A Long-Time Patient Comes to the Office for a Routine

A long-time patient comes to the office for a routine physical examination accompanied by his wife.  He has a history of hypertension, obesity, and osteoarthritis.  At the last visit, the physician recommended an exercise and weight loss regimen to improve his condition.  The patient subsequently cancelled his next 2 appointments, explaining that things came up at the last minute.  At today's visit, the patient reports low energy and pain in his knees, back, and hands.  His wife is worried that he is not doing well.  Blood pressure is 150/90 mm Hg, pulse is 84/min, and respirations are 18/min.  Examination shows a 3.18-kg (7-lb) weight gain and decreased range of motion.  During the visit, the patient shows a detailed understanding of his illnesses and readily acknowledges the importance of medication, diet, and exercise.  However, he admits that he has a hard time dieting, has not exercised because it hurts his knees, and sometimes forgets to take his antihypertensive medications.  Which of the following is the best initial response to address this patient's nonadherence to treatment?

A) "Although you don't feel the effects of high blood pressure, it is important to take your medication every day."
B) "I am concerned that your diet and lack of exercise are making your conditions worse."
C) "I can understand why your wife is worried about your health."
D) "It can be difficult to keep up with diet, exercise, and medication on a daily basis."
E) "Let me explain how diet and exercise can help you feel better."
F) "Let me provide written medication instructions and we can go over them in detail."

Correct Answer:

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