this, you know, going the right way for you."
So, what we're doing here is we're empowering the client into self-advocacy inside the healthcare system, inside the medical system. That can be a scary place to be. Again, I'm going to go back to my anecdote. I, I was never sick until the day I walked into my doctor's office and she told me I was pre-diabetic, and then I was sick for the first time ever, like actually medically unwell, and I was scared immediately. I mean, people get scared. The doctor said my cholesterol is too high. The doctor says my blood pressure is too high. The doctor says I need a medication. My mom had heart disease. My dad had heart disease. My grandpa died of a stroke. We get scared. It's scary. It can be scary. So, if we get a cluster of symptoms that shows up with our clients and it's like, you know, it's looking a little kind of high, high frequency, high severity, we have the opportunity to dial down the fear and the worry, and we can dial up the self-empowerment. The client knows I've got something maybe going on with my thyroid. Maybe not. You never know. Symptomatology is not an exact science. Lab testing is more of an exact science. The client can go in, find a thyroid expert doctor. Imagine if the client just went into their maybe family doctor and said, "Doc, I don't feel good. I'm, I'm not sleeping well, and I'm cold, and my hair's falling out, and I'm gaining weight." The doctor might say, "Well, you're getting old, so what do you expect?" But now we have this cluster of thyroid symptoms. Maybe we can go find an endocrinologist, somebody with a thyroid expertise. Maybe this client likes a naturopath more than a western medicine doctor. Maybe, who knows? Maybe they want to work in a functional concierge medical system instead of the, you know, conventional system. Who knows, right? We get to help our client take the next step into the medical system feeling empowered and not disempowered. I love that. I really love that for health coaches.
People still need doctors. We're not playing doctor. We're not doing that. People still need doctors, and they need to have trusting relationships with their doctor. They need to trust and like their doctor and be able to talk to their doctor, feel like the doctor's listening. They need to be able to jump to a different doctor if they're not happy with their current doctor. And we can help the client make those kinds of decisions. We can help our clients do lots of things in their lives. I always love telling the story of a health coach I spoke to. This is semi-related. I'll bring it around. Just bear with me. She was working with a client who was very overwhelmed and was having a hard time executing her healthy lifestyle habits. And through amazing motivational interviewing and coaching, the coach uncovered that the client was feeling overwhelmed because she hadn't completed the thank you cards for her baby shower. So, the goal that the coach and the client co-created that week was to do the thank you cards for the baby shower. Just get the thank you cards done, and then we'll pick up on the healthy behaviors next time. The reason I mentioned that is because we want to get the client to be able to take the next step. The next step on the journey to their health. They're kind of walking down a path, trying to take a step in the right direction. The next step might be, "You got to go to the doctor." "How do you feel about that?" "I don't like the doctor. I don't like my doctor. I don't have a doctor in this city. I just moved here. I just got some new insurance, and I don't know what doctor's in my network." Okay, we got to solve that little barrier. Barrier solving is a coach's job. Whether it's a thank you card or finding a doctor or anything in between, helping a person get their next workout in or eat a really protein-forward breakfast, we're in the business of helping the client take the next step. Sometimes the next step is, "Let's find you a doctor." I love that for us. I love that for our clients, too.
Now, the fourth reason I love symptomatology for health coaches is because it can be re-evaluated. So, imagine your client comes in on day one and they complete a symptom self-assessment, and they're feeling kind of bad, and they've ranked a lot of things. Three out of three, three out of three, five out of five, 10 out of 10, whatever scaling. I think a scaling question is a good way to rank symptoms, and I think frequency and severity is generally a good unit of measure. There's lots of ways to do it, but, um, frequency and severity, like headaches or heart palpitations or sore knees, you know, that kind of works for everything, right? So, let's say the client comes in and they have quite a few things that are, you know, highlighted, really highly ranked symptoms. We can retest 12 weeks later, apropos of nothing. Say, you know, just fill in this questionnaire again. The client won't remember how they rated things last time. They're going to answer the question based on how they feel right now. And then you can say, "Look where we've made some change. Look, this has improved. This is still a little heightened, so maybe we'll work on this next, but look, your joint pain improved, your sleep has improved, you feel like your skin has improved, you feel like you've lost some weight, you feel more energetic. Look at all these improvements you've made." That's pretty cool to quantify improvement because sometimes we're working on things with our clients where the obvious data point, like for example, I'm a weight loss health coach, right? So, my clients don't lose weight quickly. Weight loss just takes a long time. So, if they're getting on the scale every day, they're going to be discouraged. And discouragement is a very, it's a feeling that can block people from from making meaningful moves. Quite honestly, I think discouragement is one of the biggest feelings. I talked about this in a previous episode. Um, discouragement, disappointment, frustration are the three feelings that people struggle up against when they're making change. So, imagine how encouraging it would feel to see the needle move on these symptoms. Oh my gosh, Sally, there's 10 symptoms here that you rated three out of three 12 weeks ago. Now, you rated them zero or one, or even two. Can you see that we're moving in the right direction? Let's keep going. That really motivates a client to keep going.
Symptomatology is sometimes referred to as symptomology, and basically, it comes down to it's a set of symptoms that shore up to some kind of potentially diagnosable disease or condition. It can point to body systems that are out of balance, like the liver being kind of overburdened or the thyroid being sluggish, things like that. Things that might require medical intervention, and also they point the health coach to how the client is feeling, and then we can make moves to help them feel better. And that's our job.