Jennifer Edgoose, MD

Jennifer Edgoose, MD

Madison, Wisconsin – Physicians and other health care providers who use a simple preparation and breathing technique before encounters with “difficult” patients are more comfortable when treating those patients, according to a study published in the Journal of the American Board of Family Medicine.

The study by Dr. Jennifer Edgoose of the University of Wisconsin School of Medicine and Public Health department of family medicine shows a technique called BREATHE OUT increases provider satisfaction scores and makes encounters with perceived “difficult” patients more comfortable. Working with “difficult” patients is linked to greater burnout among doctors, an important consideration as the nation faces a continuing shortage of primary-care providers.

“Other studies have shown that young clinicians are more likely to consider patients challenging, while more experienced clinicians who believe they have a large number of difficult patients are 12 times more likely to experience burnout,” said Dr. Edgoose.

Edgoose evaluated 57 physicians, nurse practitioners, physicians’ assistants and residents, all with varying lengths of experience, at six family-medicine clinics.  The clinics, which included those in urban, suburban and rural areas, were randomized to administer regular care or the BREATHE OUT technique.

The BREATHE steps are:  list a Bias about a patient; Reflect on why this patient is considered “difficult”; list what you’d like to Accomplish today; THink about one question you’d like to address to further explore your bias; and stop before you Enter a room and take three deep breaths.

Following the patient visit, the OUT portion of the technique is used:  reflect on the Outcome of the encounter; did you learn anything Unexpected?; and list one thing you want to address if you were to see this patient Tomorrow.

The 57 participants had a total of 112 encounters with perceived difficult patients over a five-week period.  The study used the Physician Satisfaction Score (PSS) to evaluate the physician’s emotional state, confidence and feelings about the previous patient encounter.

“We discovered that BREATHE OUT improved physician satisfaction compared to the group not using the technique,” said Edgoose.  “One really interesting finding is that female physicians had worse satisfaction scores than male physicians, regardless of BREATHE OUT usage.”

Edgoose said that future studies might introduce BREATHE OUT to other members of the health care team, like front and back clinic office staff, as a way to improve their satisfaction with daily interactions with challenging patients.