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PART TWO — Interviewing Techniques and Strategies

The Medication Passport Question alone – even without the Medica- tion Passport Follow-Up Package – can uncover a rich database for under- standing the patient’s feelings about medications, immediately suggesting avenues for discussing medication recommendations later in the initial appointment as well as in future appointments. Consequently, I always try to fit this question into a first meeting with a patient. I then use as much of the Medication Passport Follow-Up Package as time permits. There is one more question that I recommend trying to ask in the first meeting as part of the patient’s medication passport, if at all possible. Directly Exploring for Perceived Medication Sensitivity The question in question was developed in response to the simple rec- ognition that few encounters are more critical in establishing alliances with our patients than our first meetings, and few moments are more treacherous to their development. The success of the first encounter can be more assured if we keep in mind that two opinions exist about every medication prescribed: the prescriber’s and the patient’s. With regard to whether the medication ever leaves the bottle, in the final analysis, only the latter opinion counts. In this light, it can be argued that one of the most important questions to ask during a medication history is, “Do you take your medications as prescribed?” because the answer undoubtedly determines whether the medications that we are about to suggest will be given a fair chance to help (or even be tried in the first place). The art is how to ask this question in such a manner that it is engaging, not challenging, in nature. Let us see whether the MIM can provide some guidance on how to proceed. Keeping in mind that we want to minimize any phrasing that causes even subtle hints of opposition, the above question may be too so- cially blunt, almost accusatory in tone. It is probably ill advised. To figure out how to phrase the question in a less oppositional manner, it may be useful to examine the patient’s perspective on it, for our question – “Do you take your medications as prescribed?” – is often mirrored by a quite different question on the patient’s side of the stethoscope: “Is this guy go- ing to overmedicate me?” The latter question frequently arises from an ingrained opinion that previous prescribers have “overmedicated me because they just don’t get how sensitive I am to medications.” It is an opinion that, for many patients, is a deeply held belief. In fact, it is often an entrenched conviction garnered from decades of legitimately bad experiences with prescribing clinicians.