"What can health coaches do?" And, more specifically, "Can health coaches order lab tests and interpret them?" These are some of the most frequent questions I get at Functional Lawyer, and today I'm going to give you my answer, some additional information, and what you can do about it if this is something you're planning to implement in your practice.
Before we jump into the details, we first need to define what health coaches actually do and what their job description is. Health coaches are part wellness-expert, part mentor-cheerleader, part accountability-buddy, and part psychological toolbox or life-hacks-giver who assist others to make better choices. Basically, health coaches support and act as behavior-change specialists, and they help bring people out of their ruts or encourage them to change certain habits. Health coaches can be helpful in that they respond in ways that are not judgmental or aggressively negative, especially because many people can feel a lot of shame with their current habits. Many of us need a cheerleader, accountability partner, or mentor, and health coaches can fit this bill. While that sounds like a 30,000-foot job description, that is the overall essence of a health coach.
A health coach can work with clients individually within his or her own private practice, and many work in conjunction with a doctor's or practitioner's office. They often, for example, help implement food plans that the doctor or the practitioner has prescribed or recommended for a patient. This patient, in turn, may become the health coach's client, and the health coach may go as far as to help the patient implement a new diet by way of guiding grocery shopping, cooking, finding ways around a distaste for certain foods, creating and setting goals, and taking steps to reach those goals alongside the patient. It's important that while the health coach is doing all of that, he or she is staying within a health coach's scope of practice. So, what is their scope of practice?
Believe it or not, there is not a lot of information out there from states or from their regulatory bodies that are through state governments or boards of medicine, boards of nursing, or boards of dietetics. Nobody out there is recognizing a health coach, as of yet, at the official state level. It's incumbent upon any individual who's calling themself a "health coach" or "health consultant" to know what the rules are when it comes to the unlicensed dispensing of medical or health and wellness information. It can be a slippery slope.
A health coach's scope of practice is sort of defined in the negative. In other words, we know what they can not do, but what can they do? We know what the scope of practice is for an MD, DC, and everybody else all the way down the line, but we don't know what a health coach's scope of practice is from the states.
However, we must make sure health coaches adhere to the spirit of the same oath as doctors: "do no harm." Part of doing no harm is not going beyond one's level of education, training, and experience. Health coaches must know their limits. Some dangerous situations could arise if this area becomes gray. If a health coach is ordering labs, interpreting labs, and making recommendations, they may not know what they don't know. They could certainly be missing many red flags regarding a person's health. This could lead a patient to either delay or completely go without the professional, licensed medical help that they need based on either the lab tests or on some of the medical history that the health coach hasn't had enough training to identify serious issues. Therefore, working within the scope of practice helps protect not only the health coach from their own liability but also protects the patient and additionally protects this rapidly growing field from having a bad image or bad name.
I'm sure we all can name, or at least identify, a couple of licensed practitioners or practices that are giving functional medicine a bad name. Maybe those patients have been disgruntled and have called your office afterward and said, "Yeah, I went to Dr. So-and-So, and all they did was sell me a bunch of supplements and order a bunch of lab tests, and I'm no better or worse for the wear." You want to make sure that you're protecting yourself, that you're protecting your client or patient, and that you're also protecting everybody else in your field of medicine. You don't want to exceed your scope of practice and have a big fallout from it. If you are working as a health coach, you can help support great health outcomes within your own scope of practice. You don't want to cross the line into an area that does not fall under your category of expertise and potentially get yourself and others in trouble. For example, if you are to support your clients through a food plan prescribed by a doctor or other licensed professional, you can guide those patients on recipes, shopping lists, how to prepare food, how to read nutrition labels, and what to look for. You can be there as a motivator, accountability partner, and support system; but again, you should do so by recognizing your title as a health coach.
There is a firm belief by me and most lawyers in this industry that, without a proper license in the state where the patient is located, coaches should not order, diagnose, or interpret lab tests. This would likely be infringing upon the licensed practice of medicine and is the work of licensed medical professionals, not health coaches. As a health coach, you should not prescribe (or recommend) any nutrition plans, exercise plans, or supplements, or medication. You, as a health coach, should not act as a medical expert, since you're not serving as a licensed medical professional-- even if you hold a license in another area.
Perhaps you have thought of calling yourself a health consultant or health coach, but you're actually a licensed NP or an MD. Sometimes the temptation is there because you are frustrated by all the regulations and you want to have more freedom to practice how, when, and where you want. You think that becoming a health coach can give you more flexibility. Maybe you want to be a health consultant because you have seen someone selling an online course and they make it look super easy. (A lot of these testimonials say, "I switched and gave up my medical license to become a health coach, and now I'm free and can make $21,000 in six minutes!" I mean, come on, common sense can tell you that it's not that easy!) It actually takes a lot of work, number one. But, number two, health coaches or consultants should not be ordering labs and doing work reserved for licensed medical practitioners.
As I mentioned, there are a lot of unknowns out there in the legal world concerning health coaches. It's a fairly new term. And, since it is new to the legal world, we haven't had many cases nor have we had solid decisions made regarding this specific field of work. There hasn't been much activity from regulatory agencies, and legislators definitely aren't even talking about health coaches yet. So, there is some gray area, and what I will tell you, as I usually say in most of my content, is: there is risk here. If you want to be on the safe side of the risk spectrum as a health coach, don't order lab tests, don't review lab tests, and don't make recommendations based on lab results. If you do, just recognize that you're probably practicing unlicensed, which is illegal, whether that be nursing, medicine, dietetics, or all three. Instead, refer your client to licensed professionals when the situation might call for it. It protects you, and the client will respect your professionalism.
We don't know how aggressive the criminal prosecution will be going forward, and we don't know how much they're enforcing this or what the penalties may be at this point. Therefore, use your own judgment and your own risk tolerance level as a guide, knowing that legally, as it stands right now, health coaches should not be ordering tests and labs.
Also, again, please know that this is not just me. This is not my own unique opinion. If you go talk to the Functional Medicine Coaching Academy or the National Board for Health and Wellness Coaching which certifies the graduates of FMCA, along with many others, they will tell you the same thing. Health coaches are to act as a support, as a kind of cheerleader, or a trusted individual who has some expertise but is not technically a licensed medical professional.
Health coaches may teach their ways and offer support, but any kind of ordering, interpreting, or recommending in terms of prescribing definitely crosses the line into the practice of medicine. So, think twice or talk to an attorney before you set up your practice as a health coach or if you go and expand as a consultant practice. Not that it can't be done, but it's very tough for licensed professionals to shed their label and then just be a cheerleader. It can be difficult to go from practicing medicine to showing people how to make Swiss chard or add more protein into their diet. It's hard to transition from prescribing and recommending a course of action to a patient to then sharing with a client how to get more leafy greens in their diet so that they can stomach them, no pun intended.
It's a lot to think about, but please assess your own risk before you make changes to your title or in your practice. And if you're a health coach, stay within your scope that protects you and your own liability, protects the client from physical and emotional harm, and protects the entire field as well. Health coaching can become a professional level of the healthcare team as health coaches certainly have a lot to offer. They take the weight off of personalized lifestyle medicine doctors and physicians and other practitioners and add a lot of benefits to the patient or client. So, stay safe out there, and if you have questions about your health coaching business, or adding a health coach to your medical practice, reach out to us at Functional Lawyer.