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How can health care professionals improve verbal communication with patients and families?
The average consumer is not familiar with health terminology and does not think about health information in the same way as health professionals. Patients don’t understand or forget at least 50% of what is discussed in a typical office visit.15
There are many simple techniques to improve verbal health communication, such as
- assessing patients’ baseline understanding
- using plain language
- effectively soliciting questions
- using teach-back to confirm understanding
- focusing on a few key points
- giving patients clearly written information to take home
Assess patients’ baseline understanding before providing extensive information. This allows the explanation to be tailored to the patients’ needs.
- Example: For a patient just diagnosed with diabetes, you can state, "before we go on, could you tell me what you already know about diabetes?"
Explain things clearly in plain language.
- Avoid medical jargon. Example: Say "chest pain" instead of "angina" and "high blood pressure" instead of "hypertension."
- Avoid vague statements that require interpretation. Example: Don’t say, "You should get some aerobic exercise." What is "some"? What is “aerobic”? Instead be specific by saying, “Since you enjoy walking, I’d like you to try walking for 30 minutes each day, 3 or 4 times a week. Walk fast enough to break a light sweat, but not so fast that you can’t carry on a conversation.”
- Avoid terms that have different meanings in medicine and normal conversation, such as “stool,” “gait,” or “negative.” Example: Don’t say, “Your biopsy was negative for cancer.” Say, “Your biopsy was normal. You don’t have cancer.”
When you ask patients for their questions, use an open-ended approach.
- Example: If you ask, “Do you have any questions?” it’s easy for patients to simply say, “No.” Instead, ask, “What questions do you have?”
Confirm understanding through teach-back. This involves asking the patient to repeat back their understanding of the information you have discussed. Teach-back can also be used to confirm that the patient can demonstrate a new skill. Teach-back takes about 1 minute, and it is one of the most important things you can do when counseling patients. There are a few key steps to performing an effective teach-back.
- First, make it normal, so the patient does not feel singled out. Example: “I do this next part with all my patients.”
- Second, put the burden on your shoulders. It’s your job to have explained things clearly. Example: “I want to be sure I explained things clearly today.”
- Third, be specific about what you would like the patient to tell you. Example: “We talked about starting a new medicine today. Please tell me your understanding of why it’s important… Ok, now please tell me your understanding of how to take it.”
- Fourth, if the patient’s explanation is insufficient, put the burden on your shoulders, reteach the information, and reassess understanding. Example: “I must not have explained that very well. The new medicine is for… I’d like you to take it… Now, let’s see I did a better job explaining it that time. Could you please tell me again what the new medicine is for, and how you should take it?” When the patient teaches back the information correctly, this is called closing the loop.
- Teach-back can also be used to assess a skill. Example: “Please show me how you would use this inhaler.”
- Focus on a few key points. It is very difficult for patients to remember more than this. Emphasize those points through repetition and teach-back.
- Give the patient written information or instructions to take home. Writing down a few key points or providing good quality educational materials is very helpful for reinforcement.
15Kessels RP. Patients' memory for medical information. J R Soc Med. 2003;96(5):219-222.