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CHAPTER 6 — The First Script

uncovered, in a very conversational fashion, some important factual infor- mation about the medication attitudes and practices of Martellus, but also actually strengthened the medication alliance in a subjective fashion. Factually, Martellus might have a proclivity to “play around with his medications,” which as we shall see in future chapters is a normal human proclivity. I might add that physicians and nurses (including myself) are notorious patients for doing such things when we are on the other end of the stethoscope. In addition, Martellus, as is the case with just about all patients, will need to have intermittent reenforcement about how to use medications. Whether one is a prescriber, a clinic nurse, or a case manager, when picking up a patient from another provider, never assume the patient has adequate know- ledge about his or her current medications. Even if the provider gave excellent education about the medication usage, it is all too easy, as was the case with Martellus, to forget information or confuse it. With regard to subjective material, the informality of this exchange may prove to be quite useful in the future. It has created a unique exchange of shared experience for the newly evolving clinician-patient dyad. Martellus has shared some potentially sensitive or embarrassing details (about not always taking medications as prescribed) while he has learned that his new prescriber is not one to pass judgments, and, indeed, seems to have a sense of humor housed in a genuine concern about his safety regarding medications. All good stuff! I think you will find that this type of naturalistic engagement, initiated by indirect questioning, provides a rich substrate for future interactions. Later, perhaps months or years later, if this clinician prescribes a medication that is dangerous to abruptly stop, it will be meaningfully personalized for the patient when he hears the clinician say, “Martellus, you remember when I told you about your Tegretol being important to never stop abruptly, this new medication for your irregular heartbeat is just like it. You should never just stop it, without first checking with me, let me explain what could . . .” The shared past experience will tend to make this new information stick better. It’s more vivid, and it has a shared foundation to build on. Put simply, it will be easier for Martellus to remember. Eliciting the Patients’ Views on Their Interactions with Previous Prescribers As intimated above, during the patient’s treatment journey the patient has often encountered many prescribing clinicians. Patients may have experi- enced not only “problematic drugs” but also, unfortunately, “problematic