10 / 28
CHAPTER 6 — The First Script
81
To my puzzlement, the “Mr. or Mrs. Jenkinses of the world” did not seem
overly impressed by my well-intentioned educational foray, and, if their
frowns were any indication, they were not particularly pleased with it.
Here is where the MIM suggests not only what to say, but also what
might be best not to say. Keep in mind that we are discussing our first en-
counter with a patient. According to the MIM, the single most important
thing to achieve by the end of the interview is that the patient feels allied
with us. Any feelings of lingering opposition as the patient walks out the
door may be fatal to the filling of our first prescription and may undercut
the likelihood of a return visit as well.
With these ideas in mind, let us look at what – beneath all my
well-intentioned verbiage and intentions – Mrs. Jenkins may be actually
“hearing” as I provide the educational information described above:
Clin.:
Mrs. Jenkins, do you think that you are particularly sensitive to
medications?
Pt.:
Yes, definitely.
Clin.:
Well, I don’t (patient’s eyes get big). In fact, I have all sorts of other
medications I’d like to try on you (eyes getting even bigger).
Pt.:
Okay (patient thinking, God help me! He’s going to overmedicate me
like all the other idiots).
If we are honest, this is exactly what some of our patients are think-
ing at the time and “it doesn’t bode well” for medication interest. From
the perspective of Mrs. Jenkins, I have asked for her opinion. She gave it.
I ignored it. And I have assured her that I intend to continue to ignore it.
Hmm. I think I might be in a bit of trouble here.
Our model clearly suggests that this may not be the most effective
direction to be taking in an initial appointment unless we want it to be the
patient’s last appointment, in which case it is very effective. But what direc-
tion might be better, keeping in mind that Mrs. Jenkins may be convinced
by years of bad experiences with medications that she is overly sensitive?
What to Do If Patients Perceive Themselves to Be Overly
Sensitive to Medications
If it is clear that the patient is, indeed, sensitive to medications (each
person’s body handles medications differently and genetic variations can
significantly alter blood levels at similar doses) or if the patient perceives
himself or herself to be overly sensitive (when he or she may not be), it
makes no difference in how we approach the first prescription. In either