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The Fifteen Minute Hour

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Doody's Review (5th Edition)

Description
This book provides a strategy to help primary care clinicians focus an office visit when an underlying psychological issue is the reason behind it. It also lays out a number of treatment options that can be used during a short patient visit. The previous edition was published in 2008.

Purpose
The stated purpose is to give primary care physicians the ability to recognize and address patients' concerns at an early and manageable stage. The authors specifically state that this is not a book on long-term or in-depth counseling. It is a fresh approach to a preventive manner of thought.

Audience
Primary care practitioners are the focus of this book. Having said that, learning about and reconsidering one's approach to caring and compassion is a valuable exercise for all healthcare providers. The authors are well known and honored in the family medicine community.

Features
One of the central themes is the BATHE technique, offered by the authors as a way to foster patient positive thinking. (This is an interview technique that allows the physician to assess the Background situation, the patient's Affect, the problem that is most Troubling for the patient, and the manner in which the patient is Handling the problem. It concludes with the physician's response that conveys Empathy.) The first two chapters give a historical perspective, and the third introduces this technique. Subsequent chapters delve into situations in which the technique may be useful, emphasizing specific ideas such as: the practitioner is not responsible for solving the patient's difficulties, is the patient's responsibility and how to "end a session." This edition adds a number of references to recently published literature supporting these techniques and adds new thoughts and material to the discussion.

Assessment
This is a highly valuable addition to and ancillary reading for a primary care practitioner's library. It is worthwhile reading to remind us why we became physicians.

Weighted Numerical Score: 100 - 5 Stars!

Vincent F Carr, DO, MSA, FACC, FACP
(Uniformed Services University of the Health Sciences)


Review from the Nov/Dec 2009 issue of
Family Medicine

When I began work as a behavioral scientist in a family medicine residency program 15 years ago, one of the major orienting books was the first edition of this book. I was new to assisting physicians with their patient care, and I struggled with how to best assist them. The Fifteen Minute Hour helped me to bridge the gap between my training as a family therapist and the needs of physicians in addressing the psychosocial issues of their patients in a fast-paced office setting. I found that the interventions presented in the book were practical, concise, and logical; they resonated better with the residents I was teaching.

Additionally, they were more patient friendly than some of the theoretical and time-intensive interventions from my graduate studies. The book has now gone through three more editions, revealing its status as a time-honored classic. Read More


Cancer Care News - August 2009

Communication remains one of the perennial problems in health care and a source of persisting complaints from patients. Any resource that helps address these issues is welcome. The simple, pragmatic patient interviewing and counselling techniques illustrated in this book will have a utility to many practitioners and not merely those employed in primary care.

Dion Smyth
Lecturer Practitioner in Cancer and Palliative Care


Delaware Medical Society Review

Due to my interest in fostering improved access to mental health care in the State and due to the fact that the majority of mental health care is administered by the primary care physician, I have been asked to provide a critique of a book co-authored by a distinguished member of our Society. The book has been a tremendous success, now in its fourth edition. It serves as a guideline for the busy primary care physician in approaching the patient suffering from the pressure that our society places upon them in their daily lives. I must admit that prior to this request to review this text, I had not read it.

I do admit that I wish I had discovered this text years ago, as it is a very concise, educational, and practical study of the mind-body connection, as it applies to the primary care physician’s everyday encounters with those suffering from mental illness. Read More


Doody's Review (Fourth Edition)

Description
This excellent book attempts to help those in everyday clinical practice to recognize a psychological issue underlying a patient visit and how to focus the patient without labeling the problem as psychological. The previous edition was published in 2002, the first in 1986.

Purpose
The stated purpose is to give primary care physicians the ability to recognize and address patients' concerns at an early and manageable state. The authors specifically state this is not a book about long-term or in-depth counseling. This is a fresh approach in a preventative manner of thought, and references a newly published article on the success of the approach.

Audience
Primary care practitioners are the primary focus of this book. Having said that, learning about and reconsidering one's approach to caring and compassion is valuable for all healthcare providers. The authors are well known and honored in the family medicine community.

Features
One of the central themes is the BATHE technique, offered by the authors as a way to foster patient positive thinking. (This is an interview technique that allows the physician to assess the Background situation, the patient's Affect, the problem that is most Troubling for the patient, and the manner in which the patient is Handling the problem. It concludes with the physician's response that conveys Empathy.) The first three chapters give a historical perspective, and the fourth introduces the BATHE technique. Subsequent chapters delve into situations in which the technique may be useful, putting forth specific ideas such as: the practitioner is not responsible for solving the patient's difficulties, that is the patient's responsibility, and how to "end a session."

Assessment
This is an interesting addition and ancillary reading for a primary care practitioner's library. It is worthwhile reading to remind us why we became physicians.

Vincent Carr, DO, MSA, FACC, FACP
(Uniformed Services University of the Health Sciences)


I want to endorse the Fifteen Minute Hour. It is focused on what residents actually experience and besides BATHE has sections on Anticipatory Guidance, physician self care, etc. From the 15 minute hour I often use the concept of a healthy self and a neurotic self, wherein during stress the system goes on tilt and the neurotic self comes to the fore. One of the miracles I see with patients is the transformation within a session between those two selves as I or we do something that allows them to get in touch with their healthy self. Most residents can see the change, and are intrigued about what might have brought it about.

Sally Dunlap
Univ of TX HSC, San Antonio


The 15 Minute Hour is a best-seller because it understands and validates physicians' experiences and needs, and is therefore an emotionally supportive and healing reading experience for physicians, not because of the BATHE technique. (Books which recognize and explicitly address physician stresses in a supportive, understanding manner, even while exhorting physicians to do more for patients are not as common as they ought to be.)

Stuart Green, MSW, MA
Overlook Family Practice #L01
33 Overlook Rd.
Summit, NJ 07901


This book is now in its third edition and the authors' approach will be familiar to those who heard Marian Stuart in her lectures and workshops during her visit here last December.
The focus is on psychotherapeutic techniques that every primary care physician can use in the day to day care of his patients. How to incorporate these into our busy practices is of course the crucial question, and they advocate using their BATHE technique which is described in detail and illustrated with numerous clinical examples.
Their approach is very much patient-centered, and takes full account of the unique context in which we work.
I especially enjoyed the first chapter "Focusing on the totality of the Body-Mind"—the best overview I've seen on the subject, and chapter 5—on differences in approach between primary care practitioners and psychiatrists.
Despite their behavioral/cognitive bias they have included an excellent new chapter on psychopharmacology which stresses the role of psychopharmacology as an adjunct to psychological interventions. This is in line with much recent research showing improved outcomes with combined treatment, and interestingly the authors have included information on herbal products.
New material on the use of narrative therapy, a variety of stress management techniques, talking with adolescents, focusing on lifestyle changes and a serious updating of references make this book an extremely useful addition to the library of any family doctor who is keen to enrich the psychological dimensions of his work.
The significant change in subtitle from the 2nd edition's "Applied Psychotherapy for the Primary Care Physician" to the present "Practical Therapeutic Interventions in Primary Care" I think expresses more than anything the intention of the authors to avoid presenting us with a psychotherapy "cookbook" but instead to achieve their aim of helping us do—how does Marian Stuart put it—what we already do . . . better.

Barrie Rapoport
Review from Israel Journal of Family Practice
Vol 12 No. 99-100 November-December 2002.