Psychiatric technique may help time-strapped FPs
CMAJ 1998;159:753
© 1998 Kate Cottrell
Physicians attending a recent update conference in Montreal learned about a method that may help them deal quickly with patients' emotional problems. The BATHE technique involves a series of 4 questions followed by an empathic response; the acronym refers to the interview components: Background, Affect, Trouble, Handling and Empathy. Dr. Alan Buchanan, clinical associate professor of psychiatry at UBC, told family physicians attending the 10th Annual Psychiatric Update Conference in Montreal that BATHE is no substitute for in-depth psychiatric counselling. However, he said it offers time-strapped physicians a supportive approach for helping patients identify their problems and deal with them.
He said the first step is getting the patient's Background, perhaps by asking, "What's going on in your life?" Patients are given 2 uninterrupted minutes to answer, but should not be allowed to speak at length. The doctor then summarizes the answer and determines Affect by asking: "How do you feel about that?"
Buchanan offered a few gender-specific tips. Female physicians interviewing male patients should not be too concerned about receiving monosyllabic answers, although increasing their distance from the patient and decreasing eye contact may elicit a more detailed response. Female patients may volunteer their feelings before the Affect question is asked, but Buchanan says the physician should not "skip the second question — you'll get a different answer the second time."
Buchanan said physicians should watch patients carefully when asking the pivotal third question: "What troubles you most about that?" He said doctors "may see the beginning of small but significant shift in their perspective on the problem." Patients may pause, drop their eyes or look away, or show signs of agitation, and Buchanan said these are cues that the technique is working.
He said the fourth question, "How are you handling that?," reminds patients that they can cope. He told the FPs that their job is not to solve patients' problems immediately but simply to provide support and clarification.
Dr. Eric Bagnall, an FP at Ontario's North Kingston Community Health Centre, said the BATHE technique helps "when you're in a pressure situation with limited time and have a patient with a situational crisis — you're trying to help them collect their thoughts and connect with them emotionally so they know you're sympathetic. It's more a time-management technique than a real therapy — you have to follow up."
Buchanan stressed that the BATHE technique should not be used with patients who have a personality disorder or are suicidal, psychotic or in severe pain, or who are substance abusers or victims of abuse. As well, it should not be used with patients who seem hostile or suspicious.
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