“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 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. At the close of the visit, we ideally agree on a plan we can remember and use.

Recap the visit

It is okay to ask to quickly review what was discussed in the visit. In an increasingly complex healthcare system, we may have to hear things multiple times to fully take them in. If we’ve covered several topics, the suggestion that seemed right initially may not be a good fit after some thought, and this is our time to speak up.

Studies show that forgetting or jumbling information after a visit is more common than not. Repeating out loud in our own words will help ensure we will remember the right things, and as we tie each problem to the next steps, we remember not just what we need to do, but why.


Connect about next steps
What next steps are needed and who takes them?

Next steps might include:

  • Taking new medication(s): Do we know how it is taken, and what we should do about missing a dose? Side effects to watch for?
  • Future tests: Is a special preparation required before the test? How should we expect to receive results?
  • Making a decision about treatment: What is the timeline for the decision, and what information is still needed? Is there someone else we want to talk with? If we are in conflict about a plan, can we name what the conflict is about? What values are at odds?
  • A follow-up visit: Is one needed? When?
  • Referrals to other professionals: How to arrange them?
  • Reaching out for extra support: If we are dealing with a serious diagnosis, what kind of extra support, or specialists, might be available to help us plan and cope?
  • Ensuring new information is communicated to other clinicians (more on this under Document, below)
  • Getting in touch if questions arise: Do we know who to contact and how (by phone, email, patient portal)?
  • More research: Are there materials we can review, or sources like websites or patient education areas that can provide information?
  • Considering the wide impact: For any of the above, are there implications for your finances, function or family that you want to plan for?

Get realistic
As we get a more complete picture of what might be ahead, it is time to get honest about financial and time constraints, competing priorities, and other barriers to the plan. While it can be uncomfortable, it is better to ask if there is a compromise or back-up plan than to agree to something unrealistic. Having a plan we cannot follow can feel worse than having no plan at all. Advocating for ourselves is important because no one understands our lives the way that we do! The goal is to leave the visit feeling confident.

Get specific

Taking time immediately after the visit to consider what steps we can take to put the plan in action is key. If we don’t consider what specific habits we will change or who in our lives can support us in making the plan work, the best laid plans can falter. Taking ownership of our decisions is vital to health and living our lives deliberately and healthfully.


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 next: “D” for Document.