The fifteen minute hour: efficient and effective patient-centered consultation skills PDF
Preview The fifteen minute hour: efficient and effective patient-centered consultation skills
S I X T H E D I T I O N The Fifteen Minute Hour Efficient and Effective Patient-Centered Consultation Skills http://taylorandfrancis.com 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 Taylor & Francis Group 6000 Broken Sound Parkway NW, Suite 300 Boca Raton, FL 33487-2742 © 2019 by Taylor & Francis Group, LLC CRC Press is an imprint of Taylor & Francis Group, an Informa business No claim to original U.S. Government works Printed on acid-free paper International Standard Book Number-13: 978-1-138-49777-1 (Hardback) International Standard Book Number-13: 978-1-138-49771-9 (Paperback) This book contains information obtained from authentic and highly regarded sources. Reasonable efforts have been made to publish reliable data and information, but the author and publisher cannot assume responsibility for the valid- ity of all materials or the consequences of their use. 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Visit the Taylor & Francis Web site at http://www.taylorandfrancis.com and the CRC Press Web site at http://www.crcpress.com 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
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