BATHE with SOAP!
Background What is going on in your life?
Affect How do you feel about that?
Trouble What about the situation troubles you most?
Handling How are you handling that?
Empathy That must be very difficult for you.
How do you feel about that?
What troubles you most?
How are you handling that?
What are you feeling right now?
What do you want?
What can you do about that?
What are your options?
What's the best thing that can happen?
What's in it for you?
What does it mean to you?
What, specifically, do you want from me?
That must be very difficult for you.
I can understand that you would feel that way.
Under the circumstances, I'm sure that (you, he, she, they) did the best that (you, he, she, they) could.
Allows patient to set agenda, reveal what they choose.
Immediately allows openings for 30% plus of consultations with a primary psychological content.
Simple screening for depression and anxiety.
Trouble encourages patient to begin to prioritise the area that they would most like help with, which is in itself a therapeutic process.
Handling allows doctor to look at possible areas that may usefully be targeted for intervention.
Say it's OK to raise these matters in the consultation.
Where is the batheing best done in the consultation?
How is the information generated best remembered and recorded?
Rules for survival.
1) Do not take responsibility for things you cannot control.
2) Take care of yourself or you cannot take care of anyone else
3) Trouble is easier to prevent than fix.
4) When you get upset, tune in and three-step:
- What am I feeling?
- What do I want?
- What can I do about it?
5) If the answer to Rule 4.3 is "nothing" apply Rule 1.
6) Ask for support when you need it - and give permission to others to feel what they feel.
7) In a bad situation you have four options:
- Leave it;
- Change it;
- Accept it;
- Reframe it.
8) If you never make mistakes you are not learning anything.
9) When a situation turns out badly, decide what you would do differently next time.
10) At any given time you can only make decisions based on the information you have.
11) Life is not fair - and life is not a contest.
12) You have to start where the patient is at.
Subjective The history of the presenting symptom
Objective Examination, laboratory and radiological findings
The Fifteen Minute Hour: Applied psychotherapy for the primary care physician 2nd Ed. Praeger, Connecticut, USA Stuart, M.R. and Lieberman, J.A.
Weed, L. Medical Records that guide and teach. NEJM 1969