72
PART TWO — Interviewing Techniques and Strategies
T
oolbox
for
the
F
irst
P
rescription
The act of writing (or typing an e-script) for the first prescription is an act
of immense import to our patients. It is an act of trust with an almost total
stranger. Whether the patient will follow through with what we write or
type is not known. Indeed, the patient’s subsequent, and ultimate, percep-
tion of the value of that first prescription may be the determining factor as
to whether there is a return visit.
Whether a prescriber, from whatever discipline, decides to provide a
prescription at the end of the first appointment will be determined by a
variety of factors including the proclivities of the prescriber, administrative
pressures to do so, and time pressures within the clinical setting itself. It
should also be related, indeed, determined, by whether the prescriber feels
that the therapeutic alliance is strong enough that this particular patient
is open to the idea of using the medication that will be waiting for him or
her at the pharmacy.
If, as the initial appointment proceeds, the clinician intuits that the
patient has little or no interest in the use of a potentially helpful medi-
cation, it is generally folly to push the issue by writing a prescription,
for the nascent therapeutic alliance may suffer irreparable harm by such
an oppositional push against the Agreement Continuum. Such an ill-
advised push may result in there being no second appointment. Instead,
the clinician can opt to recommend the medication in the next or a later
appointment once the therapeutic alliance has been strengthened and
the patient is in agreement with the medication choice. (Note that in
subsequent chapters we will address interviewing techniques that can
be used in the relatively infrequent situations where the seriousness of
the patient’s medical state in the initial outpatient appointment suggests
that it is very important that the patient begin the medication immedi-
ately, if at all possible).
The following toolbox is designed to minimize the likelihood of
precipitating the type of dismal initial outcome caused by premature
prescribing. Indeed, in a more positive sense, the chapter is designed
to maximize both the patient’s medication interest and the power of the
therapeutic alliance in the fastest possible fashion. Directly concerning
medication use, other than eliciting an accurate medication history,
there exist three tasks during the first appointment: (1) uncovering the
patient’s views on his or her current medications (as well as the concept
of taking medications at all), (2) introducing your personal approach as
a prescriber to the use of medications, and (3) if one feels that a new