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CHAPTER 6 — The First Script
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No matter when in the initial appointment you decide to uncover the
patient’s medication passport, I have found that the easiest way to do so
is to simply ask as with the following inquiry, our very first interviewing
technique:
I think that you will discover that the patients’ responses to the Medica-
tion Passport Question can range from a short, “They’re okay” to a spirited
discussion in which the patient relays significant concerns, and may even
openly share what – without our inquiry – might otherwise have been a
withheld secret such as, “but I don’t take that medication the way the doc-
tor wanted anyway.” By the way, if the patient is not on any medications,
the Medication Passport Question looks like this:
“What are your feelings about taking medications in general?”
Patients with a strong leaning toward complementary and alternative
medicine (CAM) may have antagonistic or ambivalent opinions about
medications. It is best to have these feelings out on the table for shared
discussion as opposed to having no idea they exist. Indeed, a CAM inter-
vention may be an excellent first choice.
In any case, I have found that many patients seem to appreciate that
the prescriber is asking for their opinions. Apparently, not every previous
clinician may have shown such spontaneous interest. In a similar vein,
some patients may have a preconceived notion that all that doctors like
to do is to prescribe medications, and that the role of the doctor is to
make sure the patient stays on his or her medications. Naturally, such a
preconception predisposes to the creation of an oppositional alliance as
described in Part I. Despite its simplicity, the Medication Passport Ques-
tion can go a surprisingly long way toward dispelling this potentially
damaging preconception.
A physician at one of my Arizona MIM workshops, Harold Meyerow-
itz, shared some questions for use after asking the Medication Passport
Question that he has found useful for more effectively undercutting such
an unproductive preconception before it can even raise its head. With the
use of these follow-up questions, the prescriber openly acknowledges the
“How do you feel about the current medication(s) that you
are on for your diabetes?”
TIP
1
Medication Passport Question