Table Of ContentS I X T H E D I T I O N
The Fifteen
Minute Hour
Efficient and Effective
Patient-Centered
Consultation Skills
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S I X T H E D I T I O N
The Fifteen
Minute Hour
Efficient and Effective
Patient-Centered
Consultation Skills
Marian R. Stuart, PhD
Professor Emeritus, Family Medicine and Community Health
Rutgers–Robert Wood Johnson Medical School, New Brunswick, NJ
Joseph A. Lieberman III, MD, MPH, FAAFP
Professor, Family and Community Medicine
Sidney Kimmel Medical College at Thomas Jefferson University
Philadelphia, PA
CRC Press
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Contents
Foreword viii
Preface x
Authors xvi
Acknowledgments xviii
1 The BATHE technique: Key to making your practice patient-centered 1
Mental health practitioners by default 2
Opening the therapeutic inquiry 2
The BATHE technique 4
What is the best time to BATHE? 7
Supporting the patient 10
BATHE: A useful technique for many reasons 14
The efficacy of time 18
One last point 18
Summary 18
References 19
2 Broadening the context of the office visit or medical consultation 21
Social support 22
The medical visit as a stressful event 24
The story as personal steady state 25
Why patients adapt differently to stress 26
Application to illness behavior 31
The crisis intervention model 33
Application to the office setting 35
Summary 36
References 37
3 Promoting wellness and managing chronic conditions 39
Focusing on wellness 40
The importance of understanding the patient’s health belief model 42
Dealing with resistance 45
The wellness message in brief 47
Summary 47
References 48
v
vi Contents
4 Small interventions and why they work 50
Cognitive behavioral therapy and other practical therapeutic techniques 51
Human beings tell stories 52
Why it is important to have patients back in control 53
Five common elements in effective psychotherapy 55
Psychotherapy means editing the story 57
Useful techniques from a variety of sources 62
Determining levels of involvement in practice: PLISSIT 67
Summary 68
References 69
5 Therapeutic pearls for brief counseling sessions 72
Routinely inquiring about current life situations 73
Editing the story 77
Controlling the interview 79
Valuable strategies for empowering patients 82
Summary 92
References 93
6 Structuring a fifteen minute counseling session 95
Using BATHE as an approach to cases of self-harm 95
BATHE can create the structure for the session 97
The opening inquiry 98
Facilitating patients’ ability to change 101
Acceptance is key to effective treatment 103
Formatting the change process 105
Collateral visits with family members 112
The role of advice 114
Winding the visit down 118
Ending the session 119
Summary 122
References 123
7 Managing difficult patients: Their pain and yours 124
Reacting to difficult patients 125
A roster of difficult patient presentations 127
Treating children 143
Summary 145
References 146
8 Accenting the positive: Putting an affirmative spin on the BATHE technique 149
Positive affect influences in health 149
From the traditional to the positive BATHE 151
The power of forgiveness 155
Other positive cognitive strategies 157
Summary 158
References 159
9 Handling special situations, staff, and assurance self-preservation 162
Handling difficult family members 162
Managing unacceptable behavior 165
Training the office staff 167
Rules for practitioner survival 170
Contents vii
Medical mistakes and self-forgiveness 174
Summary 175
References 176
10 Wrapping up: Integrating treatments, modifying lifestyles, getting results 177
Depression and anxiety: Causal factors in obesity 177
Effects on the practitioner 179
Effects on the patient 183
Effects on the family 186
Putting health promotion and disease prevention into practice 187
Summing it all up 188
Summary 190
References 190
Appendix A: Twelve good questions and three good answers for all seasons 193
Appendix B: Recommended books and other resources for patients 194
Index 199
Foreword
Health systems across the globe are confronting a wide variety of issues, rang-
ing from controlling rising health care costs associated with increased disease
burdens of aging populations to containing new epidemics with the potential
of rapid spread worldwide. The importance of primary care in contributing
to the reduction of disease burdens and maintaining health in populations
is now recognized worldwide. At this level, the delivery of health care services
in most countries remains fundamentally a relationship-oriented interaction
between providers and patients. Yet, many systems of care continue to be
afflicted by an organizational and cultural pathology of Cartesian dualism
that separates the care of the mind and body.
The challenge for health care practitioners on the front lines of delivering
services has been in bridging this divide. As primary care practitioners know,
patients most often do not present with discrete singular problems, but rather
with a mélange of inter-related and connected biomedical and psychosocial
problems. Ascertaining the status of and connecting with patients’ affective
domains remain two of the fundamental skill challenges for all practitioners,
and are absolutely essential to achieving beneficial therapeutic effect.
Fortunately, this new edition of The Fifteen Minute Hour provides health care
professionals with the necessary knowledge and skills to accomplish this
daunting task. Building on the strengths of previous editions, this update
weaves contemporary knowledge and practical skill techniques into the fabric
of a well-written, readable text. The result provides the practitioner with an
efficient and time-effective set of practical approaches to building the thera-
peutic relationship to achieve beneficial results for the patient.
Whether it’s providing background material on the mind-body link, the
time-tested method of BATHE in extracting psychosocial data, or concrete
examples of cognitive behavioral therapy, this book illustrates the knowledge
and skills in straightforward coherent prose with many useful examples and
viii
Foreword ix
vignettes that bring the material to life. New material on wellness and liv-
ing with chronic conditions enhances this edition and fits with practitioner
goals of meeting the needs of increasing longevity in populations in many
countries.
I know you will enjoy reading this text as much as I have and will benefit
from the many pearls of practical advice contained herein. Drs. Stuart and
Lieberman have again provided healthcare professionals with another out-
standing contribution to improving the care of those we serve. Happy read-
ing and learning!
Alfred F. Tallia, MD, MPH
Professor and Chair
Family Medicine and Community Health
Robert Wood Johnson Medical School
Rutgers University, New Brunswick, New Jersey
Executive Director
Robert Wood Johnson Partners, LLC.
Accountable Care for New Jersey
Rutgers University and
Robert Wood Johnson University Hospital Health System
