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PART TWO — Interviewing Techniques and Strategies

We began this section with an interviewing principle, “Before pre- scribing your first medication take the time in the first appointment to introduce your medication-prescribing approach.” We have now looked at five interviewing techniques of use when introducing one’s approach to using medications (the Medication Interest Opening, Introducing Shared Expertise, the Shared Journey Analogy, the Call-Me-First Invitation, and Feel Free to Discontinue). These techniques show us how to implement the above abstract principle in the real world of a hectic clinic. If the reader, whether a student or more experienced clinician, finds that it is useful with certain patients to pair two of these techniques sequentially (or perhaps three or more), the reader will have created a personalized interviewing strategy that can be easily remembered for practical use (or taught to other students, residents, or staff). I frequently weave together three of the above techniques into an inter- viewing strategy I like to call Forging the Medication Alliance . This interviewing strategy consists of the following three interviewing techniques sequentially employed: 1) the Medication Interest Opening, 2) Introducing Shared Ex- perience, and 3) the Call-Me-First Invitation. Let’s see how a clinician can effectively and naturalistically use it by imagining a bit of prototypic dialogue. Illustration of Forging the Medication Alliance We will imagine that the patient, a mid-level manager from a large retail chain, has just moved to Sacramento, California from Los Angeles second- ary to a job relocation. In this instance, the patient, whom we shall call Juan, is being transferred from one clinician to another. He presents as a 55-year-old, who could afford to lose a good 20 lb, but is otherwise in rea- sonably good shape. He has been coping with type 2 diabetes, high blood pressure, and dysthymia for more than 15 years, all of which his primary care doctor has been successfully managing with medications. He really liked his previous doctor, and, as one might expect, he is worried about finding a new one. In particular, he has fears that the new prescriber will “monkey around with my meds.” We are picking up the conversation in the closing phase of the initial appointment in which, following the H&P, the clinician and patient are collaboratively sharing opinions on what is going on and how to proceed with treatment planning. You will also notice that our interviewer, before employing the three techniques of the strategy of Forging the Medica- tion Alliance, will use the technique of Exploring the Patient’s Passport on Previous Prescribers. In addition, she will opt to use the technique of