Preparing for a follow-up visit: what changed, a symptoms diary and questions to ask

What a follow-up visit is for

A first consultation is about finding out what is wrong. A follow-up visit asks different questions: has the treatment worked, have new problems appeared, do the test results suggest changing anything, and what happens next? The doctor usually has far less time than at the first visit and starts from the notes of the last one.

That makes you the best source of information about what has happened in between. Doctors can examine you and read results, but they cannot see how you slept, whether tablets upset your stomach or how many times you missed a dose. A little preparation turns your memory into usable information. It also helps you to leave knowing what was decided, rather than remembering half of it on the journey home.

Our guide on preparing your medical records before a doctor’s appointment covers the paperwork for a first visit. This guide focuses on the follow-up.

Step 1: write a one-page “what has changed” summary

Take a sheet of paper or a note on your phone and write the date of the last visit at the top. Then answer these questions in a sentence or two each:

• Overall, am I better, the same or worse than at the last visit?
• What did the doctor ask me to do (take a medicine, change my diet, get a test, rest), and how much of it did I manage?
• Have I had any new symptoms, however minor they seem?
• Have I had any hospital visits, emergency visits, falls, infections or new diagnoses, even if treated elsewhere?
• Have I started, stopped or changed any medicines, supplements or home remedies, or seen another doctor?
• What has been difficult: side effects, cost, supply of medicines, or finding time for tests?
• What do I most want to get out of this visit?

Keep it brief enough to read aloud in a minute. If you only have time for one thing, write down the last question, because it focuses the whole conversation.

Step 2: keep a short symptoms diary

Memory is poor at summarising weeks of symptoms. A diary captures the pattern. It does not need to be elaborate: a line a day, or a line whenever the symptom occurs, is enough. Record:

• The date and time.
• What you felt, in plain words, and where in the body.
• How bad it was, on a scale from 0 (none) to 10 (the worst you can imagine).
• How long it lasted.
• What you were doing just before, such as eating, exercising or being under stress.
• What helped or made it worse, including any medicine you took.

An example entry, with made-up values: “Tue 21 Oct, about 6 pm: headache behind the eyes, 5 out of 10, lasted two hours, after a long day at the computer, eased after drinking water and resting.”

Patterns such as symptoms that appear after particular meals, at a particular time of day or after taking a particular tablet are exactly what doctors are listening for. If you also measure something at home, such as blood pressure or blood glucose, keep those readings in the same place. Our guide to home blood pressure monitoring includes a log you can adapt.

Step 3: gather the records to bring

Bring what lets the doctor see what changed. A reasonable bundle is:

• Your medication list, current and including supplements, with any changes marked. See keeping a reliable medication list.
• All test results since the last visit, in date order, with the previous results for comparison. Our guide to reading a laboratory report explains why the same laboratory and trends matter.
• Any discharge summary, emergency room note or letter from another doctor.
• Scan or X-ray reports, and the images themselves if the doctor will want to see them.
• Your home readings and diary.
• The previous prescription and the doctor’s earlier notes, if you were given them.
• Your identity document, insurance or scheme card, and the appointment slip.

If a result is not available yet, tell the clinic in advance, as the appointment may be better scheduled for after the report arrives. Where possible, bring original reports or clear copies, because a photograph of a page taken at an angle may be unreadable.

Step 4: prepare your questions

Write the questions down and put the most important first. Appointments often run short, and the question that worries you most is the one people forget. Useful questions at a follow-up include:

• How are my results compared with last time, and what do they tell you?
• Is the treatment working? How will we know, and by when?
• Do I need to change anything: medicines, dose timing, diet, activity?
• What side effects should I watch for, and what should I do if they happen?
• Do I need more tests or a visit to a specialist? Why, and how urgent is it?
• What should I do if I feel worse before the next visit, and who do I contact?
• When should I come back, and what should I do or bring beforehand?

If you do not understand an answer, say so. A good habit is to repeat it back in your own words: “So I should continue the same tablets, get the blood test in four weeks and come back with the report. Is that right?” Doctors appreciate this, and it catches misunderstandings.

Step 5: record the decisions

During or just after the visit, write down:

• Any change in diagnosis or any new diagnosis, in the doctor’s words.
• Every medicine started, stopped or changed, with the exact instructions.
• Tests to be done, where, when and any preparation (fasting, for example).
• The date of the next visit, and the warning signs that mean you should call earlier.
• Who is responsible for each next step, such as booking a scan or sending a report.

Update your medication list the same day. If a family member could not attend, share these notes with them, since they often help with medicines and appointments. Many clinics will give a printed summary, and you can ask for one.

Telephone and video follow-ups

Many follow-ups now happen by phone or video. The same preparation applies, with a few extra points. Test the app and your connection beforehand, find a quiet well-lit place, and keep your medicines, home readings and notes within reach. Have a pen ready. If the doctor needs to see something, such as a swelling or a rash, take clear photographs in good light beforehand. Ask how to reach the clinic if the connection fails, and how any prescription or test request will be sent to you, because that is often where confusion arises. Teleconsultations are not suitable for emergencies, so seek urgent in-person care for severe symptoms.

If you are a caregiver

If you are accompanying someone else, ask them in advance what they would like you to say or not say, and ask whether they are comfortable with you being in the room for the examination. Take notes so that the patient can listen. Speak with the patient’s permission, and make sure the doctor hears from the patient directly first. If you notice changes that the patient may not mention, such as confusion, falls or reduced appetite, write them down in your own diary and share them with consent.

A worked example (example values)

An example of a one-page summary for a follow-up visit: “Last visit 15 September. Overall about the same. I took my morning tablets every day except twice, when I was travelling. New: ankle swelling in the evenings for the past ten days, 4 out of 10, better after lying down. Home blood pressure this week averaged 142/88. Blood tests done on 10 October attached. I started a herbal tonic on 1 October. Main question: do I need to change the dose of any tablet, and is the swelling related to it?”

In under a minute, the doctor learns about adherence, a new symptom, home readings, a new product and the patient’s priority, which is the information a doctor most needs at a follow-up.

Sources

• MedlinePlus: Talking With Your Doctor — NIH tips for preparing questions and understanding answers
• National Institute on Aging: Medical care and appointments — preparing for and getting the most from a visit
• World Health Organization: Patient safety fact sheet — the role of clear communication and patient involvement in safe care
• MedlinePlus: Health Literacy — understanding health information and asking questions

A note on this guide

This guide is general information about preparing for appointments. It is not medical advice. If you develop severe or worsening symptoms before your visit, contact a doctor or emergency service rather than waiting for the appointment.