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Rethinking heart health, one question at a time.
I’m Dr. Sanjay Bhojraj—interventional cardiologist, functional medicine expert, and lifelong student of what really keeps us well. In this podcast, we go beyond prescriptions and procedures to explore the deeper drivers of health, disease, and healing.
From inflammation to intuition, cholesterol to consciousness, I sit down with doctors, researchers, and changemakers who are reshaping how we think about the heart—and the whole human behind it.
Whether you're a fellow clinician, a health seeker, or someone navigating your own transformation, this show will challenge what you thought you knew—and invite you to stay curious.
Sanjay Bhojraj MD (00:01.348)
Hey everybody and welcome to this episode of the Curious Cardiologist. I'm Dr. Sanjay Bhojraj, your host. And today I'm so excited to be here with Sandy Scheinbaum, who is the creator of the Functional Medicine Coaching Academy. And today in our discussion, we'll talk about the role of health coaches in today's medical landscape, why they are completely needed, why doctors don't have the skillset for what it is they do, and I think more importantly,
how that leads to better patient outcomes and overall just better health for all the people that we care about. So Sandy, so good to have you here. Thank you for being a part of the podcast today.
Sandra Scheinbaum (00:40.888)
Thank you so much. It is a delight to be here.
Sanjay Bhojraj MD (00:43.77)
And our paths have crossed so many times at a few meetings, but we just realized that not only did we go to the same undergrad college, but we went to live in the same dormitory at different times, of course, but always interesting. So go Northwestern Wildcats. Absolutely. We should have. have my Chicago Cubs hat here in the background. I've got a Northwestern hat somewhere around here, but, but amazing to have you here. Let's just dive right in. So health coaches now.
Sandra Scheinbaum (00:58.407)
Yes, go Wildcats, we should have been wearing our purple.
Sanjay Bhojraj MD (01:12.706)
When we look at the current medical landscape, I think there's a lot of things that are not looking well. We're spending more in the United States per capita on our patients. We've got, I think, the 37th worst outcomes or we rank 37 in outcomes. So what we're doing is clearly not working. And I think a lot of times what we're seeing is that there's a gap in healthcare literacy amongst what physicians, and I've seen this certainly in my practice, what I think I'm telling patients.
and what the patients are actually hearing, right? So there's a big communication gap and oftentimes that leads to either misunderstandings or miscommunications or just bad outcomes. So in the milieu of the healthcare kind of situation that we're in right now, how did you come into this idea of health coaching? What is the role of a health coach? Let's just jump right in.
Sandra Scheinbaum (02:07.576)
Well, I came to health coaching. It was a very circuitous path. When I was at Northwestern, I was studying education and thought I was going to be an elementary education teacher. Then went into special education, end up teaching in teacher training programs.
And even at the time, we're talking the 70s, I was focusing on things like stress management. was doing stress management workshops for teachers. I was doing relaxation tapes for children and got a doctorate in clinical psychology. And I was focusing as a health psychologist. So rather than I did see a lot of people with depression, with anxiety, panic disorder. But what I loved doing is working with people with
who had a diagnosis of a physical condition, migraine headaches, for example, irritable bowel syndrome. And I would get referrals from physicians and they didn't quite know what I was doing, but they would say to their patients, you know, there's this lady, don't know, I prefer a lot of my patients to write out, I exactly what she's doing with relaxation techniques, biofeedback, but it seems to work. And so what I was doing was mind-body medicine years before it had an official name.
And I was bonding it with positive psychology, which is focusing on what's right as opposed to what's wrong with you. And found that putting the two together was quite powerful. And I had a lot of people coming to me who were health coaches and they had trained, but they felt like they really didn't know how to coach. And they were asking if I would create a program to train health coaches. And I had recently got certified as a psychologist.
through the Institute for Functional Medicine. In fact, I was in their first certification class. I had to petition as a psychologist. I think I'm still the only psychologist who got certified. And that laid the foundation for Functional Medicine Coaching Academy. And we entered into a collaboration agreement with IFM, Institute for Functional Medicine. And have now, that was about 10 years ago, and we have trained about 5,000 people around the world.
Sandra Scheinbaum (04:22.902)
and we train them in a collaborative care model, not to replace the doctor, but to be a valuable team member to help people change when change is hard and lifestyle change as we all know is so hard.
Sanjay Bhojraj MD (04:38.328)
Yeah, and what I love about what you said in there is just something that I think as physicians we're just not good at is focusing on the positive, right? I just got off a call with someone and there's this scarcity mindset that happens in medicine where you focus on the bad things, right? Because your cholesterol is this, your EKG looks bad, this happens, that happens, and it's no wonder that...
patients don't want to listen to their doctors because all it is is bad news all the time. I get it, right? Like you're telling me all the things I'm doing wrong, not what's going right. And so I think that that's such an important part of the coaching dynamic and the difference in communication between physicians and coaches, right? Because physicians, we talked about this earlier, we're not coaches, right? We don't have that training to be that way. Now some of us may think we have the skillsets and some are probably better than others, but I think
Having someone who's focusing on kind of these incremental changes, these 1 % changes that you can make and have that add up over time is a huge value for patients.
Sandra Scheinbaum (05:46.734)
It absolutely is. It's a huge value and it's focusing on somebody's strengths, helping them find their strengths. So for example, if somebody has gone from one clinician to another and they're trying to find answers and that coach may point out, that is perseverance.
or maybe they have love of learning. And so what might be annoying where people are on Google or chat GPT trying to find answers, but that can be reframed as love of learning, wanting to find out more information. And then you partner with that individual where you are enlisting their support. Like they are crucial to make the decisions about their health. And one of the main values of health coaching has to do with self-efficacy. We have study after study that
points that out, that people who are receiving health coaching, they are asked the right questions so that they are now valuing their health and most importantly, they are seeing that they have a role in their healthcare, which has to do with those daily habits that...
Sanjay Bhojraj MD (06:56.43)
Right.
Sandra Scheinbaum (06:57.292)
they are seeing, their genes are not their destiny. I used to think that way. I just think that, okay, my mother had a heart attack. have heart disease, runs in my family big time. All my cousins have hypertension and high cholesterol. And so it is that belief that, well, I don't have to be, that doesn't have to be my destiny. And that's, can engage in a lot of physical activity that is going to increase my VO2 max, for example, or.
increase my nitric oxide by taking certain supplements. So it is a way of thinking that is different, that I can control many of these factors, of course, accepting what is not in your control, but primarily it is that change in self-efficacy that is so critical to the success of your medical care.
Sanjay Bhojraj MD (07:48.002)
Yeah, and I completely agree. One of the things that frustrates me about working in a healthcare system as I did before was patients completely just offloaded all their healthcare stuff onto the doctor, right? It's like if you have a contract and you give it to your lawyer, but you don't read it yourself, right? You're like, that person is going to take care of everything. But when it comes to your health, oftentimes what I'd say in my clinic is, look, I see you twice a year for 15 minutes, right? So that means that the other
179 days, 23 hours and 45 minutes of the life, you're in the driver's seat. And so I really need you to be active in terms of taking a role. it's a weird position, I think a lot of patients feel because rarely do doctors kind of speak to them. And I always say, you know, who's the most important person on the healthcare team? And they go, my primary care doc at this specialist, that's specialist. I say, no, the most important person is you, right? Because you are there.
on a daily basis making those unsexy decisions about broccoli versus candy or whatever it might be, that you need to not just be aware of what the right choices are, but the why behind them, why we need to make them. And I think it's really intriguing that you look at the individual and what their love language is in terms of learning versus some people might feel overwhelmed with too much information. Some people might feel empowered by it.
and really kind of diving into those personality aspects of people to engage in whatever the health success outcome is gonna be for them as an individual.
Sandra Scheinbaum (09:22.868)
absolutely it.
Sanjay Bhojraj MD (09:23.746)
Yeah. So when we talk about health coaches, how do you, so you had a background in psychology, which I think makes sense. What is generally, you know, in the academy, what is the background that you're getting? Are you seeing a lot of like non-medical people or getting a lot of nurses, a lot of people who've been in the healthcare realm that just want to be more effective? What is the coach of today look like?
Sandra Scheinbaum (09:47.256)
Yeah, one of the reasons I love this health coaching profession is because it is remarkably accessible. You do not need a background in health care. That's often misunderstood. Often we'll get job descriptions by practitioners and they'll say, well, they have to have a degree in nutrition and be a health coach. But that is actually not true. The research doesn't bear that out. Some of the best coaches have no background in health care.
nor do you need a degree, an advanced degree. You can have, you can be a high school dropout. And if you want to go for board certification, you need an associate's degree or higher. But there are many coaches out there who don't have that formal education and they don't have that background in healthcare. Many do, about half and half. So we have many people come to us who are nurses.
Sanjay Bhojraj MD (10:40.931)
Okay.
Sandra Scheinbaum (10:44.716)
nurse practitioners. have a lot of doctors who are increasingly discovering health coaching, either because they are retiring and they are ready to give up their medical license, but they still want to do something that is serving others. Or we have many doctors who want to learn coaching so that they can really make a difference with their patients. So that is one model as well. It's another way.
But people who are in health and wellness yoga teachers personal trainers and we get a lot of career changers We get a lot of we actually just had someone enroll who is a was on a professional athletic team and Is now retired from that career. We've got a dentist we have farmers we have many people from police officers many people are coming to
Sanjay Bhojraj MD (11:26.02)
Okay.
Sandra Scheinbaum (11:38.946)
be a health coach. So it's really exciting and it is also international. We have a large, large group of international students.
Sanjay Bhojraj MD (11:47.01)
And I've actually met a few of your international students and they're all just fantastic individuals. And what I love about this as well is there's so much more awareness, I think, of health and wellness in just the general population, right? Currently, there's a big debate about cane sugar versus high fructose in Coca-Cola, which I think we're all missing the boat. Maybe don't drink sodas. That might be the most important thing to do, not worry about what kind of sugar there is in there. But I think there's so much more awareness.
Sandra Scheinbaum (12:10.003)
Right, exactly. Yeah.
Sanjay Bhojraj MD (12:16.342)
And what I love about the varied backgrounds is that people are able to draw from their experience in whatever it may. I love that there's a law enforcement kind of component to this as well. mean, you know, people are, people are drawing in from all sorts of different experiences, into this realm. And I think that just makes the soil more rich, right? As we talk about the, the, coaching aspect of things, because, you know, you, the thing about a coach is there, they will just find what's inside of you and make it better.
And a lot of times I think back to my basketball coaches growing up that unfortunately made me better shooters. They just couldn't make me taller. So my basketball career ended pretty like around eighth grade or so. But they have this ability, whether you're a healthcare person or not, like people just intrinsically would have this ability to kind of find the light within an individual and make you understand that that's where you need to focus. So I think it's great that there are a lot of non-conventional medical people
Sandra Scheinbaum (12:54.158)
you
Sanjay Bhojraj MD (13:14.51)
kind of entering the coaching profession. And I almost suspect that they might be less burdened by the history of medicine to be able to come in and suggest, you know, think about things maybe in new ways or different ways or approach things completely differently.
Sandra Scheinbaum (13:30.668)
That is so true. And in fact, those who have been trained as clinicians now are going into health coaching and they may have a harder time adopting the coach approach because the coach approach is quite different from being the expert. The experts are used to looking at data, lab data, coming up with a diagnosis, a treatment plan, and then going to patients and saying, okay, this is what I want you to do. This is what you need to do. That is telling people what to do.
and often it backfires. It doesn't work. But coaches are really the ones who ask those questions, starting with finding their meaning and purpose in life. What do you want your health for? What matters most to you? Where do you want to start? Your doctor has given you this treatment plan. Now tell me your thoughts about it. And what we know consistently is that they will often underreport or misrepresent
to the clinician. see the coach more as their peer. And then so they'll be totally honest. And they might say, you know, all those supplements, I can't afford them. Or I'm just buying them at Costco. Or they might say, they might talk about a symptom that maybe they were too embarrassed or felt like the doctor so rushed or I don't want to talk about this with my doctor. They see them as the authority figure. They might not say, I
ate a whole bag of Oreo cookies last night, for example. But they'll tell the coach that because the coach, it's more like a peer to peer relationship. And so that is something that has been shown to be critical when a coach is on a medical care team, that then they can go back there, that bridge of communication where they will go back to the doctor and say, you know, Mrs. So-and-so has not been compliant with her medication. She's cutting the pill in half, for example.
Sanjay Bhojraj MD (14:59.194)
Yeah.
Sandra Scheinbaum (15:26.926)
And again, they are the ones who might find this out where a doctor might have never known for so many reasons. Often it's cultural. They see the doctor as an authority figure or they're thinking, well, he's got a waiting room for a group of patients, doesn't have time for, it's a silly question. might not, I don't need to ask it. And so when they have a coach, they know they can tell that person anything.
Sanjay Bhojraj MD (15:52.898)
Yeah, and I experienced this as a physician as well, is that some things that my medical assistant or my nurse practitioner, the information would get, I'm like, boy, why didn't they tell me? And it's almost like, you don't want to tell your parents certain things, but you'll tell your cool uncle or fun aunt or whatever, know, like they're more relatable. So I think that part of it is that we've created this hierarchy in medicine with hiding behind the white coat, I call it. So I never really...
Sandra Scheinbaum (16:06.636)
Yes.
Sanjay Bhojraj MD (16:21.742)
wore a white coat in my clinic and I'd always try to be more friends than an authority figure, but I think it's just natural. But ultimately, if you understand that your patient's blood pressure is elevated, not because you don't have the right dose of medication, but they can't afford it, so they're having to cut the pills in half or go every other day, that leads to a very different health outcome, right? Then maybe as a doctor, I can choose a less expensive medication or change the dose or whatever it may be, as opposed to just going from...
50 milligrams to 100 milligrams because I think their blood pressure is not controlled, there's a lot of other factors at play. I think, you mentioned culturally, having trained where I trained in downtown Chicago and downtown Detroit, there are so many cultural nuances that we need to understand of our patients that don't just come in clinic, right? So I think that that level of approachability is hugely important for patient outcomes.
while we're on the subject of patient outcomes, I'm sure there's studies that have been done looking at this, but in terms of the actual improvement in health, are you seeing it faster with health coaches? Is it more lasting? Like what does that body of literature look like?
Sandra Scheinbaum (17:32.87)
absolutely. And in the book that I wrote, your health coach will see now, there's a whole chapter that is about research. And what we found is that you name the condition and there's a study or one that is underway that is looking at the effectiveness of health coaching. Often these are randomized controlled trials. The control group will get the usual care, which would be the equivalent of a pamphlet.
and the usual medication, for example, the pamphlet about lifestyle, and then the experimental group gets a health coach. And time and time again, they have better outcomes, biomarkers. There's been studies on hypertension, for example. There's studies on cognitive decline, Parkinson disease. There's studies on chronic pain, length of stay post surgery, for example, when somebody has had a health coach.
Parkinson's there's been a study on effectiveness of COPD. There's quite a few studies of course obesity type 2 diabetes other issues that have to do with metabolic disorders. We see the effectiveness of health coaching and it is again increases in self-efficacy quality of life on measures like the promise 10. We saw that on our own study that we've done just five sessions of health coaching can make a huge difference it improves
clients. so it is improvement in physical biomarkers as well as a sense that, I can make these particular changes. There's been a recent study on people on GLP-1 agonists and those that worked with a health coach were able to make greater gains and sustain their weight loss. So that's another very promising area. So it is really that we have the evidence.
And now that's why I'm on a mission to tell everybody how remarkably effective it is. And one of the ways that I think health coaches can play a huge role is to help people understand that they are unique and that it is not a one size fits all approach, either when they get their medical care, but also that we are bombarded with information, often conflicting, and people are so confused.
Sandra Scheinbaum (19:54.574)
Is it carnival or is it vegan? One day they'll hear red meat's bad for you, the next day it's great, it's a health food. And they're very confused and they tend to look at, what are these social media influencers, for example. But we often lose sight of the fact that what is right for one person might not be right for somebody else. so often use helping people be their own detectives, which is becoming easier.
Sanjay Bhojraj MD (19:57.849)
Right.
Sandra Scheinbaum (20:23.31)
for continuous glucose monitor, for example. maybe that's not such a good food, because I got a big spike in my glucose on my CGM. So health coaches can help monitor. there are even Medicare is reimbursing when health coaches are in practices and they're monitoring all of that data from approved wearables.
Sanjay Bhojraj MD (20:46.094)
Yeah, no, I think that's great. You know, one of the things that happens, like for instance, in my clinic is I get so booked out. get, people don't realize that doctors get stressed out about this as well. But you know, for someone to set up a follow-up appointment with me in my clinic was almost eight to nine months out. Like it's, it's crazy. Like I know what I'm going to do every 15 minutes for the next nine months, right? Like that's, that's how far booked out I am. And what I always get concerned about is, you know, we need someone that has more touches with, with our patients, right? To kind of, as opposed to, you know, going,
off the track and veering for months, if we can correct that within a week or two, right, and get people back on the narrow, straight and narrow path, that keeps their healthcare outcomes that much better. So what is, I'm sure there's a lot of different models, but you mentioned in one of the studies that you did, just five sessions with a health coach can be a benefit. What does working with a health coach look like? Is it a weekly?
kind of half hour visit as a monthly, like what are some of the most successful models for working with a health coach?
Sandra Scheinbaum (21:47.854)
Sure, so usually there is a foundation session where it's people tell their story and the health coach will insert their strengths into that story because they're used to talking about their medical history, for example. But this is about your what's strong with you, your strengths history and really having this deep conversation of what do you want and then how can I help you get there? And so health coaches help people go from where they are.
to where they want to be. And it's that ability to imagine their future self and talk about, well, I want to have the energy to be able to play with my grandchildren, for example. And then they will keep referring back to that in terms of making that commitment. Where do you want to start now? And often it is setting those goals that are actionable, that are realistic, and then celebrating wins. And they'll tell the coach how they want to be held accountable.
There are many practices who are having patients see coaches in groups. Cleveland Clinic did this model very successfully. And so with those long wait times, they can start, they are not getting a diagnosis, they are not getting any medical treatment, but this would be a group where they can just talk about where they want to be. And often they'll start to make some lifestyle changes.
and many times they get better. And so the doctor becomes the consultant, reviewing labs, coming up with, often tweaking a treatment plan. But the power of seeing people in groups is just tremendously effective where the community becomes the medicine. I ran a group when I was a psychologist, I was really practicing health coaching but we didn't have such a thing back in the day.
But I went into a medical practice that happened to be an oncology practice and would take over their staff lunchroom and people would come in and that group went on for years and they were supporting one another, which is the value of groups and many of the time that the value was they were lonely. It was a group of older people and they loved the connection that they had in those groups. So that can be a very effective model. So they're seeing people
Sandra Scheinbaum (24:07.744)
at the front end, even before they've gotten to see the doctor, and then they continue for those follow-ups. And I do want to point out that health coaches are not a replacement for doctors. you think you're having a heart attack, you don't call your health coach. It's time to get, you we have the best acute care medicine. And in terms of having access to that care, we need our acute care treatments.
And we're talking about once you get discharged, you've had your cardiac procedure, now what? And it's working with a health catch on those lifestyle factors. And those lifestyle factors are, we often think of diet, but it's movement or lack of movement throughout the day. It is sleep, it is relationships, and it is a way to transform the inevitable stress that's in your life to something that's.
Sanjay Bhojraj MD (24:45.571)
Yeah.
Sandra Scheinbaum (25:05.375)
is manageable or even positive. And so it is those thoughts, the changing processes that can be so, so effective.
Sanjay Bhojraj MD (25:13.722)
Yeah, and I think in the cardiology world, after somebody has had a heart attack or a heart surgery, whatever it may be, we have this very robust network of what's called cardiac rehabilitation, which is a structured exercise program after the cardiac event, after discharge. And what I love about that, I've got patients who became best buds through there was that sense of community, as you mentioned, and seeing people, I may be at week 12 of my recovery, seeing someone who's at week two and-
You know, it's one thing hearing from a doctor, you'll feel better, but hearing it from someone who's actually going through it and has lived in those shoes and knows how it feels when you sneeze after you've had a heart bypass surgery, like there's something more about that peer to peer network. and, and so now extending that to a lot of other diagnoses, like, like I think of my father-in-law who had a knee surgery and had a bad comp, luckily he's doing okay, but had a complication after knee surgery. And I just felt like even as a doctor, I'm like, what do I do here? Who do I call? And it would have been so nice to.
to have a health coach or someone outside of the doctor's office who really the doctor's office only cared about, does he have a fever and more surgical type complications, but almost dealing with the psychology and the other part of the wellness cycle, which is, as you mentioned, plugging into community, feeling safe, knowing what to eat. always thought for a patient that first meal after you go home of what to eat.
must be so intimidating after you've had a major surgery, right? So someone who can kind of guide you in a more approachable fashion. So, you I think everybody should probably have, if you have a doctor, it almost seems like you should have a health coach, you know, at your side as well. think, you know, what great outcomes, you know, what else, you know, what else would be better than to have almost like that personal concierge with that? So are you seeing a rise of like diagnosis or condition specific health coaches? Like,
like post-op health coaches or, you know, like an OBGYN, they've got doulas that kind of usher people through. you seeing a lot of these specializations forming within the health coaching world as well?
Sandra Scheinbaum (27:21.582)
Absolutely. Our graduates often have a niche where they're specializing and often, just as so many practitioners come to functional medicine because they had an issue themselves, a medical crisis, and they found alternative, integrative functional medicine as the way to go and they got better. And so many people come to health coaching because they had a crisis. For example,
We have students who were diagnosed with MS and they thought it was hopeless and they started on a path using functional medicine often and they got better and now they are specializing in helping people with MS. We have quite a few who have gone on after they graduate from us and they specialize in helping people with early stage Alzheimer's, cognitive decline.
And that is an area that there's a great need for coaches, coaching families, caretakers, as well as coaching kids. We've seen people even wanting to specialize in things like mold or those very specialized populations. And again, they are not the practitioner. They are not the ones who are diagnosing, who are interpreting labs, who are developing treatment plans. They are working collaboratively with practitioners.
They are the ones who are providing support, often by deep listening, because people are not feeling heard and understood these days. And when they have that connection and they're committed to, again, very often it doesn't matter, as we know in functional medicine, what we name the condition, but it is focusing on these critical lifestyle factors. And that's complicated. For example,
It is so much more than just eat this, don't eat that. We teach a lot about eating psychology. Back in the day, I taught a lot of courses in psychology of eating and looking at your age, your gender, your cultural background, what part of the country you live in. Our choices of food are so tied in with many different factors. Older people who are losing their sense of taste and smell, for example.
Sandra Scheinbaum (29:40.046)
We launched a functional nutrition course where we address a lot of these issues where you can really support people not by being a nutritionist and telling them what to eat and doing special assessments, but more so by helping them where they are in charge to say, this is the plan that I want to do and carry out.
Sanjay Bhojraj MD (30:01.508)
Yeah, I mean, again, I think it just makes so much sense. So are we seeing for the most part in the health coaching universe, is there such a thing as like an independent private practice health coach? Are they mostly associated with physician practices or hospital groups or what does that landscape look like?
Sandra Scheinbaum (30:20.844)
It's about 50-50. So it depends on who you are. If you're entrepreneurial, many people come from a profession where they have a specialized population. Like for example, we have people who are lawyers and they become health coaches. And now so they are specializing in helping people in legal profession. We have people who want to work on a collaborative care team.
And that's the area where I think we're seeing a lot of growth, especially for primary care practices. Those who are, because the most coaching now is cash-based, but we have many practices, insurance-based, that now, and a lot of doctors don't know about this, but if you take insurance, Medicare specifically, you have, if you have...
patients who are getting their chronic care management visits, you can have your health coach handle that session. As long as there is a provider providing that oversight, that Medicare considers that auxiliary services, it's called incident two benefits. And that can be covered and there have been meetings.
by the National Board for Health and Wellness Coaching, their advocacy team has been meeting with the Center for Medicare Medicaid and being told, yeah, this is fine. Their coaches can handle those sessions.
Sanjay Bhojraj MD (31:54.975)
I mean, I think that's hugely important because, you know, in a 15 minute session that I have with a patient, right, let my 15 minute visit, I'm always running five to seven minutes behind. Right. So that it goes into that. I think what is the average now when a patient starts talking, you mentioned being listened to, it's like 28 seconds before you're interrupted by a physician. If it's even that long. And, and health coaches really, if they're, if they're
Sandra Scheinbaum (32:06.828)
Yeah.
Sanjay Bhojraj MD (32:22.656)
empowered to be able to do some of the chronic management or at least discussion and then report up the chain, it becomes a powerful tool as a doctor to kind of engage and leverage to really, number one, keep patients engaged in their healthcare to, something that I don't think I was able to successfully do in my clinic was individually kind of learn the strengths and the weaknesses of everybody and have a different.
language that I use with my 815 patient versus my 830 patient versus my 845 patient. We just don't have the time to be able to do that. But then also, part of it is just creating a relationship over time. And a lot of that is just presence, being in the same room. So having a half hour, 45 minutes hour with a health coach, you're just naturally going to feel closer to that person, assuming that you get along, right? Than a doc who might have even now a scribe in the room that they're barking.
kind of what to say, it's just, you know, we're getting so much erosion in the physician-patient relationship that I think it's just a remarkable tool to leverage kind of experience and to improve outcomes. What are the main resistances? I know that physicians, you I always say doctors are like probably the first cavemen or women, cave humans to see fire, right? With anything that comes, you're like, is it a destructive force? Can it be used for good? We don't like change at all.
Right and and the dumb thing is is that we don't even like change when it's going to make us more efficient or better at our jobs or improve patient outcomes, right? Because we just don't like anything challenging the status quo. what are some of the main objections or I guess maybe concerns reframe it that you get from physicians and and and if you can address those individually, let's maybe go top three top five.
Sandra Scheinbaum (34:04.024)
sure.
Sandra Scheinbaum (34:08.438)
Yeah, so there are some bad actors out there not trained from our program, but there are health coaches who think they know more than doctors, think they can act like doctors, think they can, with the explosion of direct to consumer labs, they're out there advertising on their website that they can interpret lab results, they can order supplements for you, and that's dangerous, and we...
think that is practicing medicine without a license. That tends to give the field a bad name. So if a doctor has a patient who may have seen one of these or may have seen an advertisement for a health coach doing this, they think, wow, I went to medical school. What's this person doing thinking that they are, you know.
Sanjay Bhojraj MD (34:44.964)
Well, it's funny. One of the first interactions I ever had with a health coach was that kind of person exactly. She was a health coach to the stars. I live here in California. And she told me, I'm smarter than any doctor could be. But she didn't have answers to some basic questions like medical questions that I was asking. And I didn't realize she was a health coach at the time because she's kept calling herself Dr. XYZ, whatever her name was.
And I said, where did you go to medical school? And then ultimately after some peeling back of the onion, I realized that she didn't go to med school, that she was a health coach. And at that wasn't even like a certified, she just kind of like hung a shingle one day and said, I'm a health coach. You know, I think of that was it Lucy or who was the character in peanuts that had the advice booth, you know, just, just, you know, just kind of did that. So I do think that there's a, there's an importance in, in having someone who knows how to play well with others, but kind of understands.
Sandra Scheinbaum (35:29.132)
Yes, Lucy, yes, uh-huh, yes. Yes.
Sanjay Bhojraj MD (35:41.06)
their their boundary and scope. So I appreciate that that's the first thing that that you talk about.
Sandra Scheinbaum (35:44.886)
Yes, yes, absolutely. Just having them a coach who is board certified in health and wellness coaching. So that would be a good starting point as a school. are approved by the National Board. So that means our graduates can sit for that board certification exam. So that is the first step. And then the having someone understand that their role is behavior change. Their role is to listen, not to replace a doctor.
and also that many doctors think that they need to have a background. So they'll submit, we have a job search and many doctors come to us and they will submit a job description and they'll say, we see this all the time. Well, we must have a background in nutrition, for example, but that's actually not the case because they don't prescribe meal plans. That's the provider's role. A health coach, and we do have great...
coaches who do have a background, maybe a degree in nutrition, but that is not what makes a health coach. A health coach is somebody who doesn't tell you what to do, what to eat, prescribe a meal plan. They are the ones who help you carry it out, who help you determine what is where you are in control as that individual, as that patient to make that decision, but you work collaboratively. And so a health coach who understands that role and doctors who understand that
as we talked about earlier, some of the best coaches are not going to have a background in as a clinician. They have a sense, this gift to serve others, to really listen to somebody and relate to them on a basic human level. And so that's what you look for to hire a health coach.
Sanjay Bhojraj MD (37:29.7)
Yeah. So, I mean, I think of them as like actualizers. They take what you say and actually make it happen, almost like a project manager. so, the project manager isn't the one coming up with the project. They're just holding everybody accountable and using a skillset. So I think that that, as I see it, is a huge misconception I had, probably because I was scarred by my first working was a health coach is really just doing
Sandra Scheinbaum (37:36.622)
Yes, exactly.
Sanjay Bhojraj MD (37:57.166)
what I say in making it or what I'm asking a patient to do and making it happen in whatever way it takes to get that. In Chicago, we call that Grabowski football, just whatever it takes to get it done, right? If you're a Bears fan like me. And so that's what I love about the coaching universe is, and I think, like you said, probably the number one misconception among physicians is they're not going to look at labs and change plans or anything that's well outside of the scope, but rather,
Sandra Scheinbaum (38:06.68)
Yeah.
Sanjay Bhojraj MD (38:23.258)
kind of have that two-way discussion, ask, all right, what do we, from a physician standpoint, what do you want this patient X, Y, Z to be able to accomplish? Let's get their thyroid in balance, let's do this, let's talk about their diet, this is the lifestyle program that I want them to enact, but then in that 15 minute encounter, it's hard to make it happen. So they're the ones that are actually gonna sit with the patient, sort out how to communicate best with that patient, and actually make it happen.
Sandra Scheinbaum (38:49.578)
Exactly. The other objection, well, I can't afford to pay a health coach. And there are great models you can start by just referring to a health coach in the community. You can have an independent contractor. And we have a lot of data showing that it actually boosts your ROI. People will stay in the practice. They like to feel like that their health coach is on the team. And so they will increase referrals.
with friends and family, will really feel taken care of. And at the end of the day, doctors want to know that their patients with these chronic conditions are getting better. And we have tremendous amount of burnout, as you know, in the medical community. And this is a way to help solve that. Just having a coach, we have doctors who say when they have their coach in the practice, they know that their patients are being taken care of. That relieves a lot of burden on them. They don't have to give him that same talk about
diet or exercise or follow through because they know that their patients are in good hands with lifestyle with their health coach.
Sanjay Bhojraj MD (39:56.058)
Yeah, and I think what we're learning, and you'd mentioned this before, in the acute care universe, I think we've done a great job in conventional medicine, right? If you're having active chest pain and you're sweating like an elephant, you on your chest and all that stuff, yeah, don't sit here and talk about the seven things that you need to get motivated. Like, go in and have someone like me open up your arteries. But I think where things fall apart, and part of it is the time constraint that we're under in medicine, but is...
and you said it before, listening, right? Actually having the ability to listen to patients and even more importantly, hear what they're saying or I think what they're not saying, right? And there's a lot of nuance in what people say. And I can think back to kind of the different areas that I practiced in downtown Chicago, downtown Detroit, here in Orange County. And I think back to my Michigan patients and what they had to say and what they didn't say.
You know, oftentimes the power was what they didn't say. And luckily at that point I was still in training, so I had the ability to listen, or the time I should say, I the privilege of time to be able to hear what they were not saying. But, you know, it's something that we don't think about particularly in the chronic disease management world. And oftentimes, as we talk about physician burnout, one of the things that leads to that is feeling like patients aren't listening, like, my God, this guy, like, you know, he's got bad diabetes. And I talked to him about.
drinking sodas and why that's bad. And then now he said he's drinking juice, right? And that's even worse, right? Whatever it may be. And you just feel like you're, know, Sisyphus, right? He was the one that was climbing, like trying to push the boulder up the mountain for eternity. know, so you just feel overwhelmed and now you're dealing with that story a thousand times, right? And it leads to burnout pretty quickly. So I think one of the other kind of aspects, particularly in healthcare systems, that would be great if they kind of listened in on this is,
Sandra Scheinbaum (41:27.968)
Yes! Yes!
Sanjay Bhojraj MD (41:52.09)
kind of engage a health coach for the health of your physicians and for the, you know, we talk about longevity all the time on the podcast, but career longevity becomes an issue. Um, and, and I think the health coaches could maybe kind of help not just unload some of that burden from the physicians or a lot of that burden, but actually make things more efficient for them as well.
Sandra Scheinbaum (42:12.526)
Another area that we have not talked about is the value for emotional health. So they are not therapists, coaching is not psychotherapy in any way. It is for emotional health. And we know that levels of anxiety, depression are decreased, self-report measures, quality of life indices, and it's just having somebody to talk to, somebody who gets you.
And so very often, as you know, we have a tremendous shortage, a crisis in mental health where, you know, good luck finding a therapist or it may not fit your insurance plan. And for whatever reason, there may be a long wait list. And so if medical practices have health coaches, they can often work with people who will find that they are getting better. And even because they are using lifestyle as a way of helping people. So
We know the benefits of walking. It's a great antidepressant for example. So because they are focusing on food They're focusing on sleep on managing stress having meaning in your life Dressing those areas then they may not need psychotherapy Which and as a psychologist I've seen too many examples of bad therapy where people are in therapy for life and they are convinced that
They have a mental disorder that can only be that there's something wrong with them and it is often something that is not going well in terms of they're just stuck in therapy.
Sanjay Bhojraj MD (43:47.438)
Yeah, I mean, and I think of, you know, maybe the health coach, the skills that you learned bleed into all sorts of other aspects of life as well. Like I know that I did some career coaching before and not that we would want to cross borders, but I mean, if, you know, what's good for the goose is good for the gander probably, you probably see, as you mentioned, kind of lifts and depression, lifts and anxiety scores, just like quality of life scores, I would guess, would just increase.
For a couple of reasons, number one, having someone that you can feel that you is listening and confiding in, but number two, the skillset that they give to focus on your coaching, on your health rather, probably leads to success in other areas of life as well.
Sandra Scheinbaum (44:27.414)
Absolutely. So it cuts down on the need for psychotherapy, which I'm not saying is, you know, if people do need therapy or they do need psychiatric meds and off we train our coaches how to make referrals for that, how to recognize when somebody does need those interventions. But very often with lifestyle factors changing and just having somebody who will listen to you, where you feel heard, you may find that you may not need.
psychotherapy or medication.
Sanjay Bhojraj MD (44:59.62)
So what are some of the, in that vein, I guess, what are some of the greatest success stories that you've heard either that you've experienced personally through coaching clients or you've heard through your students? Because I'm sure there must be some amazing turnarounds that happen with a simple coach, I mean, not simple coach, but just coaching as an intervention. We think of these completely high tech million dollar solutions, but sometimes just connecting can be so powerful. What are some of those great stories that you've got in your...
cabinet back there, your file case.
Sandra Scheinbaum (45:30.328)
Yeah, well, people who were told they had an autoimmune condition, like something like MS, like they were, and they had a health coach, they started to initiate lifestyle change and they were now in remission and felt much better. That is often a common story. People who had, in my own work, I would just a few breathing sessions, helping people to breathe.
to understand why they were having anxiety or panic, were able to completely get those conditions to disappear. And again, it was not psychotherapy. It was integrating the techniques of mind-body medicine and also having them paying attention to movement throughout the day. so we're seeing a lot of success with people.
who are on weight loss medications, who are also working with a health coach who have made tremendous progress in keeping that weight off when they are off that medication. So there are just a lot of examples of that. Practitioners who have worked with a health coach where they were able to report tremendous.
changes pre and post coaching in terms of the levels of stress that they were reporting.
Sanjay Bhojraj MD (46:58.362)
Yeah, I mean, I wish I could go back in time and have some health coaches in my old practice. Maybe that would have improved my career longevity, but I love the path that I'm on currently. So what are the current trends that you're seeing? Like in terms of coaching, you mentioned kind of people from different areas of life or aspects of life coming in. Are you seeing changes in the type of people who are?
Sandra Scheinbaum (47:03.214)
So.
Sanjay Bhojraj MD (47:23.096)
reaching out for health coaches in terms of being a client? Like what does that market look like currently?
Sandra Scheinbaum (47:28.598)
Yeah, so we're seeing companies recognizing that the well-being of their employees is critical for the success of the company. And so we're seeing a lot of corporate wellness programs that are offering health coaching to their employees. We're seeing some hospital systems looking at the benefits of having health coaches and more and more of the medical community. Certainly those
practitioners who are specializing in functional integrative medicine are bringing in health coaches and even those who have more of the so-called traditional practices. It's a way to bring in a service for their patients where they can see payoffs. So that's an increasing number of people. We have a job board and also the National Board for Health and Wellness Coaching is seeing an increase in the number of practitioners who are
or who are looking at the benefits of health coaching.
Sanjay Bhojraj MD (48:29.186)
Awesome. So if we've got people listening to the podcast or watching the podcast and they want to find a health coach, how does that happen? Where can they go?
Sandra Scheinbaum (48:35.916)
Yeah, can, sure, well, they can go to functionalmedicinecoaching.org and we have find a coach, we have a directory, but if they want some more hands-on assistance, they can post a job description, and we have somebody in our alumni department who can help them with that so that they find the right person to meet their patient's needs.
Sanjay Bhojraj MD (48:59.416)
And then similarly, if we have someone who's interested in becoming a health coach.
Sandra Scheinbaum (49:02.062)
Similarly, they can go to functionalmedicinecoaching.org and we are enrolling. We have two classes. One starts the beginning of September and the other the beginning of March. It is all remote. And this, should say that for the person studying coaching, it brings joy and personal transformation because what you are learning is a different way of communicating with people. And
in the process you yourself are personally transformed. We hear that again and again from our graduates.
Sanjay Bhojraj MD (49:34.914)
Yeah, I mean, just being in the functional medicine world myself and having trained, like I know how much the functional medicine world changed how I communicate with patients, but also people in my day to day life. you know, I can only imagine if you have that intrinsic desire to help people and now given the tools to actually make it happen, you know, it just wants to be transformative for students, in the program. How long is the certification program? How it's offered twice a is at six months, four months. How long does it last?
Sandra Scheinbaum (50:02.19)
It is a year. We have found that people need that year to really study at a deep level, to really hone your skills as a coach. And so that's why our program is a full year. And it's based on cohort groups. You meet twice a month for a couple hours based on your time zone with your fellow students, about 10 to 15 in a cohort.
Sanjay Bhojraj MD (50:05.338)
A full year, okay.
Sandra Scheinbaum (50:30.466)
based on your time zone and availability. And that's where the real magic happens, where you are practicing coaching and being coached, where you experience being a coach yourself. And so we also have a number of initiatives for our graduates where they are paired with people who want to be coached. And it is a growing field. And I'm so excited for the future of health coaching.
Sanjay Bhojraj MD (50:56.186)
Well, I mean, I think it's great and I think it's important for for health systems and physicians to understand that this isn't just a you go to a weekend course and you get a diploma that there is a whole curriculum and science behind this. It's not just something that magically happens. So as we are then looking for health coaches in our practice or community or whatever it may be, it becomes very important to look for that board certification to understand.
how they were trained. It's one thing to go to, I'm sure there are less scrupulous places to go that'll say, sit in on this three hour lecture and you'll be a certified health coach, but that's maybe not worth the paper it's printed on. But really kind of looking to your institution, really there's a robust training behind this. just like with anything, it makes a huge difference, right? I was just.
Sandra Scheinbaum (51:31.406)
for sure.
Sanjay Bhojraj MD (51:52.59)
talking to one of my daughters about this doctor who said that he was Harvard trained. And I looked at it and turns out he went to like a continuing medical education course, you know, for a weekend, like, you know, updates and hypertension or whatever is and called himself Harvard trained. And how I just said, you know, there's so many people out there. And I think particularly, as you mentioned in the functional medicine world, it gets a bad name a lot of times because people are just putting stuff out there. That's why it's so important for, it was important for me to be IFM certified through a suite of functional medicine, because I know.
you know, what that requires. And you've been through the certification process as well. So, you know, it's not an easy thing to do. Probably the hardest exam I've ever taken in my life. And I've taken a ton of exams. But it becomes very important to not just know the degree or the credential, but how the training happens. So think it's remarkable. And I think that you'd mentioned this several times. You're right. I think coaching is what's missing currently in the healthcare system in the United States, right? We all know
Sandra Scheinbaum (52:29.271)
Yeah.
Sanjay Bhojraj MD (52:50.552)
what we should do. I say this to people all the time. Michael Jordan knew that he needed to throw the round ball into the, into the round hole, right? But it wasn't until he got Phil Jackson as his coach, as the right coach that he started winning championships, right? So there's so much importance to coaching. And I know that anything I've done in my life where, where, like I've had an accomplishment, like I think of, did a half iron man triathlon years ago, and that was something that I needed a coach for. do competition powerlifting and I know how much my coach kind of
pulls in and she knows how to motivate me. And we've known each other now for 10 years. And she'll be like, all right, is this a grumpy pants day or what's going on? You know, she just knows me so well and knows how to motivate me. So to have that in the healthcare world, I think becomes so important. So I think you're filling a role that we didn't even know needed to be filled, but just like any good invention where you're like, oh, I didn't know I needed that, but now I can't live without it. You know, I think that's where health coaching is going to come into the fold for healthcare. you know.
Sandra Scheinbaum (53:26.926)
Yeah.
Sanjay Bhojraj MD (53:48.826)
Thanks for doing what you do. A couple of questions I always end the podcast with, if that's cool, I'll wrap it for you. Nothing illegal or anything, but number one, where's your favorite place you've been on earth? Like if you said, I could go back there and live forever, where would that be?
Sandra Scheinbaum (54:03.298)
Yeah, I've got to say it would be Santa Barbara, California. is around Montes. That is just so, so gorgeous. So anything along the coast of California, I remember that I got a lot of training at Fielding Graduate Institute in Santa Barbara. And that's just heaven. But I'm really happy wherever I am. And I think it is just what's real in the mind is, you know.
Sanjay Bhojraj MD (54:09.742)
Okay.
Sanjay Bhojraj MD (54:29.05)
Well, that's a great answer, but I'll take Santa Barbara. It is a gorgeous place for sure. Number two, what's your favorite food to eat? And does it have to be healthy if you could eat this for the rest of your life?
Sandra Scheinbaum (54:36.398)
So yeah, well, it's surprising for those who knew me in my younger days at steak because I spent many years as a vegan, a raw vegan, never realized how bad I felt on those dietary plans. But now it's like, yes, I could filet. I love it.
Sanjay Bhojraj MD (54:55.224)
You know, and I talk about all that time, like people think you need to be vegan, vegetarian for health, and that's a whole other podcast that we could talk about. And then number three, what keeps you curious? This is, you know, the curious cardiology podcast. So what are you curious about? What books are you reading? What are you learning more about right now?
Sandra Scheinbaum (55:00.93)
Yeah.
Sandra Scheinbaum (55:11.512)
So yeah, well, I am just curious about everything around me. AI, just found some, an AI for doing slides in an easier way. I just love learning. And also I love fiction, historical fiction. For example, I'm reading, I'm in three book clubs and I just led a book discussion about the she-wolves of Wall Street, about the pioneering women.
the New York Stock Exchange. And so I just love reading historical fiction as well as interesting books about the past.
Sanjay Bhojraj MD (55:51.834)
That's funny, my two kind of guilty pleasure shows are number one, Antiques Roadshow, because I love the history behind all that. And there's one on, it's on Smithsonian channel called Aerial America, where they just kind of fly drones over like Civil War battlefields and you learn all the stories. And my kids are like, dad, come on, like watch something more exciting. I'm like, no, this is exciting. So I totally get that passion for history and for understanding. So, thank you for spending the time. Thank you for sharing your passion with us about health coaching. Like I said, I think this is something that we need to...
Sandra Scheinbaum (55:56.748)
Yeah.
Sandra Scheinbaum (56:03.727)
Mmm. Yeah.
Sanjay Bhojraj MD (56:20.57)
kind of doubled down on it's what's missing in healthcare. And I think all that's gonna happen is that patient outcomes are gonna be better and people are gonna live longer. So Sandy, thank you for being here. I appreciate you and your time with us this afternoon. And thank you guys for being here on this episode of the Curious Cardiologist podcast. If you like what you heard today, then please click the button below, like, subscribe to the podcast. Remember, we're always trying to bring you.
Sandra Scheinbaum (56:31.746)
Well, thank you. It's been a delight.
Sanjay Bhojraj MD (56:45.892)
kind of new ways to look at old problems. And so today we talked about health coaching. In the past, we've talked about, you know, as heart, as cardiac issues, autoimmune, you know, what are, what are peptides, all these different things. you know, like, like, subscribe to the podcast. And if something, you know, really connected with you, leave a comment. love listening or reading the comments and, hearing back from you guys. So, so definitely leave comment. I'll take a listen. And I will look forward to seeing you on the next curious cardiology podcast. Bye everybody.