“Teach-Back”–a solution to verify understanding

Verify understanding with Teach-Back

Verify understanding with Teach-Back

My last post concluded with the question, “What communication tool used by airline pilots is identical to a tool that should be used by all healthcare providers? What I should have said for even more emphasis is “What communication tool is always used by airline pilots…”

Pilots call their tool “read back.” They always use “read back” to make sure they understand the information the air traffic controller (ATC) is transmitting (air speed, runway number, etc.). Accomplishing this task is relatively simple, quick and effective. The pilot simply repeats back to the ATC what he/she heard the ATC say. And then the ATC corrects any misunderstanding. Long ago it was recognized that accuracy of information exchange between the two participants was vital. When one party is thousands of feet in the air, it wasn’t difficult to figure out that miscommunication could have disastrous consequences.

If an accident should occur, the aviation industry undertakes a special investigation to determine its cause. Even with “read back,” miscommunication can still occur. By reviewing conversations from the airplane’s black box, if miscommunication did occur, the industry develops training procedures to decrease the chances of re-occurrence. That’s why commercial flying is one of the safest ways to travel—mistakes are corrected and “read back” is always used.

When you’re talking with your doctor, confirming understanding is also vitally important because the consequences—for you—can be as disastrous as a plane crash. That’s why health literacy experts provide communication training to doctors with their version of “read back;” they call it “teach back.” Unfortunately, this readily available communication training is drastically underutilized by doctors, and procedures are not in place to analyze, review, and correct miscommunication to prevent re-occurrence. Sometimes the courts become involved in malpractice cases and the cause and effect of miscommunication are determined, but follow up is limited—if any.

What your doctor is coached to say during communication training is some version of, “Tell me in your own words what I just said.” As you know, your doctor will do most of the talking in his (for simplicity, I will always refer to your doctor as “he”) office and he is supposed to initiate “teach back.”

So you must then ask the question, if my doctor doesn’t or won’t use teach back to verify if I understood what was said during my office visit, how can I fix that? And the answer is that YOU can initiate teach back—patient-initiated teach back. When your doctor asks “Did you understand what I said?” or “Do you have any questions?” or even if the questions aren’t asked, you can say, “Doctor, what I understood you to say was…” You then repeat back what you thought your doctor said. And then if you get something wrong during your repetition, he will correct you—and misunderstanding is prevented. Mission accomplished.

You need to understand that normally patients stay silent when asked the previously mentioned questions. Usually it’s because they’re embarrassed that their doctor may think they’re not very bright because, after all, they didn’t understand simple, plain language; which may or may not have been used. Or they may think that they may embarrass their doctor by saying something and implying that their doctor is not a good communicator (which may truly be the case).

What you’re doing when you reply as I’ve suggested, is showing that you’re inquisitive and thoughtful. And that you were paying attention to what your doctor was saying. Everyone, including your doctor, finds it appealing when they realize someone is actually listening to what they say.

Use patient-initiated teach back whenever appropriate and make sure you’re practiced those eight words at home so they roll off your inquisitive and thoughtful tongue when needed. If you care to go even one step further to improve your doctor’s communication, I’ve written the following letter you can share with your doctor’s office. Just copy and paste.

In my next blog post, I’ll discuss how to best prepare yourself for an office visit and some of the reasons you may unknowingly set yourself up for failure-to-understand during your visit.


Dear Dr…, thank you for the care I’ve received from you over the years. One of the reasons I’m one of your patients is that I’m convinced you have a high level of medical expertise and you’re motivated to keep yourself up to date in the health care    arena.  I understand that it’s impossible to keep abreast of all the new advances in medicine, especially advances not directly focused on the science of the treatment of diseases. 
I’ve recently become informed of the remarkable value of one of those advances not directly related to medical science. It’s concerned with doctor-patient communication. As you know, effective communication is vital to good outcomes based on your medical recommendations.  The advance I’m referring to is called Teach-Back and it’s used to verify patient understanding. Healthcare communication experts suggest that doctors refrain from saying, “Did you understand,” or “Do you have any questions,” and instead ask their patients to restate in their own words what you have just said.
I would like our doctor-patient relationship to become even better. I’m confident you’ll carefully consider the thoughts in this note as an avenue towards that goal. I’m hoping you will implement this new communication strategy for my benefit and the benefit of all   your patients.    

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