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Communication III: The BATHE Technique: A Framework for Understanding Patients in the Context of Their Life Situations (Large then Small groups) - |
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September 23, 2009 1:00 PM - 3:00 PM |
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John Muench M.D. |
| Assignment Due Today: |
Students should come prepared to discuss a patient they have seen with a psychosocial issue (not a diagnosable mental illness) that directly or indirectly affected their medical care.
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| Student Readings: |
| Syllabus |
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“BATHE: An Approach to the Interview Process in the Primary Care Setting” Lieberman and Stuart |
| Syllabus |
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Lecture Power Point |
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| Faculty Only: |
| Syllabus |
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Small Group Activity |
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| Internet Sites: |
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| Session Goal: |
To recognize that understanding patients in the context of their life situations can improve their overall health care.
To present a technique for eliciting the psychosocial context of a patient’s condition within the time frame of a medical visit.
To further acknowledge that noticing and working with what occurs at the relational level is critical for understanding and resolving difficult interactions.
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| Student Objectives: |
Describe how patients’ psychosocial stressors can contribute to physical manifestations of disease.
Describe how a physician’s awareness of psychosocial stresses can assist in both diagnosis and treatment of medical conditions.
List what each letter of the BATHE acronym stands for and the interview questions associated with each.
Describe the importance of each of the BATHE questions to the patient-physician relationship and overall patient care.
Demonstrate the ability to use the BATHE technique as an aid in eliciting the psychosocial context for an encounter and to comfortably inquire about patients’ concerns, emotions, social situations and behaviors.
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| Small Group Activities: |
- The group should have the opportunity to discuss any issues that came up for them in the reading or large group presentation. What kinds of concerns might some physicians have about discussing their patients “personal problems”? How would the group respond to such concerns in light of today’s presentation? From watching interview vignettes in the large group, when would be the most effective point in an interview to ask the BATHE questions? What are advantages and disadvantages to using a framework like this in talking to patients?
- Have several students share their patient stories. If asked, how would these patients have responded to the BATHE questions? Overall, what have students observed with their preceptors in terms of talking to patients about psychosocial stressors or issues?
- Make sure to reserve at least half the session for the last activity. Cases and instructions are provided. Students should all have the opportunity to try out the BATHE technique. Divide into groups of three: one to play the patient (roles are provided), one to play the physician (to ask the questions), and one the observer (to give feedback to the physician). Facilitators will act as timers (5 min per brief interview) and rotate to observe as many groups as possible. Keep the same case through at least two interviews to consider how things change with even subtle differences in timing or emphasis.
- Get the whole group back together to discuss what students learned from their inter-actions: what worked, what didn’t work, and why?
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Assignment
Due
Sep 30:
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Bring an example of a case from your preceptorship of a patient who would benefit from a change in behavior. How did your preceptor address it?
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