# 114 August 2009

A Note from the Director of TISA:

Continued thanks to everyone who has contributed interviewing tips to the TISA website and to all those who are enjoying reading them. The tips have been great, and we are building an excellent resource for clinicians around the world, on a skill often not given enough attention. Please keep the tips coming! Remember, they can be as simple as a single question and all you need to do is click here or on our E-Mail Button at the bottom of the page to submit one. Be sure to check out our ever growing Tip Archives with over sixty different interviewing tips. Just scroll down for our March Tip of the Month.

Best wishes,

Shawn

Personalizing Potential Side-Effect Choices

TISA Description of the Problem: In helping patients as they are deciding whether to use a medication or not, one of the critical issues will be the potential side-effects of the medications. Medications within a given class, that are appropriate for the patient, may display varying side-effects. Melinda Cobb, M.D. has a nice approach for collaboratively addressing this issue.

Tip: I often let patients know about the key side-effects of several medications that could help them. After doing so, I actively seek input from the patient over which side-effects may be most concerning to them personally as with either of the following questions:

“If we were to use one of these medications, is there a potential side-effect that you would most want to avoid?”

or

“Considering the potential side-effects of these
medications, which medication do you find the most appealing to try?”

TISA Follow-up: Besides its emphasis upon collaborative interviewing, another aspect of these techniques from Melinda that I really like is the fact that they address an important aspect of side-effects that is often not addressed enough. Namely, patients may vary on how problematic a particular side-effect is to them. One patient may find a side-effect to be a mere inconvenience (dry mouth for an accountant) while another patient may find the exact same side-effect to be highly problematic (dry mouth for an actor). In my practice I have sometimes been surprised at patient’s thoughts on side-effects, assuming that a patient may view a particular side-effect as very bad when indeed, for him or her, it is “no big deal” or vice versa. The above techniques nicely help to ensure that the clinician assumes nothing and is truly guided by the input of the patient, yet another example of the fine art of clinical interviewing.

Tip provided by:

Melinda Cobb, M.D.

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