'Teach back' technique improves patient safety

Good physician-patient communication does much more than eliminate the need for repeated visits. Effective communication has been demonstrated to result in better outcomes, greater patient satisfaction, and decreased likelihood of lawsuits.

An approach called "teach back" is one that can greatly improve provider-patient communication, according to the U.S. Department of Veterans Affairs (VA) National Center for Ethics in Health Care and the National Quality Forum, which listed teaching back as one of its 30 safe practices for improving patient safety.

Asking open-ended questions (rather than yes/no questions) and repeating patients' questions or comments back to them are common tools for good communication during patient encounters. However, striking the right balance between knowing what information patients want or need and the physician's skill at delivering that information can be hard to do. The VA Center for Ethics says that a recent study found that 37% of patients reported understanding what they were told during medical visits, while the physicians of those same patients thought that 80% of the patients understood.

Asking the patient "Do you understand?" is one way to approach finding out if the patient does, indeed, understand; however, that head-on questioning can make the patient feel uncomfortable and may elicit a positive response when, in fact, the patient really is not sure he or she understands.

Teaching back is simply the practitioner asking the patient to tell what he or she understands has been discussed. For example, after going over a new medication, the physician might ask, "Now, I want to be sure I was clear in explaining this to you. Can you tell me what you understand the instructions and dosage are for your new medicine?"

The National Quality Forum found that teaching back is especially helpful when the patient has a low health literacy, has a cognitive impairment, or has limited proficiency in English.

Some suggestions from the National Quality Forum include:

  • Have patients explain, in their own words, their diagnosis or the medical condition that they have sought care for;
  • Describe the nature of the treatment or procedure, including the risks, benefits, and any alternatives that have been discussed;

Don't ask yes/no questions such as "Do you understand?" or "Do you have any questions?"


For more information:

  • U.S. Department of Veterans Affairs National Center for Ethics in Health Care ,"Teach back: A tool for improving provider-patient communication," at www.ethics.va.gov.
  • National Quality Forum, "Improving patient safety through informed consent for patients with limited health literacy," at www.qualityforum.org.