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PART TWO — Interviewing Techniques and Strategies

Indirectly Uncovering Concerns About Medication Sensitivity and Medication Practices

Before wrapping up our discussion on the importance of understanding and responding to our patients’ perceptions regarding their medication sensitivity, let me share one more valuable tip. It is a tip that returns us to the question of how to uncover our patients’ fears or concerns in the first place. I think you will find the tip to be both a bit unexpected and novel. As it ends up, it is also quite useful. I wish I’d thought of it myself. When providing my workshops on the MIM, one of my greatest pleasures occurs when a clinician proffers an interviewing technique that I would not have thought of using in a million years, yet I subsequently find to be quite useful. For instance, Michael Applebaum, a physician from Idaho, described a technique he likes to use when uncovering a patient’s personal feelings about medication sensitivity and dosage. You will note that our techniques thus far, such as the Medication Passport Question, are fairly direct in their wording. Applebaum suggests a technique that is indirect, yet because of its indirect nature may uncover information – with reticent or more wary patients – that may not have sur- faced with a more direct approach. Not only does Applebaum’s tip provide a novel way to uncover patients’ perceptions of how sensitive they feel they are to medications, but an adaptation of it can also shed light on another key aspect of patients’ medication passport – the patients’ medication practices in the only world that really counts: What do they do at home after leaving our offices? Applebaum’s technique looks like this: “Mr. Jamison, when you take an aspirin or Tylenol or Motrin for a headache or pain of some sort, how much do you usually take?” TIP 6 Let’s See, What Dose Should I Try? As the patient goes about nondefensively describing his or her medication practice toward an over-the-counter commonly taken medication, all sorts of little secrets can emerge. A patient with a fear of medication sensitivity will often betray that concern by his or her choice of a low dosage, or the patient may make a revealing spontaneous comment (while shaking his or her head) such as, “Oh, I don’t like to take medications at all, so I only take a few tablets, if any.” Such a comment provides a surprisingly good glimpse at our patient’s feelings about medication use in general while offering us an indirect hint at his or her current medication practice. More than a hint