Shea_Chapter 6

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PART TWO — Interviewing Techniques and Strategies

The answers are occasionally fascinating and, almost always, useful. If the patient quickly answers, “No, not particularly,” then we have a “green light” to proceed with our initial medication recommendations. But, if the patient answers “yes” or indicates nonverbally through broken eye contact, tone of voice, or a pause before answering, then we have a “red light.” The light will not turn green until we sensitively uncover the patient’s concerns and address those concerns, a process that, in itself, will con- vincingly demonstrate that we have no intention of overmedicating him or her. Paradoxically, we will have answered the patient’s question “Is this guy going to overmedicate me?” by asking one. If the patient says that he or she is very sensitive to medications (and a good number of my patients emphasize, “I’m very sensitive to medications”), then it is common sense to follow up with an exploration of that patient’s potential sensitivity with an open-ended question such as, “What types of bad experiences have you had?” or “What are some of the things you’ve en- countered that have shown you that you are overly sensitive to medications?” Not only does such a question convey the clinician’s genuine concern, but it can also dig up all sorts of interesting information. In some instances, we discover that the patient does indeed seem to experience an overabun- dance of side effects, perhaps suggesting that the patient is a slow metabo- lizer. This information is invaluable in setting an appropriate initial dose to minimize side effects while maximizing medication interest and safety. However, as I am sure you have seen in your own practices, or will see in your future practices, we sometimes discover that some patients who view themselves as particularly sensitive to medications are, in truth, not so. They simply encounter the typical side effects seen with medications of the class in question and, mistakenly, view themselves as being more side-effect prone than are other people. Obviously, with such patients, their inaccurate view of being “unusu- ally sensitive” to medications will cast a considerable damper on their medication interest. In the past, I saw the uncovering of this unwarranted bias as an opportunity to provide some productive education to counter my patient’s misinformation. I might say something like, “Mrs. Jenkins, I have some good news for you. In actuality, you aren’t really overly sensitive to medications. You are simply getting some of the very common side ef- fects we see with those types of medications. Thus, we can try some other medications, and you may not get many side effects at all.” My hope was that by clearing up Mrs. Jenkins’s misperception of being biologically overly sensitive, I would increase her interest in trying subse- quent medications. Sometimes this happened, but many times, it did not.