Early in my career, I noticed a pattern: I'd ask patients if they were taking their medications as prescribed, and nearly all of them would say yes. However, lab results, refill histories, and follow-up conversations often told a different story. I quickly realized that this was a shared frustration across primary care. 

We receive the “correct responses” when inquiring about medication adherence, tobacco use, and sexual activity, only to later discover that patients have been smoking, skipping medications, and that it was chlamydia, not prostatic hypertrophy. Our patients aren't always giving us the whole story, but why not?

I learned that I needed to rethink how I ask sensitive questions and look for ways to approach these conversations that invite honesty, reduce shame, and lead to more meaningful dialogue.

Here are six strategies that, in my experience, tend to elicit more honest, meaningful responses. I hope you find them just as useful in your own practice.

Reframe the Behavior as a Relationship

Instead of: "Do you smoke?"

Try: "What's your relationship with tobacco these days?"

Why it works: This removes moral judgment and opens the door to more nuanced disclosures, like cigars, vaping, or chewing tobacco, that patients might otherwise think don't count.

Normalize the Struggle Before Asking

Instead of: "Are you taking your medications?"

Try: "If I were taking as many medications as you are, I might forget a dose now and then, especially the second one of the day. How has that been for you?"

Why it works: Adherence is less about perfection and more about rhythm, reality, and refill data.

Use Open Curiosity, Not Binary Traps

Instead of: "Are you sexually active?"

Try: "What does intimacy look like in your life these days?"

Why it works: This question is open-ended, inclusive, and less likely to shut down the conversation for patients who may not identify with assumptions behind binary phrasing.

Invite the Story, Not Just the Answer

Instead of: "Have you had surgery before?"

Try: "Tell me about any past procedures or hospital stays. What stands out?"

Why it works: Memory is narrative. When you ask for the story, you invite emotional context, key details, and potential trauma that a checkbox might miss.

Anchor in Compassion, Not Compliance

Instead of: "Why didn't you come back for follow-up?"

Try: "It's not always easy to come back in. Can you share what made it hard last time?"

Why it works: This verbiage reframes the question to focus on barriers, not blame. You might uncover transportation challenges, time constraints, financial issues, or trust concerns.

Treat Natural Products Like Medications, Because They Are

Instead of: "You're not taking any supplements or herbs, are you?"

Try: "Many people take natural products like herbs, teas, or supplements to support their health, like fish oil, turmeric, garlic, and similar things. Are you using anything like that right now?"

Why it works: It normalizes the behavior and reduces the chance of patients withholding information. Nearly 60% of U.S. adults report using dietary supplements, yet many do not disclose this to their clinician.

Effective communication in health care isn't just about the questions we ask. It's how we ask them. When we normalize imperfection, drop the script, and lead with curiosity, we create space for truth. Sometimes, a better question is the best intervention.

How have you changed your approach to patient interactions to improve the relationship and trust? Share in the comments!

Ashley Ingram-T’Siobbel, DNP, FNP-C, is a board-certified family nurse practitioner who provides primary care for Veterans. She specializes in health literacy, plain language, and humanistic care, and leads trainings on effective communication and patient education both within and outside of the VA.

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