Beyond the prescription: how coaching helps doctors support patient well-being
Recently, an older patient visited me for a routine renewal of her chronic prescription for depression. While her depression had improved, she now found herself constantly anxious. Two glasses of wine each night helped her manage, but she wanted something more — medication to ease the anxiety.
We had touched on this before. She had already made an effort to cut down on alcohol. I could have easily written the prescription — it would have been quicker, simpler. But instead, I paused and asked, “What else might help?”
Exploring alternatives beyond the quickest fix
We discussed breathing exercises, meditation, and movement. I expected some reluctance, maybe even a little pushback. Instead, she nodded thoughtfully. “I used to walk every morning,” she reflected. “I think I’ll start again.”
In healthcare, these moments are crossroads. Many patients seek — sometimes even demand — quick fixes for anxiety or sleep issues. And in a stretched-thin healthcare system, writing a prescription can feel like the most efficient solution. But is it always the best one?
The path of least resistance vs. meaningful engagement
In South Africa’s overstretched healthcare system, writing a prescription often feels like the most practical path. Yet, is it always in the patient’s best interest?
Many healthcare professionals grapple with this dilemma. When patients insist on medication for anxiety or sleep disturbances, are we reinforcing a belief that relief is external, that they are powerless to influence their own well-being?
A useful framework for understanding these dynamics is the Drama Triangle, developed by psychiatrist Stephen B. Karpman. In this model:
The patient appears as the victim, powerless against their anxiety.
The circumstances (life stressors) take on the role of the persecutor.
The doctor becomes the rescuer, with medication as a quick-fix solution.
The dilemma for healthcare providers often becomes:
Do we play the rescuer, providing medication as a quick fix and reinforcing the belief that relief is only external?
Or do we take a coaching approach, helping patients engage with their anxiety and build their capacity to cope?
Moving toward the Empowerment Triangle
An alternative to the Drama Triangle is the Empowerment Triangle, or The Empowerment Dynamic (TED), proposed by business consultant David Emerald. What if we shifted our approach?
What if, instead of rescuing, we coached?
What if, instead of assuming helplessness, we nurtured agency?
What if anxiety wasn’t just a persecutor but a challenger, inviting exploration of new coping strategies?
What if, instead of fixing, we facilitated — viewing anxiety not just as a problem to eliminate but as an opportunity for deeper engagement with life?
Coaching for healthcare professionals: the way forward
As doctors, we often find ourselves balancing the need for immediate solutions with the potential for deeper, transformative change. Developing coaching skills can help us navigate this balance — to hold space for patients’ experiences while guiding them towards greater self-awareness and agency.
If you're a healthcare professional in South Africa interested in integrating coaching techniques into your practice, consider exploring how coaching can enhance patient care, reduce burnout, and create more meaningful patient interactions.
Written by Dr. Hoffie Conradie
If you’re interested in exploring coaching, please reach out to set up a free 30-min discovery call.