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CHAPTER 6 — The First Script

is of vital importance. It is not some secondary task that “I’ll do if I have time.” From the very first courses on clinical interviewing and the devel- opment of the therapeutic alliance, the pivotal importance in treatment outcome of securing and enhancing the medication alliance in the initial appointment should be “front-and-center-stage.” Unfortunately, in the harsh time demands so common to this age of mixed-payer care, it can be easy to omit the few minutes it takes to effectively introduce one’s prescribing practices, yet these 3 or 4 minutes may prove to be the defining moments for establishing a powerful ongoing medication alliance. They may well set the stage for all future medication interest in the patient. Although this particular chapter is addressed primarily to prescribing clinicians, bear with me as I diverge for a moment from prescribing clini- cians in order to emphasize a point often not emphasized enough: learn- ing how to effectively talk with patients about their medications – so as to enhance medication interest and ongoing use – is a concern for all health care providers, not just prescribers. In this light, the many nonprescribing readers of this book mentioned earlier, such as nursing students who do not ultimately choose to pursue advanced degrees and all case managers (both degreed and nondegreed), will find some of the MIM principles and techniques from this chapter to be generalizable for use in ongoing medi- cation monitoring and case management. Moreover, I can assure my nonprescribing readers, that most of the principles and interviewing techniques of the remaining chapters will prove to be of great importance to you when providing ongoing medica- tion monitoring and management whether in an inpatient unit or in an outpatient clinic. The reader may recall from Chapter 2 that the MIM was born from observing and obtaining input from the case managers and other clinicians on my original outreach team. Indeed, case managers, and other nonprescribers, play pivotal, often determinative, roles in enhancing effective ongoing medication use, for they may see the patient much more frequently than a prescribing clinician. Let us now return to the focus of this chapter – there is another import- ant and practical, reason for taking the time to effectively introduce one’s prescribing practices. These 3 or 4 minutes – if they successfully result in enhancing the patient’s subsequent medication interest and use – may save many hours of preventable wasted time for yourself and your staff. The return on your time investment can be enormous. Patients, decompensating because they have discontinued medications, will demand progressively larger amounts of time as they place an increasing number of phone calls