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PART TWO — Interviewing Techniques and Strategies
a certain degree of anticipatory “baggage” in tow. This baggage will often
shape the patient’s level of interest in our first prescription.
One can view this treatment journey, sometimes decades in length, as
being recorded in a psychological “medication passport” of sorts. It is useful,
I would argue – critical – to get a look at this passport before recommending
a new medication or a change of medications during the first or subsequent
meeting.
A good understanding of how the patient views medications can greatly
alter how we first suggest their use and even whether it is wise to suggest their use
as an initial line of intervention in the first place.
Whether one is a prescriber
(physician, advanced practice nurse, etc.) or following the patient’s subse-
quent care (nurse or case manager), the principles in this chapter can help
to forge a powerful and honest medication alliance, not only during the
initial appointment, but in ongoing care as well. We will find that it is not
enough to just take a patient’s medication history, for it is important to find
out not only what medications a patient has taken but also to uncover what
the patient thought about those medications when taking them.
Requesting the Passport
We have arrived at our first interviewing principle. It is simple in theory and
powerful in practice.
Before prescribing a first medication, review the patient’s
personal views on his or her current medications and/or past medications
. It is
also a bit trickier to do effectively than first meets the eye. Time remains
problematic, especially in an initial appointment that will include an H&P.
Indeed, as we shall soon see, it will be next to impossible to review the pa-
tient’s full medication passport in the first meeting, especially if the patient
is elderly and enters our offices with a suitcase of medications. Prioritizing
will have to be done.
One of our first practical questions might be, “When do I address the
patient’s views on his or her medications?” The answer can vary, depending
on the clinician’s personal proclivities as well as the unique unfolding of the
relationship with the patient in the first encounter or those that follow. You
may find that you prefer to elicit this information when taking the patient’s
medication history or while immediately eliciting the patient’s list of current
medications. Or you may decide that you prefer to elicit the patient’s views
on current medications after you have introduced the patient to your own
approach to using medications. There is no right or wrong way as long as
the task is completed before the patient departs with prescription in hand
or the e-script has been sent. In this chapter, you will have a chance to see
various approaches.