What Actually Happens in a First Coaching Session
It Is Just a Conversation
I have had hundreds of first coaching sessions. And the most common thing that happens in the first five minutes is this: the physician on the other end of the call exhales.
Not dramatically. It is the kind of exhale that happens when you realize no one is about to evaluate you. There is no rubric. No committee deciding whether you measured up. Your first coaching session is a conversation -- probably the most honest one about your career you have had in a while.
If you have been wondering what actually happens in a first coaching session with a physician coach, here is the inside view.
Getting Settled
I start by asking how you are doing. Not as a formality. Are you calling between patients? Did you just finish a fourteen-hour shift? Are you sitting in your car in the hospital parking garage because it was the only quiet place you could find?
Then I explain the ground rules, which are short. Everything stays between us. There is no report card. You can bring anything -- career, leadership, the thing your chair said last Tuesday that you cannot stop thinking about.
The Question That Opens Everything
After that, I ask some version of the simplest question in coaching: What is going on?
Not "What are your five-year goals?" Not "Tell me about your leadership philosophy." Just: what is going on?
Edgar Schein argues in Humble Inquiry that the most powerful thing a helper can do is ask a genuine question and then actually listen. That is what this part looks like. You talk. I listen. I am tracking themes -- what you keep returning to, what you skip over, where your energy changes. But I am not interrupting to prove I am paying attention. I am paying attention.
Most physicians tell me afterward that this part alone felt different from anything they had experienced. Not because the question was brilliant. Because someone waited for the whole answer.
The Questions Get Harder
Once I understand the landscape, the conversation shifts. I start asking questions that take longer to answer.
- What would need to change for you to feel like your career is working?
- When was the last time you felt genuinely energized by your work?
- What are you tolerating right now that you have stopped noticing?
These are not gotcha questions. They are designed to move you from describing your situation to examining it. There is a real difference. Describing is what you do in a faculty meeting. Examining is what you do when someone creates enough safety for honesty.
The pauses tell me more than the prepared statements. If you stop and say, "I honestly don't know," that is one of the most useful things you can say in a first session.
What I Am Not Doing
This is worth naming, because most physicians expect it: I am not giving you advice.
I am not going to tell you to leave your institution or hand you a time management system. Coaching researcher Anthony Grant at the University of Sydney has shown that the primary mechanism of coaching effectiveness is not information transfer -- it is self-reflection and insight. The coach creates conditions for you to see your situation more clearly. The clarity is yours.
Think of it like a pitching coach working with a veteran pitcher. The coach is not throwing the ball. They are watching mechanics, asking what the pitcher felt on that last throw, and helping them see the one adjustment that changes everything. The insight belongs to the athlete.
How It Ends
Toward the end, I do three things.
First, I reflect back what I heard -- not a transcript, but a distillation. The two or three threads that seemed to matter most. If hearing it reflected back feels uncomfortable, pay attention to that. It usually means we found something worth exploring.
Second, I ask what felt useful. Not to fish for compliments. To understand how you process, so I can calibrate for next time.
Third, we talk about what comes next. Maybe a question to sit with for a week. Maybe a small experiment -- a conversation to have, a request to decline, a boundary to test. Nothing dramatic. The physician coaching process is built on small, intentional shifts.
The Thing No One Tells You
Here is what surprises most physicians about their first coaching session: it does not feel like work. It feels like relief.
Not because I told you something you did not know. But because you finally said the thing you have been carrying -- to someone who was not going to fix it, judge it, or report on it. Just help you figure out what to do next.
If you'd like to learn more, contact us to schedule a time to chat.
