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PART TWO — Interviewing Techniques and Strategies
The Medication Passport Question alone – even without the Medica-
tion Passport Follow-Up Package – can uncover a rich database for under-
standing the patient’s feelings about medications, immediately suggesting
avenues for discussing medication recommendations later in the initial
appointment as well as in future appointments. Consequently, I always try
to fit this question into a first meeting with a patient. I then use as much
of the Medication Passport Follow-Up Package as time permits. There is
one more question that I recommend trying to ask in the first meeting as
part of the patient’s medication passport, if at all possible.
Directly Exploring for Perceived Medication Sensitivity
The question in question was developed in response to the simple rec-
ognition that few encounters are more critical in establishing alliances
with our patients than our first meetings, and few moments are more
treacherous to their development. The success of the first encounter can
be more assured if we keep in mind that two opinions exist about every
medication prescribed: the prescriber’s and the patient’s. With regard to
whether the medication ever leaves the bottle, in the final analysis, only
the latter opinion counts.
In this light, it can be argued that one of the most important questions
to ask during a medication history is, “Do you take your medications as
prescribed?” because the answer undoubtedly determines whether the
medications that we are about to suggest will be given a fair chance to help
(or even be tried in the first place). The art is how to ask this question in
such a manner that it is engaging, not challenging, in nature.
Let us see whether the MIM can provide some guidance on how to
proceed. Keeping in mind that we want to minimize any phrasing that
causes even subtle hints of opposition, the above question may be too so-
cially blunt, almost accusatory in tone. It is probably ill advised. To figure
out how to phrase the question in a less oppositional manner, it may be
useful to examine the patient’s perspective on it, for our question – “Do
you take your medications as prescribed?” – is often mirrored by a quite
different question on the patient’s side of the stethoscope: “Is this guy go-
ing to overmedicate me?”
The latter question frequently arises from an ingrained opinion that
previous prescribers have “overmedicated me because they just don’t get
how sensitive I am to medications.” It is an opinion that, for many patients,
is a deeply held belief. In fact, it is often an entrenched conviction garnered
from decades of legitimately bad experiences with prescribing clinicians.