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PART TWO — Interviewing Techniques and Strategies
Both Introducing Shared Experience and its variation (the Shared Jour-
ney Analogy) acknowledge the fact that almost all patients have legitimate
concerns about side effects. In Chapter 9, we will delineate interviewing
techniques and strategies that will help patients to effectively sort out
whether the pros of a medication are worth the side effects caused by it.
Sometimes they are, and sometimes they’re not, as amply highlighted by
serious adverse reactions.
Despite an almost universal concern about side effects, patients
vary greatly on how comfortable they feel about sharing those concerns
with physicians and other prescribers. Some of this hesitancy has been
inculcated by long-standing, but outdated cultural norms, such as the
paternalistic concept that “one should do whatever the Doctor says.” Note
the capital “D.”
Peter Weiden, whose outstanding insights regarding improving
medication interest resonate wonderfully with the spirit and principles
of the MIM, emphasizes that interviewers must sometimes actively help
patients to move away from this “obedience mode” as he describes it
in his insightful article, “The Adherence Interview: Better Information,
Better Alliance.”
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This process of deactivating the obedience mode is an ongoing endeavor
that must be addressed again long after the first meeting, as we shall see
Weiden demonstrate with several specific techniques in later chapters. In
any case, it is often expedient to start this deactivation from the very first
encounter when it comes to reporting side effects. In short, the phrase from
the technique of Introducing Shared Expertise, “The medication goes in
you, not me and so I’m totally dependent on you to tell me if it’s helping or
not and also if it’s causing any side effects,” may not be enough. At times,
I have found it useful to be even more specific:
confidence in this medication. Our goal is to make sure
the benefits definitely outweigh any potential side effects
for you. So we are on a joint journey or trial of sorts to find
the best possible medication for you. You are the most im-
portant partner in our journey, for I am dependent on you
to tell me what is working or not working. So, please be
very open about all the benefits of the medication and any
concerns you may have about side effects. As a team, I feel
confident we will get you some help. How does that sound
to you?”