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CHAPTER 6 — The First Script

gateway to further her collaborative exploration and shared decision making.) Clin.: By the way, if we run into major problems with side effects, I’ll be the first one to tell you to get off the medication. Our goal is to help you to find a medication that you genuinely are interested in taking because it makes you feel better, not because I tell you to take it. I’m always interested in your input (clinician continues with the spirit of the MIM emphasizing moving with the patient along the Agreement Continuum by indicating that she too will be a watchdog for prob- lematic side effects; the interviewer’s goal is not to keep the patient on a medication but to find a medication that the patient is interested in keeping). In fact, I’m curious, how are you feeling about your cur- rent medications. (Medication Passport Question) Pt.: Pretty good. Dr. Travis felt things were going pretty good, but she’d said something about being worried that my A1C – I think it’s called – was creeping back up. I had the feeling that Dr. Travis was thinking of maybe making a change. I don’t know. But she didn’t get a chance to say so at the end. I transferred so quickly. (pauses) I don’t want to change any medications unless it’s really necessary. Although if she felt it was, I’d be fine with that. (Notice that the patient is subtly indi- cating that he is still very interested in the opinions of Dr. Travis. At some level, his words are an invitation of sorts, an invitation that the new clinician wisely accepts.) Clin.: She doesn’t mention that in her note, but maybe I should give her a call before we meet next time. I’d like to tap her opinion more dir- ectly. (The clinician could not give a more convincing message that In the above dialogue, the clinician has nicely set the stage for a true partnership. She has deftly, yet quickly, debunked any misconceptions that she may be a “pill pusher” while establishing her role as a con- sultant who feels comfortable with her expertise in using medications effectively. Importantly, she sought out the patient’s ideas on his role and clearly stated that she values his input. But, as powerful as her statements of interest in Juan’s input might be, it is the questions that she asks – and the actions that she takes – that truly prove her interest to him. It is striking that even on topics unrelated to symptoms or diagnosis, she is clearly interested in what Juan thinks. When he comments that he really liked his previous physician of 15 years, our interviewer inquires, she will listen carefully to the patient’s input and act on it). Pt.: That’s a great idea! (patient looks animated and pleased)