On a follow‑up visit, how should I open by eliciting the patient’s chief complaint and assessing whether the prescribed medication is effective?

Opening a Follow-Up Visit: Eliciting Chief Complaint and Assessing Medication Effectiveness

Begin every follow-up visit by sitting down, introducing yourself if needed, and using open-ended questions to solicit the patient's agenda multiple times during the first 5 minutes of the encounter. 1, 2

Initial Opening Strategy

Establish Connection and Set the Stage

• Sit down with the patient to foster trust and collaboration—this simple behavior actively demonstrates your commitment to the visit 1
• Make eye contact and maintain a calm, friendly demeanor while avoiding overly casual behavior 1
• Orient the patient to what will be discussed: "I'd like to hear how things have been going since your last visit and review how your medication is working for you" 1

Solicit the Patient's Agenda with Open-Ended Questions

• Ask open-ended questions multiple times (aim for at least 2 solicitations in the first 5 minutes): "What would you like to make sure we discuss today?" or "What concerns do you have since we last met?" 1, 2
• Research shows physicians often fail to adequately solicit patient agendas—in one study, 32% of encounters had no agenda solicitation at all, creating risk of missing important patient concerns 2
• Use reflective listening and avoid interrupting as the patient shares their priorities 1

Assessing Medication Effectiveness

Pain Control and Symptom Relief (for pain medications)

• Ask directly about average pain levels and whether pain relief is sustained throughout the dosing interval 3
• Determine if the patient is experiencing adequate symptom control: "Has your pain improved since starting this medication?" 3
• For patients on opioids specifically, identify those without pain relief at 1 month, as they are unlikely to benefit at 6 months—making this a critical decision point 3

Functional Improvement and Quality of Life

• Evaluate functional improvement by asking about interference with enjoyment of life and general activity: "How has this medication affected your ability to do the things that matter to you?" 3
• Assess progress toward specific functional goals: "Are you able to do activities you wanted to resume, like work, family responsibilities, or social activities?" 3
• Determine if overall well-being has improved since starting treatment 3

Medication Adherence Patterns

• Ask non-judgmentally about self-administration: "How successful have you been in taking all your prescribed doses?" or "Are you taking the medication exactly as prescribed, or do you feel the need to take more or take it more frequently?" 3
• Discuss barriers to adherence including adverse effects, out-of-pocket costs, and dosing inconvenience 1
• Family members often provide more objective assessments of adherence when present 1

Side Effects and Adverse Events

• Screen systematically for common side effects specific to the medication prescribed (e.g., for opioids: constipation, drowsiness, nausea, dry mouth) 3
• Identify warning signs of serious complications such as sedation, confusion, respiratory symptoms, or syncope 3
• For psychiatric medications like aripiprazole, document vital signs including blood pressure, pulse, and weight at each visit 4

Structuring the Assessment

Use Standardized Approaches

• Employ structured tools when appropriate, such as the PEG scale for pain and function 3
• For psychiatric medications, use standardized rating scales to objectively track symptom changes rather than relying solely on subjective reports 4
• Check for understanding using "teach back" method: "In your own words, what does this medication do for you?" 1

Orient Yourself to the Patient's Understanding

• Ask what the patient knows and wants to know: "What have other clinicians told you about your condition?" or "What do you understand about why you're taking this medication?" 1
• Inquire about how the patient and family are coping and feeling 1

Common Pitfalls to Avoid

• Do not assume the patient has no new concerns simply because this is a follow-up visit—new problems occur in 23% of visits, even those with open-ended beginnings 5
• Avoid asking only closed-ended questions about medication effectiveness—this limits the patient's ability to share important concerns 2
• Do not skip agenda solicitation—female physicians in particular have been shown to solicit patient agendas 42% less often than male physicians, though patients spontaneously share agendas twice as often with female physicians 2
• Avoid information overload by providing information in small doses and checking frequently for comprehension 1

Documentation and Next Steps

• Document all assessments systematically to track longitudinal patterns and facilitate evidence-based decision-making 4
• Respond empathically when patients display emotion through verbal or nonverbal behavior by acknowledging and naming the emotions 1
• Ensure all patient questions are answered before concluding the visit 1