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CHAPTER 6 — The First Script

about potential future medication practice will emerge when a different patient responds to the Let’s See, What Dose Should I Try? inquiry with the following words, “I prefer naturopathic remedies. I can’t remember the last time I took an aspirin or Tylenol. Don’t like ’em. Doesn’t Tylenol hurt your liver or something?” On the other end, one may find a patient who sheepishly answers, “Probably more than I should?” With a gently phrased follow-up question (sometimes accompanied by a gently teasing tone of voice by the clinician) such as, “How do you mean ‘more than you should?’” Overmedicators or self-medicators may unexpectedly reveal themselves often with a bit of an embarrassed chuckle. As mentioned earlier, one can extrapolate on this indirect technique by asking the patient to elaborate about a commonly prescribed medica- tion, which the patient is not currently taking (so there is no reason for defensiveness in the patient’s answer) as with, “I’m just curious, if you take something like an antibiotic, say something like penicillin or ampicillin, how do you feel about taking it in the sense of do you worry about taking such medications, or are you ever concerned that you’re taking too much of them or taking them for too long?” Said in a nonaccusatory tone, such questioning can bridge into an exploration of important material related to our patients’ medication practices with regard to a medication that they are currently taking, as seen in the following prototypic illustration. In this illustration, an internist is picking up a new patient, who has a history of migraine headaches, diabetes, and epilepsy, who is concurrently being followed by a neurologist, Dr. Nylan (fictitious name): Clin.: You know, I’m just curious, if you take something like an antibiotic, say something like penicillin or ampicillin, how do you feel about taking it, like, do you worry about taking such medications in gen- eral, or are you ever concerned that you’re taking too much of them or taking them for too long? (variation of Let’s See, What Dose Should I Try? ) Pt.: I don’t know . . . I don’t usually have any problem with them. I once had a pneumonia, and I really was grateful for whatever the hell they gave me. It worked great. Clin.: Good to hear . . . Are you pretty careful about how much medication you take? I know you’re on a few medications now, some of which I’ll be following you for. Pt.: Oh yea, my wife and I are not real keen on medications unless you really need them (pauses) like when I had that pneumonia. And I know I have to take my medications for my sugar and my seizures.