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CHAPTER 6 — The First Script
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uncovered, in a very conversational fashion, some important factual infor-
mation about the medication attitudes and practices of Martellus, but also
actually strengthened the medication alliance in a subjective fashion. Factually,
Martellus might have a proclivity to “play around with his medications,”
which as we shall see in future chapters is a normal human proclivity. I might
add that physicians and nurses (including myself) are notorious patients
for doing such things when we are on the other end of the stethoscope.
In addition, Martellus, as is the case with just about all patients, will
need to have intermittent reenforcement about how to use medications.
Whether one is a prescriber, a clinic nurse, or a case manager, when picking up
a patient from another provider, never assume the patient has adequate know-
ledge about his or her current medications.
Even if the provider gave excellent
education about the medication usage, it is all too easy, as was the case with
Martellus, to forget information or confuse it.
With regard to subjective material, the informality of this exchange may
prove to be quite useful in the future. It has created a unique exchange of
shared experience for the newly evolving clinician-patient dyad. Martellus
has shared some potentially sensitive or embarrassing details (about not
always taking medications as prescribed) while he has learned that his
new prescriber is not one to pass judgments, and, indeed, seems to have
a sense of humor housed in a genuine concern about his safety regarding
medications. All good stuff!
I think you will find that this type of naturalistic engagement, initiated
by indirect questioning, provides a rich substrate for future interactions.
Later, perhaps months or years later, if this clinician prescribes a medication
that is dangerous to abruptly stop, it will be meaningfully
personalized
for
the patient when he hears the clinician say, “Martellus, you remember when
I told you about your Tegretol being important to never stop abruptly, this
new medication for your irregular heartbeat is just like it. You should never
just stop it, without first checking with me, let me explain what could . . .”
The shared past experience will tend to make this new information stick
better. It’s more vivid, and it has a shared foundation to build on. Put simply,
it will be easier for Martellus to remember.
Eliciting the Patients’ Views on Their Interactions with
Previous Prescribers
As intimated above, during the patient’s treatment journey the patient has
often encountered many prescribing clinicians. Patients may have experi-
enced not only “problematic drugs” but also, unfortunately, “problematic