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CHAPTER 6 — The First Script

To my puzzlement, the “Mr. or Mrs. Jenkinses of the world” did not seem overly impressed by my well-intentioned educational foray, and, if their frowns were any indication, they were not particularly pleased with it. Here is where the MIM suggests not only what to say, but also what might be best not to say. Keep in mind that we are discussing our first en- counter with a patient. According to the MIM, the single most important thing to achieve by the end of the interview is that the patient feels allied with us. Any feelings of lingering opposition as the patient walks out the door may be fatal to the filling of our first prescription and may undercut the likelihood of a return visit as well. With these ideas in mind, let us look at what – beneath all my well-intentioned verbiage and intentions – Mrs. Jenkins may be actually “hearing” as I provide the educational information described above: Clin.: Mrs. Jenkins, do you think that you are particularly sensitive to medications? Pt.: Yes, definitely. Clin.: Well, I don’t (patient’s eyes get big). In fact, I have all sorts of other medications I’d like to try on you (eyes getting even bigger). Pt.: Okay (patient thinking, God help me! He’s going to overmedicate me like all the other idiots). If we are honest, this is exactly what some of our patients are think- ing at the time and “it doesn’t bode well” for medication interest. From the perspective of Mrs. Jenkins, I have asked for her opinion. She gave it. I ignored it. And I have assured her that I intend to continue to ignore it. Hmm. I think I might be in a bit of trouble here. Our model clearly suggests that this may not be the most effective direction to be taking in an initial appointment unless we want it to be the patient’s last appointment, in which case it is very effective. But what direc- tion might be better, keeping in mind that Mrs. Jenkins may be convinced by years of bad experiences with medications that she is overly sensitive? What to Do If Patients Perceive Themselves to Be Overly Sensitive to Medications If it is clear that the patient is, indeed, sensitive to medications (each person’s body handles medications differently and genetic variations can significantly alter blood levels at similar doses) or if the patient perceives himself or herself to be overly sensitive (when he or she may not be), it makes no difference in how we approach the first prescription. In either