The “Ouch Strategy” for Improving Medication Interest and Use

Mar 13, 2017

“The capacity to create and recreate worlds and parts of worlds is imagination. It is through imagination that we can flee. But it is also by imagination that we can go in search.”

Leston Havens
Psychiatrist

The “Ouch Strategy” for Improving Medication Interest and Use

TISA Description of the Problem: With patients that we know well, and have known for an extended period of time, our sense of humor can sometimes be better mobilized to enhance interest in taking their medications. This strategy is demonstrated nicely in the following clinical interviewing tip of the month. I unfortunately could not track down the name of the provider of the tip. If you recognize your tip please let me know your name so I can post it. Thanks.

Tip: I sometimes use this strategy with patients I know well who are hesitant to take their medications because they have asymptomatic diseases such as high blood pressure or hyperlipidemia. It goes like this:

“I sort of wish that your high cholesterol hurt just a little bit. I realize that it’s hard to be motivated to take a medication if your illness doesn’t have any symptoms or it doesn’t cause any pain. But because I know the risk you are taking when you don’t take this medication, it hurts me. I see your LDL at 170, and I know that you could be heading for a heart attack or a stroke. I see people with those every day, and I feel an “ouch” when I picture you having such a horrible outcome. So since you can’t feel it, help me to feel better. My “ouch” only goes away when your LDL gets below 100. Can we stick together on this goal until my “ouch” goes away, and I know that you are out of danger?

TISA Follow-up: I am always fascinated by the highly unique clinical interviewing techniques that clinicians develop to help their patients. The humor and personal warmth of this technique are self-evident. With the right patient, and with the right timing, I believe it could be quite effective and perhaps save a life.

Tip provided by:

Provider unknown