PCM1: BATHE

=BATHE Technique=

Describe how a physician’s awareness of psychosocial stresses can assist in both diagnosis and treatment of medical conditions

 * physical complaints can be manifestations of underlying psychosocial dysfunction
 * treating the symptoms will not address the cause
 * psychosocial problems can lead to situations (like poverty, lack of heath insurance, lack of education, etc) that set patients up for disease
 * physicians awareness of underlying psychosocial factors can
 * allow physicians to fully address patients problems and potentially treat the underlying causes/factors of disease
 * allow physicians to explore patient’s perception of their illness and combine it with the physician’s understanding of the disease
 * allow physicians to include emotional, relationship and social context
 * use the “doctor as drug” idea; a doctor visit in itself may have some healing power

Describe the BATHE acronym, associated questions and how they affect patient-physician relationship and overall patient care

 * BATHE technique is a –
 * screening test for psychosocial status of patient – quick, focused, supportive
 * therapeutic entity building upon preexisting PCP/patient relationship
 * technique to allow PCPs to support patient as they try and solve problems
 * technique that may be especially useful with unexplained symptoms or repetitive physical illness/problems


 * BATHE goals
 * raising patients awareness of contextual events possible affecting their lives
 * focusing patient on their emotional states
 * guiding patient into specifying the most troubling aspect or problem
 * focusing on how they are handling the problem
 * providing empathetic response validating the patient


 * BATHE
 * B: Background
 * What is going on in your life?
 * gives PCP insights into patient’s psychodynamic state and feel for potential origins of problems
 * patient is forced to give direct answer (can’t dodge question)


 * A: Affect
 * How do you feel about that? OR How is this affecting you?
 * patient can label feelings
 * PCP can evaluate appropriateness of patient’s labeling
 * focuses patient on emotional state being experienced
 * assessment of nonverbal clues = necessary addition


 * T: Trouble
 * What troubles you the most about this?
 * gives PCP idea of patient’s powers of perception, ability to prioritize, sense of self, other qualities
 * guides patient into specifying one aspect of problem
 * ability to appreciate nature/magnitude of the trouble = critical for PCP to help patient deal with trouble


 * H: Handling –
 * “How are you handling that?”
 * gives PCP sense of patient’s problem-solving/coping mechanisms
 * patients in acutely stressful situations tend to regress to lower level of functioning while dealing with situation
 * handling of problem may be more problematic than problem itself
 * ability to identify coping mechanisms and know how patient employs them = critical to understanding how patient is handling problem
 * suggestions can be offered


 * E: Empathy
 * An empathetic/support statement made by PCP to conclude That is a very difficult position
 * makes PCP an ally and resource for patient
 * indicates listening/assimilation and that patient is handling problem as well as could be expected
 * makes patient feel validated and connected with
 * allows for “doctor as drug”

Describe helpful questions and responses to use in patient encounters
1. What do you think is causing the problem? 2. Do you have any other ideas about why it might be happening? 3. Why is this happening to you now? 4. What do you fear most about your sickness? 5. What are the worst problems this sickness has caused for you? 6. What else might be helpful for you to get better? 1. How do you feel about that? 2. What troubles you the most? 3. How are you handling that? 4. What are you feeling right now? 5. What do you want? 6. What can you do about that? 7. What are your options? 8. What is the best thing that can happen? 9. What is the worst thing that can happen? 10. What is in it for you? 11. What does it mean to you? 12. What, specifically, were you hoping I could do for you?
 * Examples of questions that explore the patient’s understanding of their illness
 * Examples of questions that have therapeutic value
 * Examples of responses that have therapeutic value

1. That must be very difficult for you. 2. I can understand that you would feel that way. 3. Under the circumstances, I’m sure that you did the best you could.