Teach-Back: A Simple Technique to Enhance Patients’ Understanding

 

Half of patients leave their visit without understanding what their physician told them, but this simple technique can help.

Fam Pract Manag. 2018 Jul-Aug;25(4):20-22.

Author disclosure: no relevant financial affiliations disclosed.

Think of the last time you gave instructions to a patient, particularly when it involved medication adherence. You may have said, “I’d like you to take this pill every morning after breakfast. Do you understand?” The patient probably answered “Yes.” But were you sure the patient understood and would remember how and when to take the medication? Of course not. Many patients will say they understand even if they are not sure. Three studies have found that 50 percent of patients leave their medical visit without understanding what their physician told them.1 According to the Agency for Healthcare Research and Quality, patients immediately forget between 40 percent and 80 percent of the medical information they receive during office visits, and almost half the information they do retain is incorrect.2 When it comes to hospitalized patients, a substantial percentage do not understand their plan of care, and physicians frequently overestimate how well patients understand their discharge plans.3

KEY POINTS

  • Patients often leave their visits not understanding or remembering their physicians’ instructions, even when they say they do.

  • The teach-back technique ensures patient understanding by asking patients to repeat their physicians’ instructions in their own words.

  • Despite evidence that use of teach-back benefits patient outcomes, many physicians do not practice the technique because of a lack of training, concern for time constraints, or fear the patient will take offense.

A SIMPLE SOLUTION

Teach-back is one solution to this common problem. Also called “closing the loop,” this technique involves assessing a patient’s understanding of your recommendations by asking the patient to repeat your recommendations in his or her own words.2 For example, you could ask, “Just to be sure I was clear, how will you take your new medicine?” If the patient’s explanation is not correct, repeat the recommendation and then ask him or her to explain it again. To perform teach-back effectively, you must keep asking your patient to repeat your instructions until he or she can describe them accurately. (See “How to use teach-back with patients.”)

This technique is effective in improving not only medication adherence but also patient understanding of diagnoses, prognoses, physical rehabilitation, and care options,

ABOUT THE AUTHOR

Dr. Bodenheimer is the founding director of the University of California-San Francisco Center for Excellence in Primary Care.

Author disclosure: no relevant financial affiliations disclosed.

References

show all references

1. Bodenheimer T. A 63-year-old man with multiple cardiovascular risk factors and poor adherence to treatment plans. JAMA. 2007;298(17):2048–2055....

2. Brega AG, Barnard J, Mabachi NM, et al. AHRQ Health Literacy Universal Precautions Toolkit, 2nd ed. Agency for Healthcare Research and Quality Publication No. 15-0023-EF. Rockville, MD:AHRQ; January 2015.

3. O'Leary KJ, Kulkarni N, Landler MP, et al. Hospitalized patients’ understanding of their plan of care [published correction in Mayo Clin Proc. 2010;85(2):205]. Mayo Clin Proc. 2010;85(1):47–52.

4. Schillinger D, Piette J, Grumbach K, et al. Closing the loop: physician communication with diabetic patients who have low health literacy. Arch Intern Med. 2003;163(1):83–90.

5. Turner T, Cull WL, Bayldon B, et al. Pediatricians and health literacy: descriptive results from a national survey. Pediatrics. 2009;124 Suppl 3:S299–305.

6. Howard T, Jacobson KL, Kripalani S. Doctor talk: physicians’ use of clear verbal communication. J Health Commun. 2013;18(8):991–1001.

7. Wolf MS, Baker DW, Makoul G. Physician-patient communication about colorectal cancer screening. J Gen Intern Med. 2007;22(11):1493–1499.

8. Kemp EC, Floyd MR, McCord-Duncan E, Lang F. Patients prefer the method of “tell back-collaborative inquiry” to assess understanding of medical information. J Am Board Fam Med. 2008;21(1):24–30.

 
 

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