title: BREATHE OUT: a randomized controlled trial of a structured intervention to improve clinician satisfaction with "difficult" visits.
abstract: OBJECTIVE
  Difficult patients comprise at least 15% of ambulatory visits and are associated with clinician burnout. No structured procedure has been reported to assist health care practitioners with these challenging relationships. This randomized trial evaluated whether a pre- and postvisit patient-centered and clinician-reflective technique called BREATHE OUT improved clinician satisfaction during visits with patients perceived by the clinician as difficult.
  
  
  METHODS
  Six family medicine residency clinics paired as urban, suburban, and rural sites were randomized by clinic to the BREATHE OUT intervention or usual care of difficult patients. A total of 57 physician faculty, nurse practitioners, physician assistants, and residents participated. The validated Physician Satisfaction Scale (PSS) was administered and analyzed using hierarchical linear modeling to assess differences between the intervention and control groups.
  
  
  RESULTS
  The BREATHE OUT intervention improved the PSS score (P = .02) in the intervention group compared with the usual care group. Female practitioners reported worse PSS scores compared with their male counterparts despite whether they used BREATHE OUT (P = .009).
  
  
  CONCLUSIONS
  Application of the BREATHE OUT questionnaire before and after visits improved clinician satisfaction with difficult patient encounters.
authors.affiliation: From the Department of Family Medicine, University of Wisconsin-Madison (JYCE, LIZ); and the University of Wisconsin School of Medicine and Public Health, Madison (CJR). jennifer.edgoose@fammed.wisc.edu.
authors.forename: Jennifer Y C
authors.initials: JY
authors.lastname: Edgoose
authors.affiliation: From the Department of Family Medicine, University of Wisconsin-Madison (JYCE, LIZ); and the University of Wisconsin School of Medicine and Public Health, Madison (CJR).
authors.forename: Caitlin J
authors.initials: CJ
authors.lastname: Regner
authors.affiliation: From the Department of Family Medicine, University of Wisconsin-Madison (JYCE, LIZ); and the University of Wisconsin School of Medicine and Public Health, Madison (CJR).
authors.forename: Larissa I
authors.initials: LI
authors.lastname: Zakletskaia
mesh_terms: D001291:Attitude of Health Personnel; D005260:Female; D006801:Humans; D008297:Male; D010817:Physician-Patient Relations; D010820:Physicians / Q000523:psychology; D011320:Primary Health Care / Q000379:methods*; D011446:Prospective Studies
keywords: Burnout; Communication; Doctor–Patient Relations; Family; Medical Education; Physicians; Professional