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PART TWO — Interviewing Techniques and Strategies

“I can see why. From her notes, it looks like she took great care of you. What did you like about her?” Concerning shared decision making, right from the first mention of medications, this physician talks the talk and, more importantly, walks the walk. She has also managed to match her style to the needs, educational background, and cultural feel of her patient. She is talking with frankness to him, “manager to manager,” a style well suited to his own. She will adapt her style of introducing her personal approach to using medications depending on the unique needs of each patient. The three techniques used in the strategy of Forging the Medication Alliance (the Medication Interest Opening, Introducing Shared Expertise, and the Call-Me-First Invitation) provide her with a flexible toolbox from which she can adapt her approach to the unique needs of each patient. By previously practicing the techniques and by observing the fashion in which different people respond to them, she has gained a sophisticated, rapid, and sensitive fashion of forging the medication alliance. C oncluding T houghts At the beginning of this chapter, we had observed that there exist three primary tasks during a first appointment regarding medication interest: (1) uncovering the patient’s views on his or her current medications (as well as the concept of taking medications at all), (2) introducing the clinician’s personal approach as a prescriber to the use of medications, and (3) if one feels that a new medica- tion may be indicated, providing ample introduction to its pros and cons, collaboratively arriving at a decision as to its use, and delineating directions for its use while checking to make sure the patient understands these directions. In this chapter, we have addressed the first two tasks. In the next three chapters, we will fully explore the Choice Triad. In doing so, we will address elements of the third medication-oriented goal listed above. Patient-centered, shared decision making will serve as the foundation for our ongoing medication alliance. It only seems fitting to end this chapter with the wise words of Howard Brody with which we began it: “It may be argued that the ongoing personal relationship with each patient is the . . . tool of the trade for the primary care physician. The primary care physician’s approach to the patient’s problem is grounded in the way the patient defines the problem.” In the next three chapters, we will discover exactly how our patients go about this defining business.