Allow enough time
The real question comes last.
Because the appointment was ten minutes and it took eight to get through the first problem.
The thing people most often come in for is mentioned last, usually standing up, usually prefaced with it is probably nothing. Short appointments guarantee it stays unsaid, and no amount of clinical skill compensates for not having heard it.
Medication review needs the same time. Prescriptions started years ago for reasons nobody has revisited accumulate quietly, and interactions between them cause genuine harm. Asking each visit whether something could be stopped is unglamorous and it is real medicine.
The last part is knowing the limits — of a scope of practice, of what telehealth can assess, and of what a practice like this should manage rather than refer. Saying so costs an appointment and is the whole basis of being trusted with the next one.
The real question comes last.
Old prescriptions need re-examining.
Referral and 911 when that is the answer.
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