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CHAPTER 6 — The First Script

Furthermore, from the perspective of the MIM, it is a smart question for patients to ask because it allows them to address the third step of the Choice Triad directly. If the medication is given at too high a dose for their bodies, disturbing side effects or serious adverse reactions may indeed occur. The cons will outweigh the pros. From an intelligent consumer’s perspective, it would make good sense to consider not filling such a prescription or, if filled, to take the medication at a lower dose than recommended. In short, if patients feel that the answer to their question is “yes” – we are going to overmedicate them – they are primed to have little interest in our medication recommendations from the get-go. Very few of our patients directly ask this critical question because, like our own question (“Do you take your medications as prescribed?”), it is socially awkward. Consequently, they are forced to intuit whether we might overmedicate them, which is not a good state of affairs, for their intuition, perhaps primed by their bad experi- ences with previous prescribers, may be very wrong indeed. An effective and reliable way exists to get around this potentially fatal trap to engagement. The spirit of the MIM suggests that, paradoxically, the key to uncover- ing valid answers to our question, “Do you take meds as prescribed?” may well be to first answer (directly or indirectly) the patient’s question, “Do you overmedicate?” Only after the patient feels safe about this issue are we likely to get valid answers to our question or, for that matter, to trigger interest from the patient in our medication recommendations. Specifically, we want to demonstrate that we possess a keen interest in their concerns about side effects and, even more particularly, their views as to their medi- cation sensitivity. The question becomes, “How?” I have found that one practical, and surprisingly effective, answer to the dilemma lies in a simple question that can be asked when exploring the patient’s medication passport. It is a question that indirectly metacommu- nicates that, not only am I not a stereotypic overmedicator, I am actually a person who is quite concerned about the potential for overmedication. Note that I often personalize it by using the patient’s name. See what you think:

TIP 4 Medication Sensitivity Inquiry

“Mrs. Jenkins, do you think that you are particularly sensitive to medications?” . . . or a slightly different variation is worded as follows: “Do you feel that you tend to get bad side effects from medications?”