The Fifteen Minute Hour

Like its predecessor, The Fifteen Minute Hour, 2nd edition, is essential reading and an invaluable tool for all family practice physicians. During this time when our evolving health care delivery is shaped by ever expanding general medical knowledge and technology, limitations of financial resources, and relative increase in chronic illnesses, comprehensive primary health care may be provided only by incorporating strategies for addressing the psychosocial and biological ailments of our patients. The text outlines the systematic means for integration of psychosocial patient assessment into routine patient care in a format that is well organized and easy to assimilate. The book begins with a discussion of the trends of the current health care delivery system and the need to integrate a biopsychosocial model into the context of existent social, political, and economic realities. A review of pertinent research substantiating the effectiveness of brief psychotherapy is included, as well as an examination of the natural proclivities and characteristics that make primary care physicians ideal psychotherapists. The authors describe the common elements of all psychotherapy techniques and introduce new concepts that simplify the process for physicians. Traditional psychotherapy and psychotherapy taught and advocated in the text are contrasted. The text provides readers with information on the BATHE method, a psychotherapeutic procedure that serves as a rough screening test for anxiety, depression, and situational stress disorders. The BATHE method consists of 4 specific questions about the patient's background, affect, troubles, and handling of the current situation, followed by an empathetic response (i.e., B Background, A-Affect, T-Trouble, H-Handling, E-Empathy). Further discussion includes rationale and techniques of the 15 minute therapy session, methods for handling challenging patients (e.g., hypochondriacs, chronic complainers, substance abusers), and a review of the application of psychotherapy in special situations (e.g., difficult family members, confronting the patient when acceptable limits have been exceeded). For primary care physicians trained in the traditional disease-oriented medical model, this publication is a survival guide to negotiating a course of complete patient care within the context of a truly enjoyable and fulfilling medical practice. For those of us who developed our own strategies for addressing complete patient needs from the first edition of The Fifteen Minute Hour or by other means, the second edition warrants reading for its clarification and expansion of important issues as well as the addition of new care material, concepts, and techniques.