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CHAPTER 6 — The First Script

equal importance. To do so would be quite natural. It could also be quite dangerous. The fashion in which your patients respond to the above questions can also shed light on various useful bits of information, including your patients’ intelligence, memory retention, ability to express themselves, and ability to effectively assert their viewpoints. Patients’ answers may also provide indirect information on the quality of the previous patient-prescriber alli- ance and the quality of previous provider education regarding medication use. For a small number of questions, the Medication Passport Follow-Up Package goes a long way toward fostering a nonoppositional partnership, while yielding surprisingly useful information. Depending on your practice, it should be noted that your patient’s medication passport may be held in small hands. In another MIM workshop, a pediatric social worker, Kay McAuliffe, pointed out that with children below age 10, it is often still important to uncover their personal views (as opposed to relying solely on their parents’ views) as to “what this pill business is all about.” Despite the fact that the child’s parents are distributing the medication – ensuring that the medication is being taken – important psychological concerns can arise in a child ingesting a pill that may warrant attention. Medications can be extraordinarily confusing to kids, and they may develop untrue and potentially worrisome distortions about their medications, even medications as “simple” as antibiotics. She further points out that, although the clinician is basically exploring the same material as with adults, there are some subtle changes in the wording that can make the inquiries more effective at getting a child’s true opinions. Such questions are encapsulated in her following technique, which is employed selectively as indicated by the child’s level of intellectual development:

a. “Why do you think you are taking this pill?” b. “How is it supposed to help you?” c. “Do you want to be taking it?” TIP 3 Medication Passport for Small Hands

Besides immediately allaying the fears of a child regarding his or her medications, it should also be noted that any person’s subsequent adult views on medications may have first been forged – and rather permanently forged at that – by his or her interactions with those who prescribed medications to him or her as a child, a fact of which talented pediatricians are often well aware.