The Three Breath Method: Teaching Coping Mechanisms for Processing Patient Death

The target audience for this video is any provider who is likely to experience patient death. We have demonstrated this method to medical students, residents, and faculty and across departments and disciplines of health care including physician assistants and nurses.

Emergency medicine (EM) physicians frequently encounter patient death, requiring effective coping strategies. Brief mindfulness practices, including focused breathing, can promote emotional regulation and reduce perceived stress. These techniques are particularly relevant in acute care settings where rapid cognitive and emotional transitions are required.1 While techniques such as "The Pause"-a moment of silence after death-have been proposed, their impact remains understudied. 2-4 In addition to the Pause Method, many physicians at our institution utilize the "Three-Breath Guided Meditation" technique, a structured deep-breathing exercise designed to help reduce stress. This study aimed to assess EM physicians' perceived ability to process patient death, explore coping strategies, and evaluate the effectiveness of both "The Pause" and the "Three-Breath Method."

After watching the video, proposed viewers should be able to: 1) describe the Three-Breath technique, and its potential impact on healthcare providers' ability to manage stress and process patient death, 2) evaluate the effectiveness of the Three-Breath guided meditation in improving emotional reconciliation and reducing stress for emergency medicine physicians, and 3) demonstrate the Three-Breath technique and implement it into their own practice.

Emergency medicine residents and faculty were invited via email to watch a 4-minute instructional video on the Three-Breath Technique. This video lecture was made available asynchronously, and participants were encouraged to watch the video at a time that was suitable to them.

Emergency medicine residents and attending physicians completed a mixed-methods questionnaire on their coping abilities after patient death. The survey included baseline experiences, coping practices, comfort levels, and the 4-minute instructional video. Responses were analyzed using descriptive statistics, Spearman's correlation for continuous variables, and thematic analysis of free-text data.

Of 79 invited EM physicians, 49 responded (62%), including 39% attendings and 61% residents (median age 33.5 years, 53% male, 47% female). A weak correlation was found between training level and perceived ability to process death (r=0.27), with attending physicians reporting greater comfort (mean = 4.45) than residents (mean = 3.75). Perceived ability to process death moderately correlated with comfort returning to work (r=0.55). Overall, 59% used the Pause or Three-Breath techniques, and 94% reported comfort coping after patient death.

Physicians' comfort in processing patient death increases with training level, with attendings feeling more prepared than residents. Most providers use the Pause1-3 or Three-Breath Method and report comfort in coping. However, the study's single-institution scope, modest sample size, and reliance on self-reported data may limit generalizability. Future efforts should be expanded to additional specialties and emphasize flexibility and individualized strategies to support emotional well-being in clinical practice.The Three-Breath guided meditation technique, as an extension of The Pause,2-4 is being widely adopted by physicians at one US academic institution and may enhance physicians' ability to process patient death, promoting emotional reconciliation and stress reduction in high-pressure healthcare environments.

Physician coping with patient death, coping strategies, novel coping strategy, emotional resilience.