Shea_Chapter 6

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PART TWO — Interviewing Techniques and Strategies

Clin.: Good to hear. Makes sense to me. You don’t want to take any more medication than you need to be effective (the clinician is deftly taking advantage of a naturally arising chance to gently move with the patient on the Agreement Continuum to enhance the feeling of “going with” the patient in a nonoppositional sense, furthered by the next statements). I’m careful like that for myself. It’s smart. (slight pause) Do you ever find that you don’t always need the amount of medication that has been prescribed. Pt.: You mean, like stop it early or something? Clin.: Yea, something like that, or cut back on it, like with an antibiotic. Pt.: (patient smiles) I suppose so . . . actually, I sort of stopped that anti- biotic, the one for the pneumonia, a few days early . . . it had, sort of, you know, once I knew it had worked and stuff. Clin.: You know what, Martellus, truth be told, you can sometimes get away with not finishing up with a medication like that (pauses) and some- times you can’t. It’s usually best to stay on antibiotics till all the pills are done, just to make sure the bacteria are all dead, but it looks like you were lucky and it worked out okay for you with your antibiotic in this case (notice that the clinician effectively makes her point – it’s best to stay on medications until they are done – without lecturing or scolding the patient). On the other hand, there are a few medications that you can’t stop quickly. It actually can be dangerous. I’ll always let you know if I’m prescribing a medication like that, if that’s okay with you. Pt.: Sure. I’d always want to know that. (pauses) Am I on a medication like that now? Clin.: Actually, yes. Do you have any idea which one? Pt.: Not for certain. No, is it the Tegretol, no wait, is it the, no, no, I think it’s the Tegretol . . . over the years I’ve been on so many, I don’t know for sure. Clin.: You’re right on the mark, Martellus, it’s the Tegretol. If you stop it all of a sudden, you definitely could increase your risk of having a seizure. Pt.: Whoaa . . . I think Dr. Nylan told me that once, but I sort of forgot it. Clin.: I’m sure he did. He’s a good doctor. Pt.: It was years ago when I started . . . How many days can you miss? Clin.: If you don’t mind me asking, why are you asking? (smiles) Pt.: (smiling) Oh, I don’t know, I might miss a day or two once in a while, just once in a while. Our clinician’s indirect chit-chat about medication practice (which is far from chit-chat and is quite intentional by the prescriber) has not only