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BREATHE OUT intervention leads to improved clinician satisfaction

Increased clinician satisfaction with difficult patient encounters was associated with use of the BREATHE OUT technique, which allows physicians to reflect on their own biases and ‘check in’ with themselves before interacting with a difficult patient, according to a recently published study.

“The BREATHE OUT intervention increased clinician satisfaction with difficult patients, suggesting its use could be part of an overall strategy toward a more positive perception of the patient and the encounter. This implies a trend toward perceiving the patient as less difficult and may lead to improved doctor-patient relationships and decreased clinician burnout,” Jennifer Y. C. Edgoose, MD, MPH, of the department of family medicine at the University of Wisconsin, and colleagues wrote.

Jennifer Y. C. Edgoose

To assess the efficacy of the intervention in correlation with difficult patients, researchers evaluated a total of 57 physician faculty, nurse practitioners, physician assistants and residents in six family medicine clinics. The clinics were paired based on urban, suburban or rural setting, and randomized to administer either regular care or the BREATHE OUT intervention.

Results demonstrated that the BREATHE OUT technique improved the Physician Satisfaction Score (PSS) outcomes in the intervention group (P = .02), compared to the regular care group. Notably, the researchers found that female physicians had worse PSS scores compared with male physicians, (P = .009), regardless of BREATHE OUT usage.

According to researchers, BREATHE, the steps to be performed pre-patient interaction, is a mnemonic for: listing at least one Bias/assumption you have about this patient; REflect on why you identify this patient as ‘difficult’; list one thing you’d like to Accomplish today; THink about one question you’d like to address today that would enable you to further explore your assumptions; and stop before you Enter the room and take three deep breaths, in through the nose and out through the mouth. OUT, the steps to be performed post-patient interaction, is a mnemonic for: to reflect on the Outcome of the encounter; did you learn anything Unexpected?; and list one thing you look forward to addressing if you were to run into this patient Tomorrow.

“The overall goal of the BREATHE OUT tool is to find the person behind the difficult patient and to discover enrichment through not only a better understanding of our patients, but also a better understanding of ourselves,” Edgoose told Healio.com/Internal Medicine.

“Future studies may wish to introduce BREATHE OUT to other members of the health care community, such as front and back office clinic staff, to improve their satisfaction with their daily interactions with these challenging patients,” Edgoose and colleagues wrote. – by Casey Hower

Disclosure: The researchers report no relevant financial disclosures.