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CHAPTER 6 — The First Script
97
gateway to further her collaborative exploration and shared decision
making.)
Clin.:
By the way, if we run into major problems with side effects, I’ll be
the first one to tell you to get off the medication. Our goal is to help
you to find a medication that you genuinely are interested in taking
because it makes you feel better, not because I tell you to take it. I’m
always interested in your input (clinician continues with the spirit of
the MIM emphasizing moving with the patient along the Agreement
Continuum by indicating that she too will be a watchdog for prob-
lematic side effects; the interviewer’s goal is not to keep the patient
on a medication but to find a medication that the patient is interested
in keeping). In fact, I’m curious, how are you feeling about your cur-
rent medications.
(Medication Passport Question)
Pt.:
Pretty good. Dr. Travis felt things were going pretty good, but she’d
said something about being worried that my A1C – I think it’s called
– was creeping back up. I had the feeling that Dr. Travis was thinking
of maybe making a change. I don’t know. But she didn’t get a chance
to say so at the end. I transferred so quickly. (pauses) I don’t want to
change any medications unless it’s really necessary. Although if she
felt it was, I’d be fine with that. (Notice that the patient is subtly indi-
cating that he is still very interested in the opinions of Dr. Travis. At
some level, his words are an invitation of sorts, an invitation that the
new clinician wisely accepts.)
Clin.:
She doesn’t mention that in her note, but maybe I should give her a
call before we meet next time. I’d like to tap her opinion more dir-
ectly. (The clinician could not give a more convincing message that
she will listen carefully to the patient’s input and act on it).
Pt.:
That’s a great idea! (patient looks animated and pleased)
In the above dialogue, the clinician has nicely set the stage for a true
partnership. She has deftly, yet quickly, debunked any misconceptions
that she may be a “pill pusher” while establishing her role as a con-
sultant who feels comfortable with her expertise in using medications
effectively. Importantly, she sought out the patient’s ideas on his role
and clearly stated that she values his input. But, as powerful as her
statements of interest in Juan’s input might be, it is the questions
that she asks – and the actions that she takes – that truly prove her
interest to him.
It is striking that even on topics unrelated to symptoms or diagnosis,
she is clearly interested in what Juan thinks. When he comments that he
really liked his previous physician of 15 years, our interviewer inquires,