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CHAPTER 6 — The First Script
85
about potential future medication practice will emerge when a different
patient responds to the Let’s See, What Dose Should I Try? inquiry with
the following words, “I prefer naturopathic remedies. I can’t remember the
last time I took an aspirin or Tylenol. Don’t like ’em. Doesn’t Tylenol hurt
your liver or something?”
On the other end, one may find a patient who sheepishly answers,
“Probably more than I should?” With a gently phrased follow-up question
(sometimes accompanied by a gently teasing tone of voice by the clinician)
such as, “How do you mean ‘more than you should?’” Overmedicators or
self-medicators may unexpectedly reveal themselves often with a bit of an
embarrassed chuckle.
As mentioned earlier, one can extrapolate on this indirect technique
by asking the patient to elaborate about a commonly prescribed medica-
tion, which the patient is not currently taking (so there is no reason for
defensiveness in the patient’s answer) as with, “I’m just curious, if you take
something like an antibiotic, say something like penicillin or ampicillin,
how do you feel about taking it in the sense of do you worry about taking
such medications, or are you ever concerned that you’re taking too much
of them or taking them for too long?” Said in a nonaccusatory tone, such
questioning can bridge into an exploration of important material related
to our patients’ medication practices with regard to a medication that they
are currently taking, as seen in the following prototypic illustration. In this
illustration, an internist is picking up a new patient, who has a history of
migraine headaches, diabetes, and epilepsy, who is concurrently being
followed by a neurologist, Dr. Nylan (fictitious name):
Clin.:
You know, I’m just curious, if you take something like an antibiotic,
say something like penicillin or ampicillin, how do you feel about
taking it, like, do you worry about taking such medications in gen-
eral, or are you ever concerned that you’re taking too much of them
or taking them for too long? (variation of
Let’s See, What Dose
Should I Try?
)
Pt.:
I don’t know . . . I don’t usually have any problem with them. I once
had a pneumonia, and I really was grateful for whatever the hell they
gave me. It worked great.
Clin.:
Good to hear . . . Are you pretty careful about how much medication
you take? I know you’re on a few medications now, some of which I’ll
be following you for.
Pt.:
Oh yea, my wife and I are not real keen on medications unless you
really need them (pauses) like when I had that pneumonia. And I
know I have to take my medications for my sugar and my seizures.