We have been told often on how to deal with a patient. Barbara Bates has taught us how to handle a patient encounter. She emphasised that after understanding the patient’s concerns and having elicited a careful history, you could move on to performing physical examinations.

It is crucial to know how to start a patient encounter as rapport needs to be built up. With that in mind, we also need to understand that the ending of an encounter is just as important as the beginning.

Making use of the BATHE technique

Like ending a romantic relationship, ending a patient encounter requires closure. Even though you are not breaking any ties with your patient, you do not want to end the session leaving them hanging so to speak. Patients come in for their check-up with questions. Not all questions may surface in time so we need to give them the opportunity to ask questions to help uncover any medical concerns they may have.

There is a psychotherapeutic procedure called the BATHE technique. It typically is used to screen psychiatric conditions such as anxiety, depression or stress disorders, but it can also be used for a general patient encounter. BATHE asks 4 precise questions about the patient’s current situation. It is meant to establish a meaningful connection and allow the patient to feel empowered.

BATHE goes as follows:

Background: "What is going on in your life?”
Affect: "How do you feel about it?”
Trouble: "What troubles you most about the situation?”
Handle: "What helps you handle the situation?”
Empathy: "This is a tough situation to be in”, "Anybody would feel as you do” or "Your reaction makes sense to me”.

Keeping the BATHE method in mind during an encounter, you will be able to address most of the possible concerns your patient may have.

Tips to end an encounter

In ending a patient encounter we need to do the following:

Give a recap

It is good to summarise all that you have done with the patient - from the diagnosis or differential diagnosis, to the findings, work-ups and treatments. Even if you were explaining along the way, it is good to end with repeating what was said to give the patient the chance to come up with more questions.

Allow the patient to ask questions

The encounter may have been full of questions but at the end, after everything has been said and done, they may come up with something else. It is best to let them ask all they need to know now instead of letting them go home with feelings of doubt.

State your plans for your patient

Let them know what to expect. There may be more diagnostic tests that need to be done, as well as further treatment. Tell them what else is in store for them and why. Give them a timeframe including when they should see you next.

End with an appropriate goodbye

Western cultures open and end encounters with a handshake. Depending on the cultural situation the encounter can be ended with a handshake, a bow or a friendly smile. There are those who rush into updating the patient’s records at the end, letting the patient leave the room with nothing more than the view of the doctor’s head bent down. It is appropriate to end the encounter sincerely and respectfully. MIMS

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