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PART TWO — Interviewing Techniques and Strategies
Indirectly Uncovering Concerns About Medication
Sensitivity and Medication Practices
Before wrapping up our discussion on the importance of understanding
and responding to our patients’ perceptions regarding their medication
sensitivity, let me share one more valuable tip. It is a tip that returns us to
the question of how to uncover our patients’ fears or concerns in the first
place. I think you will find the tip to be both a bit unexpected and novel.
As it ends up, it is also quite useful. I wish I’d thought of it myself.
When providing my workshops on the MIM, one of my greatest
pleasures occurs when a clinician proffers an interviewing technique that
I would not have thought of using in a million years, yet I subsequently
find to be quite useful. For instance, Michael Applebaum, a physician from
Idaho, described a technique he likes to use when uncovering a patient’s
personal feelings about medication sensitivity and dosage.
You will note that our techniques thus far, such as the Medication
Passport Question, are fairly direct in their wording. Applebaum suggests
a technique that is indirect, yet because of its indirect nature may uncover
information – with reticent or more wary patients – that may not have sur-
faced with a more direct approach. Not only does Applebaum’s tip provide
a novel way to uncover patients’ perceptions of how sensitive they feel they
are to medications, but an adaptation of it can also shed light on another key
aspect of patients’ medication passport – the patients’ medication practices
in the only world that really counts: What do they do at home after leaving
our offices? Applebaum’s technique looks like this:
“Mr. Jamison, when you take an aspirin or Tylenol or
Motrin for a headache or pain of some sort, how much do
you usually take?”
TIP
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Let’s See, What Dose Should I Try?
As the patient goes about nondefensively describing his or her medication
practice toward an over-the-counter commonly taken medication, all sorts
of little secrets can emerge. A patient with a fear of medication sensitivity
will often betray that concern by his or her choice of a low dosage, or the
patient may make a revealing spontaneous comment (while shaking his or
her head) such as, “Oh, I don’t like to take medications at all, so I only take
a few tablets, if any.” Such a comment provides a surprisingly good glimpse
at our patient’s feelings about medication use in general while offering us
an indirect hint at his or her current medication practice. More than a hint