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PART TWO — Interviewing Techniques and Strategies
We began this section with an interviewing principle, “Before pre-
scribing your first medication take the time in the first appointment to
introduce your medication-prescribing approach.” We have now looked
at five interviewing techniques of use when introducing one’s approach to
using medications (the Medication Interest Opening, Introducing Shared
Expertise, the Shared Journey Analogy, the Call-Me-First Invitation, and
Feel Free to Discontinue). These techniques show us how to implement the
above abstract principle in the real world of a hectic clinic. If the reader,
whether a student or more experienced clinician, finds that it is useful with
certain patients to pair two of these techniques sequentially (or perhaps
three or more), the reader will have created a personalized interviewing
strategy that can be easily remembered for practical use (or taught to other
students, residents, or staff).
I frequently weave together three of the above techniques into an inter-
viewing strategy I like to call
Forging the Medication Alliance
. This interviewing
strategy consists of the following three interviewing techniques sequentially
employed: 1) the Medication Interest Opening, 2) Introducing Shared Ex-
perience, and 3) the Call-Me-First Invitation. Let’s see how a clinician can
effectively and naturalistically use it by imagining a bit of prototypic dialogue.
Illustration of Forging the Medication Alliance
We will imagine that the patient, a mid-level manager from a large retail
chain, has just moved to Sacramento, California from Los Angeles second-
ary to a job relocation. In this instance, the patient, whom we shall call
Juan, is being transferred from one clinician to another. He presents as a
55-year-old, who could afford to lose a good 20 lb, but is otherwise in rea-
sonably good shape. He has been coping with type 2 diabetes, high blood
pressure, and dysthymia for more than 15 years, all of which his primary
care doctor has been successfully managing with medications. He really
liked his previous doctor, and, as one might expect, he is worried about
finding a new one. In particular, he has fears that the new prescriber will
“monkey around with my meds.”
We are picking up the conversation in the closing phase of the initial
appointment in which, following the H&P, the clinician and patient are
collaboratively sharing opinions on what is going on and how to proceed
with treatment planning. You will also notice that our interviewer, before
employing the three techniques of the strategy of Forging the Medica-
tion Alliance, will use the technique of Exploring the Patient’s Passport
on Previous Prescribers. In addition, she will opt to use the technique of