‘Teach back’ sends the right message both ways

We need to speak a language our patients understand. I’m not talking about cultural competence, although that is incredibly important. Rather, I’m talking about speaking in plain language to our patients about their diseases and treatments. We also need to ensure those in our care understand the information we’ve shared with them.

Several years ago, my family was on vacation and I found myself watching (at the behest of my then 13-year-old) "So You Think You Can Dance," or, as I learned, SYTYCD. Ordinarily, it would take a four-point restraint that would make The Joint Commission blush to get me to watch the show. I have nothing against dancing – I simply prefer sports or history for my viewing options. However, my daughter loves dancing and so we watched SYTYCD.

While watching the show, my wife and older daughter began talking about the various piercings and tattoos of some of the contestants.

On one level, the conversation completely freaked me out because, you know, my then 13-year-old daughter was discussing this stuff! On another level, though, I simply listened. I quickly realized their knowledge of this stuff was way beyond mine. They were basically talking another language and I was just along for the ride.

That moment made me think about some of the conversations we have with our patients and their families. Too often, we use language and terms familiar to us but completely foreign to those in our care. We talk at patients rather than with them and then wonder why our patients do not adhere to the plans we outlined.

At my former hospital, I was involved in a project to change this dynamic. Working with a talented multidisciplinary team, we started to change how we talked with our patients. We began having our patients "teach back" to us the information we needed them to know.

Using simple questions, teach back allows a provider to ensure the patient (or family member) truly understands the disease process, treatments, and follow-up plans. The lead-in is simple, but the questions are powerful – "To be sure I did a good job of explaining your medications to you, it will be very helpful to have you describe to me why you take your Lasix – your water pill." In framing the question this way, we change the dynamic, giving patients’ permission to say they do not understand what we tell them. We subtly increase the likelihood that the patient will view the relationship as a partnership where we are all working toward the same goal – the patient’s continued health.

Focus on speaking at the patient’s level of understanding – change your language as the situation warrants. I would describe heart failure very differently to a patient who worked as a nurse for 20 years than I would to my parents. It is not difficult – it simply takes practice and making a mental note to do it. It works. Look into the concept of teach back, and find situations to incorporate it into your care.

Let us speak a common language. Let us communicate with our patients.

Dr. Pistoria is chief of hospital medicine at Coordinated Health in Bethlehem, Pa. He believes that the best care is always personal.