BACKGROUND : AFFECT : TROUBLE : HANDLING : EMPATHY :
FEATURE
" What is going on in your life ?" ascertains the context of the visit . If the patient has already discussed this one , go directly to Affect " How do you feel about that ?" elicits the patient ' s emotional response . It is therapeutic for the patient to label feeling ( s ) " What troubles you the most about this ?" gets at the symbolic meaning of the situation for the patient " How are you handling that ?" helps to assess the patient ' s resources and responses to the situation " That must be very difficult for you " reflects an understanding that the patient ' s response is reasonable under the circumstances
lasting effect on patients who already are facing typical stressors . For example , our community members of color are found to have a higher prevalence of multimorbidities compared to our lighter skin toned patients . 10 From John Hopkins Geriatric Medicine department on multimorbidity , Dr . Davis et al . determined that the presence of multimorbidities independently predicts adverse outcomes , including quality of life . It is imperative that we see the multifactorial sources of stress prevalent in our patient populations ; pre-existing conditions , racially traumatic social injustice and prolonged social isolation . Even though this is our lane , many of us would not , from our own lives , have experienced all those stressors : helping patients with them means reaching out specifically , keeping such history foremost in our minds and hearts .
There are unique barriers to emergency medicine that prevent us from addressing stress in the high-pace environment of hospitals . Recent trends identify that patients are seeking out physicians to provide mental health care . A study 11 on mental health and emergency medicine states , “ that mental health burden has often forced emergency departments ( EDs ) to become the de facto primary and acute care provider of mental health care in the United States .” In this same study , they report an increase of 50 % in rates of presentation to EDs for serious mental health problems such as suicidal behavior .
How can we apply science-based stress management in the time-sensitive space of emergency medicine ? The BATHE 12 interview can help us . It ’ s a “ five step / couple minutes ” method to connect on the subject of stress even in the ER . It ’ s fast and to the point . Ask first ( Background ) “ What ’ s going on in your life today ?” Then ( Affect ), “ How do you feel about that ?” It helps a person to label a feeling . Then ( Trouble ) ask , “ What troubles you the most about it ?” You ’ re getting at the meaning of the issue to the patient - human beings search for meaning , to process things . Then ( Handling ), say , “ How are you handling this ?” to see if the person has found some coping / resources . Last , express ( Empathy ): “ This must be really tough on you right now ,” etc .
The voluble patient will take longer , but it helps you with even the very long-winded to have a structure and a plan . If you have managed to get a person to describe a stressful thing , to name a feeling about it and to pin down at all what it means to them : you have done a good job of truly listening and connecting .
It is imperative for us to not only educate our patients on stress management but practice it ourselves . We , as physicians , residents and students , are not immune to the same agents of stress as our patients . It is vital for us to practice stress management daily . Through daily commitment to this practice , we can then give the most of ourselves as we practice our beloved specialty in addition to instilling the practice in our patient lives . Here are a few tips from the American Heart Association : 13 slow down , let go , laugh , be active and give up bad habits . Let us be the change we want to see in our patients and communities .
References
1 https :// www . nimh . nih . gov / health / publications / stress
2 https :// www . apa . org / news / press / releases / stress / 2020 / report-october
3
https :// www . ama-assn . org / press-center / press-releases / new-ama-policy-recognizes-racism-public-health-threat
4
https :// apnews . com / article / democrats-popular-vote-win-d6331f7e8b51d52582bb2d60e2a007ec
5 https :// covid . cdc . gov / covid-data-tracker /# datatracker-home
6 https :// www . aafp . org / journals / fpm / blogs / inpractice / entry / countering _ vaccine _ hesitancy . html
7
https :// www . apa . org / news / press / releases / stress / 2017 / technology-social-media . pdf
8 https :// www . medscape . com / slideshow / 2020-lifestyle-burnout-6012460 ? faf = 1 # 2
9 https :// www . ncbi . nlm . nih . gov / pmc / articles / PMC7252157 /
10 https :// www . cdc . gov / pcd / issues / 2017 / 16 _ 0241 . htm
11 https :// www . ncbi . nlm . nih . gov / pmc / articles / PMC3679662 /
12
Lieberman JA 3rd , Stuart MR . The BATHE Method : Incorporating Counseling and Psychotherapy Into the Everyday Management of Patients . Prim Care Companion J Clin Psychiatry . 1999 ; 1 ( 2 ): 35-38 . doi : 10.4088 / pcc . v01n0202
13
https :// www . heart . org / en / healthy-living / healthy-lifestyle / stress-management / fight-stress-with-healthy-habits-infographic
M . Onu Udoh is a third-year medical student at the University of Louisville School of Medicine . He is on the distinction of medical education track as well as founder of Grow502 .
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