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PART TWO — Interviewing Techniques and Strategies
case, it should be approached with great caution and with appropriate
deference to the patient’s concerns. The patient’s perception of sensitivity
(whether accurate or not) is the key to the patient’s subsequent interest in
taking the medication. We are once again reminded of the wisdom of our
opening epigram, “The primary care physician’s approach to the patient’s
problem is grounded in the way the patient defines the problem.”
For a moment, imagine that I simply acknowledge her opinion that she
is overly sensitive to medications (noting to myself that in future sessions,
once we have developed a stronger alliance, I might be in a better position
to transform it). Further imagine that near the end of the first appointment
(if it is medically appropriate and safe), after I have written the name of the
medication on my first script or typed it up on my computer as I prepare
an e-script, I pause, look up at Mrs. Jenkins and say something like:
“Mrs. Jenkins, would it be okay with you if I start you off at
one half of the recommended starting dose for this medica-
tion because of your history of being sensitive to meds? I
think this would be a smart way to start you off. I call this
a mini-dose, and I think it is a very gentle way to begin
medications. This way, your body can get a feel for the
medication first before we give you much of a dose. Any
side effects, and there might not be any with this little of a
dose, will probably be much smaller in nature. Then if you
are feeling comfortable on the medication, we can slowly
increase it to get you feeling better and better. By the way
at this tiny dose you might not get any benefits from the
medication but I just think it is a smart way to start because
of your sensitivity. What do you think?”
TIP
5
Mini-Dose Recommendation
This looks good on paper, and, in practice, I have been pleasantly
surprised just how effective the above pair of interviewing techniques –
Medication Sensitivity Question and the Mini-Dose Recommendation – can
be in both spotting patients who have concerns about medications and in
allaying those concerns before the first encounter ends. A patient, such
as Mrs. Jenkins, who enters my office having been wary of prescribers for
years, may now leave my office feeling that she is in safe hands.
One can easily picture on her return home, Mr. Jenkins asking his wife,
“What did you think of Dr. Shea?” and his wife replying with an unexpected,