QUOTE OF THE MONTH:

# 74 April 2006

"The task is . . . not so much to see what no one has yet seen; but to think what nobody has yet thought, about that which everybody sees."

Erwin Schrodinger
Quantum Physicist


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INTERVIEWING TIP OF THE MONTH

# 74 April 2006

"The Paradox of 'Not Pushing' Meds"

TISA Description of the Problem: It is sometimes difficult to decide quickly whether one should start a medication or not. Seldom is such a hesitancy a sign of resistance; it is more often wisdom - the patient is being appropriately reflective and cautious. In some instances, especially if the patient appears to be quite ambivalent about trying a medication, the patient may need more time to think about it. Interestingly, by proactively suggesting more time for making a decision, patients are often more open to the idea to starting a medication as seen in the excellent tip below from Gabrielle Beaubrun.

Tip: In situations, when there is a non-urgent need to begin a medication, and especially with patients who have multiple questions/doubts about a medication, I have found the following interviewing strategy to be useful (particularly with patients who like to use the web a lot or like to read about medications). In the session, I focus upon, and emphasize, the ways that I think the medication will help. Then I surprise the patient by not giving a prescription immediately, instead, I say the following:

"I want you to be sure about this decision. Read up about this medication and give me a call if you decide you want to give it a try."

Naturally, I give the patient the name of the med on a piece of paper with some of the benefits and side-effects as well as possible resources for learning about the medication.
In my experience, almost all of these patients call me within a week to ask for the medication. Now that the patient is asking me for the medication, based upon his or her own research, I find there is a much higher likelihood that the patient will not only try the med, but will also be more interested in sticking with it despite side-effects.

TISA Follow-up: Here is a beautiful example of "going with" a patient instead of "going against" the patient. The clinician's acceptance of the patient's hesitancy opens the door for collaborative investigation. By letting the patient do the work, the patient will feel empowered, as indeed, he or she is, to make up his or her own mind. The effort the patient puts into the research also increases the likelihood that the patient will be more interested in giving the medication a fair trial.

Tip provided by:

Gabrielle Beaubrun, M.D.
Psychiatrist
Kaiser, South Bay, California