Building Bridges Between Visits

Recently I saw a patient for a follow up visit three months after starting metformin for newly diagnosed type 2 diabetes. Her lab tests hadn’t improved. She told me that after a few days, she stopped the medication on her own because of intestinal upset. 

“I’m sorry to hear that,” I said with concern. “Did you try to message the office about it?” 

“No—I thought I had to wait until my next visit to discuss it with you,” she replied. 

I knew we’d reviewed potential side effects, but I couldn’t recall the details of our conversation about how and when to contact me if she was having trouble. I realized I hadn’t checked for understanding. 

Despite the general trend toward greater patient autonomy and agency in their healthcare, many patients may still be reluctant to reach out to their clinicians between visits. Some of those most in need of interim guidance may not know how to reach out, or realize that it’s welcomed and expected.  

One thing I’ve seen in practice through the years, is that letting patients know that I’m available and making it easier for them to reach me rarely results in a greater influx of calls. Instead, it goes a long way toward forming a trusting connection, and sometimes prevents serious harm. 

Here are four tips for building bridges of continuity between office visits: 

1. Instead of first launching into instructions, ask the patient, “What would you do if unexpected problems arise before your next appointment?”  

2. Remind patients that it’s ok to reach out if help is needed before the next scheduled visit. 

3. Review, or have your staff review, the best ways to contact the office if problems arise. 

4. Do a “teach-back” to ensure clarity and understanding by asking the patient to explain or “teach” the instructions back to you or your support staff. 

This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.