“N” is for Next Steps

by Karen Knops, MD

“Sometimes the smallest step in the right direction ends up being the biggest step of your life. Tip-toe if you must, but take a step.” – Naeem Callaway

As we share our history and explore options in medical care, our brains tend to organize information into a story, linking cause and effect and past to future. Defining next steps brings us from “what is” to “what could be” and moves us from thought into action. Here we review tips for closing the visit and creating a plan you can remember and use.

Recap the visit

If you’ve covered several topics in the visit, you may have been given a sense of what is possible, but deciding on a plan can be a challenge. It is okay to ask to quickly review what was discussed in the visit as you are deciding on a plan. In an increasingly complex healthcare system, you may have to hear information multiple times to fully take it in, and you may also need to know how and if you can change course that if a plan isn’t right.

Surveys show that forgetting or confusing information after a visit is common. A quick recap of the discussion and how it ties to your “next steps” can improve your memory of the plan. As discussed in earlier posts, repeat back in your own words the plan and next steps; this will help ensure you will remember the right things.


Be specific about next steps

What next steps are needed and who takes them? (See the post on Exploring for more on decision-making.)

Next steps might include:

  • A follow-up visit: Is one needed? When?
  • Referrals to other professionals: Do you know how to arrange those?
  • Reaching out for extra support: If you are dealing with a serious diagnosis, what kind of extra support, such as palliative care specialists, might be available to help you plan and cope?
  • Ensuring new information is communicated to other physicians: Have you passed along their contact information so they receive copies of your records?
  • Getting in touch if questions arise: Do you know who to contact and how (by phone, email, patient portal message system)?
  • Taking new medication(s): Do you know how it is taken, and what should you do about missing a dose? Side effects to watch for?
  • Future tests: Is a special preparation required? How should you expect to receive results?
  • Making a decision about your treatment: What is the timeline for the decision, and what information is still needed? Is there someone else you want to talk with? If you are in conflict about a plan with your physician or within your family, can you name what the conflict is about? What values are at odds?
  • More research: Are there materials you can review, or sources like websites or patient education areas that can provide you with information? Our next post in the series, Documentation, covers this topic in detail.
  • Considering the wide impact: For any of the above, are there implications for your finances, function or family that you want to plan for?


Be realistic
As you get a more complete picture of what might be ahead, it is time to get honest about financial and time constraints, competing priorities, or other barriers to the plan. While it can be uncomfortable, it is better to ask if there is compromise or back-up plan than to agree to something unrealistic. Having a plan you cannot follow can feel worse than having no plan at all.

Advocating for yourself is important because no one understands your life the way that you do!

With these tips, we hope you will have ideas of how to reach the best possible plan and leave the visit feeling confident.

Read the introduction and previous posts in the A-S-C-E-N-D series:

“A” for Anticipate
“S” for Summarize
“C” for Concerns
“E” for Explore

Coming up: “D” for Document