Practices

Here is a question that costs nothing: has anyone in your family been told their vitamin D was low? It runs in families through genes, skin tone, where you live and how much time anyone spends outside.

The clinician telling this story found out only afterwards that his mother, father and brother had all been low. Nobody had mentioned it, because it…

Around seven in ten people who use herbal products never mention it to their doctor. Not out of secrecy, mostly because a tea or a gummy does not feel like it belongs on a list of medications.

The useful move is to answer a wider question than the one you were asked. When someone asks what medication you take, tell them what else you take…

You can say what an SSRI does in one sentence. It blocks the doorway that carries serotonin back out of the gap between two nerve cells, so more of it stays there for longer and is likelier to be picked up.

Worth being able to say plainly, because most people are carrying something vaguer and more frightening than that. It also sets a fair expectation.…

Serotonin syndrome comes from stacking, and the second agent is usually something nobody thought to mention: a migraine tablet, a cough medicine, a herbal remedy for low mood.

Triptans, tramadol, dextromethorphan, linezolid and St John's wort all count, as do other antidepressants. Someone who mentions in passing that they…

If a young driver in your house takes medication, the dose and the car keys belong together. Driving is the everyday task where one lost second costs the most.

The gap tends to open at weekends and in the holidays, when the dose gets skipped because there is no school and then someone drives anyway. Make it…

If swallowing the capsule is the sticking point, ask whether yours is the bead type that can be opened and tipped onto a spoonful of soft food. The little beads go down unchewed and the medicine still lasts as long as it should.

Inside these capsules sit lots of coated pellets, some with thin coats that dissolve early and some with thicker coats that dissolve later, which is…

There is now a version taken in the evening that only switches on around nine hours later, so it is already working when you wake. The point of it is the morning, not the night.

Most families know the first hour of the day as the worst one, because the tablet taken at breakfast has not started yet and everyone still has to…

Saying that medication helps is not the same as saying everyone should be on it. If you have walked in braced for a push, it is fine to say so at the start.

Plenty of people do well with sleep, movement, work that suits them and someone in their corner, and plenty of people need all of that and a tablet…

Writing 'do not substitute' on a prescription tells the pharmacist what to hand over. It does not tell an insurer to pay for it, and that surprise at the counter is where a lot of prescriptions quietly get abandoned.

If a particular brand is being chosen for a reason, say out loud what it might cost and what the fallback is if the price turns out to be impossible.…

Most long acting stimulant capsules hold two sorts of beads, one that dissolves straight away and one coated to dissolve later. That is the whole reason a single morning capsule can do what used to need a lunchtime dose as well.

It matters because the midday dose was the one that got missed, and missing it was rarely carelessness. A dose that has to be remembered in the…

When you need to correct one person, say it to the room. Everyone gets the instruction and nobody gets the sting.

Good instructors do this without thinking: they see one child dropping their guard and say that everybody needs to keep their hands up. The teaching…

Use a timer you can see rather than a warning you have to remember. A dial that shrinks, or a light that goes from green to red, does the work that five more minutes never quite does.

Time is not something everyone feels passing. Turning it into something you can look at moves the job from guessing to seeing, which is much easier.…

When someone describes a day like that, do not answer with a lecture on living better. Say that this is hard, and that you find parts of it hard too.

They have heard the virtue speech many times already and it has never once helped. Admitting that you also struggle to exercise, or to keep up with…

Try swapping the word picky for particular. A fair number of people with ADHD have more densely packed taste buds, so the bitterness in a sprout arrives at full volume.

That changes what is going on at the table. A child is not refusing in order to be difficult, they are tasting something stronger than you are.…

Sleeping tablets, sedatives, antihistamines and alcohol all pull on the same brake. Whoever is prescribing needs the whole list, including the things that do not feel like medicine.

People rarely mention a nightly drink or a sleep aid bought off the shelf, because neither feels like part of the treatment. Together they can add up…

If you have been given a drug from one category for a problem in another, it is fair to ask which part of it is doing the work. Often the useful effect is a side effect that has been borrowed.

The common example is an antipsychotic given in a small dose for sleep, where the drowsiness comes from its antihistamine action rather than from…

Saying that you do not know, and then showing where you would look, beats an answer improvised on the spot. It also teaches the person asking how to check things for themselves.

Name the limit, name the source you would go to, and offer to come back with what you find. Systematic reviews and an ordinary scholarly search will…

These medicines work on a timescale of four to six weeks, not days. Say the number out loud at the start, because someone expecting relief this week will have decided by Friday that it failed.

Something does happen on the first day, but it is only the first step of a change that takes weeks to finish. The useful version of this is a date:…

Describe what the first fortnight might feel like before the first tablet, not after the first worried phone call. A warning given in advance turns a bad week into a milestone.

The wording can be plain. Some people feel more wound up for the first week or ten days, it usually passes, and nobody changes anything without…

Somebody will eventually ask you whether you want what is best for your child. It is a sales line, and knowing that in advance is most of what you need to withstand it.

Parents of a newly diagnosed child are frightened, motivated and often exhausted, which is exactly the state that gets marketed to. The question is…