Bill Shankly, perhaps Liverpool’s most famous manager, once famously said “Some people believe football is a matter of life and death. I am very disappointed with that attitude. I can assure you it is much, much more important than that.” This comment was made partly tongue in cheek, and, although we often take sport seriously, we’re very lucky that athletes tend to be very healthy, and we probably never have to make life or death decisions. The medical profession isn’t so lucky and coaches can often learn from how doctors approach decision making under that kind of pressure.
Evidence, checklists, and the medical method
Those in the medical profession often have to make decisions that can have a huge impact on an individual’s quality of life, and, in many cases, their mortality. In order to make better decisions, medicine tends to adopt evidence-based guidelines, particularly around the use of medications, which increase the change of a positive decision being made. Of course, there is often nuance within this, with some medications perhaps being more effective in some individuals compared to others, and many of the best doctors make pragmatic decisions regarding patient care, taking into account the available evidence, but also the needs of the individual sitting in front of them.
As such, there are many parallels between coaching in sport and medicine. An example of this is the development of checklists, championed by Dr. Atul Gawande in his book The Checklist Manifesto: How to Get Things Right. This book is often cited by coaches as a must-read and it grew in part from the famous Elaine Bromiley case.
Another parallel can be found in how both doctors and coaches often prescribe minimally effective treatments or training. A recent paper in Nature looked at why this might be in medicine and contains some learning points that I think could be crucial for coaches. The editorial explores why patients might receive ineffective or minimally effective treatments, which has an obvious parallel with coaching, given that athletes can often undertake training sessions and plans which research has shown elicit no beneficial effect. Why?
Improving effectiveness through communication
The first point raised by the authors is that of communication. Even effective treatments are rendered ineffective through poor communication. When a doctor speaks to their patient, this exchange of information has a number of components, each of which represent potential areas where issues can arise:
- What the doctor thinks they’ve said
- What the doctor actually says
- What the patient hears
- What the patient understands
- What the patient remembers
The same is, of course, true in coaching. As a coach, you likely have far greater context and understanding of the importance of a specific exercise, training program, or decision, and why your determined course of action is the best approach, than your athlete does. If they can’t grasp your reasoning, they perhaps can’t carry out your instructions to the best of their ability. Additionally, experts often tend to poorly understand what non-experts in their field can and cannot understand, which means that a coach may think they’ve adequately explained something, but, by failing to expand upon what they perceive to be basic or unimportant points, the athletes understanding suffers.
Furthermore, much of communication can be emotional in nature. This can especially be true in athlete-coach communication, which, if delivered in a way that challenges the athlete’s (often quite considerable) ego can result in a poor information transfer. For example, after losing a race in which I expected to win, I likely wasn’t in the right frame of mind to receive feedback that would have been critical of my performance; timing is everything. Alongside this is the fact that patients and athletes often hear what they want to hear. A great example cited in the paper is that many patients undergoing palliative chemotherapy (i.e. chemotherapy aimed at improving the quality of life of a patient with terminal cancer) believe that the chemotherapy will cure them; this lack of understanding can clearly be very harmful to them. Doctors (and, by extension coaches), also tend to view information irrationally, driven by a desire to help their patients and to give them hope.
Don’t forget pragmatism
All of this suggests the importance of clear communication when working with athletes, including checking for understanding, repetition of pertinent information, and attempting to be rational. However, it is also important to be pragmatic. Many athletes may perceive a type of training or supplement to be hugely important for them, when the coach knows that, based on the available information, that specific type of training or supplement is most likely ineffective. This mirrors the softer side of healthcare; often, it can be important to let the patient undertake practices that likely have no direct positive effect, but which also have no downside. A great example from sports medicine is that of PRP injections; whilst a survey of Premier League doctors suggested that many though the therapy to be ineffective, they said they would use it on an athlete if the athlete believed in it.
Such a pragmatic approach, borrowed from sports medicine, appears to represent an ideal solution from my point of view. As I’ve previously written, when it comes to coaching, it’s more important that the athlete believes in you and your decisions. Allowing the athlete to undertake behaviors that they perceive to be beneficial, and which aren’t harmful, might mean that they put trust in other decisions you make. Furthermore, simple communication that can be understood and remembered by the athlete is, as we’ve learned from medicine, important in ensuring that the athlete can make an informed decision regarding the training they are going to undertake. In doing so, hopefully we can better assist athletes in making better decisions, and taking stronger steps towards improving their performance.