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CHAPTER 6 — The First Script

Sometimes at the end of the Call-Me-First Invitation, I’ll utilize an interviewing technique called “Feel Free to Discontinue.” I learned about the technique during a workshop I was giving on the MIM in Waterloo, Iowa from a nurse practitioner, Cyd Q. Grafft. I add it to the Call-Me-First Invitation with a patient who, in my gut, I sense is particularly frightened or hesitant about a medication but genuinely wants to try it. The following tip can help to relieve some of this fear: “By the way, I really do mean that I want to hear about any side effects you may be having. For different reasons, people sometimes are hesitant to let their physicians and nurses (insert whatever professions seem appropriate) know about side effects, but I really want to know. Some- times we can reduce them or even get rid of them, and sometimes we may need to stop the medication. And if for some reason you start getting a side effect, please call our office before you do anything. I’ll let you know what I think is happening and you can decide what to do. Even if I’m not available, one of our staff will talk with you and provide advice. But try not to stop any medication without talking with me or one of my staff first. Sometimes it isn’t a side effect. And some types of side effects even go away shortly after appearing as your body adjusts. In any case, I really am your consultant. In the end, you’ve got to call the shots, but be sure to use me.” TIP 11 The Call-Me-First Invitation “We have really covered the side effects carefully, and hopefully you won’t get many or any. But if for some rea- son, before our next appointment, you feel concerned about a side effect and you can’t reach me or one of my staff by phone or e-mail, feel free to stop the medication immedi- ately. You can give me a call afterward and we can see if we can come up with a better fit at our next appointment.” TIP 12 Feel Free to Discontinue

My only caveat here is that one can only use this technique if, indeed, it is safe for the patient to discontinue the newly prescribed medication abruptly.