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CHAPTER 6 — The First Script
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equal importance.
To do so would be quite natural. It could also be quite
dangerous.
The fashion in which your patients respond to the above questions can
also shed light on various useful bits of information, including your patients’
intelligence, memory retention, ability to express themselves, and ability
to effectively assert their viewpoints. Patients’ answers may also provide
indirect information on the quality of the previous patient-prescriber alli-
ance and the quality of previous provider education regarding medication
use. For a small number of questions, the Medication Passport Follow-Up
Package goes a long way toward fostering a nonoppositional partnership,
while yielding surprisingly useful information.
Depending on your practice, it should be noted that your patient’s
medication passport may be held in small hands. In another MIM workshop,
a pediatric social worker, Kay McAuliffe, pointed out that with children
below age 10, it is often still important to uncover their personal views
(as opposed to relying solely on their parents’ views) as to “what this pill
business is all about.”
Despite the fact that the child’s parents are distributing the medication –
ensuring that the medication is being taken – important psychological
concerns can arise in a child ingesting a pill that may warrant attention.
Medications can be extraordinarily confusing to kids, and they may develop
untrue and potentially worrisome distortions about their medications, even
medications as “simple” as antibiotics. She further points out that, although
the clinician is basically exploring the same material as with adults, there
are some subtle changes in the wording that can make the inquiries more
effective at getting a child’s true opinions. Such questions are encapsulated
in her following technique, which is employed selectively as indicated by
the child’s level of intellectual development:
a. “Why do you think you are taking this pill?”
b. “How is it supposed to help you?”
c. “Do you want to be taking it?”
TIP
3
Medication Passport for Small Hands
Besides immediately allaying the fears of a child regarding his or her
medications, it should also be noted that any person’s subsequent adult views
on medications may have first been forged – and rather permanently forged at
that – by his or her interactions with those who prescribed medications to him
or her as a child, a fact of which talented pediatricians are often well aware.