Medication reconciliation is critical to avoiding adverse drug events. This direct observation study examined primary care interactions between patients, medical assistants, and physicians. The study aimed to characterize factors associated with medication agreement between the electronic health record and patient reports at the end of the visit. Less than half of patients reached medication agreement, consistent with prior studies. Investigators assessed multiple techniques to reach medication agreement, including looking at bottles, asking about each medication, and providing paper copy of the medication list. However, only one technique was significantly associated with medication agreement: the medical assistant asking an open-ended question to initiate medication review. This study did not examine patient engagement, which enhanced medication reconciliation in a previous study.