Using Teach-Back to assist with patient communication.

 ...Hello All. Wanted to make a small contribution, best as I can, to the forum. I've posted below an article I recently wrote for my state dental association newsletter on the Teach-Back method for patient communication. I hope it might prove to be useful to some.  Best wishes from Midwestern USA----Tim

Teach-Back Method

Multiple studies have shown that 40-80% of the medical/dental information patients receive is misunderstood, misinterpreted or immediately completely forgotten. Dentists and staff are constantly sharing information and instructions with our patients all day long and the idea that half or more of this information is improperly understood or forgotten is at the very least a source of frustration. At the most it can be the cause of serious doctor-patient conflicts or lead to serious danger to the patient.

One of the simplest and easist ways to significantly reduce that 40-80% number in the communication gap is the use of the "teach-back" method, also known as the "show-me" method or "closing the loop". Teach-back has been used in the medical arena for many years with great success. Perhaps some dentists and offices are using it but I don't think it is widely used. Teach-back is a very easy way to confirm that a) you have explained to the patient what they need to know and b) that the patient has heard AND understood you. Patient understanding is confirmed when they explain it back to you.

Additionally, it can also help dentists and staff to identify what explanations and strategies are working best and those that aren't working at all well. It provides dentists and staff immediate feedback to know if they are using too much "lingo" or being too vague, scientific or unclear. The feedback is rapid, allowing us to immediately correct potential misunderstandings.

In the end, we end up with fewer miscommunications, fewer errors and less ways for things to go off the rails.

Teach-back can be used in communicating treatment procedures and consents, home care instructions, instructions for taking medications, post-op instructions, providing information to parents or caregivers responsible for elderly patients—the list is almost endless. It's very easy for staff and doctor to learn and ultimately helps to reduce our stress and let the patient participate and shoulder some of the load in their own care. We can reduce the instances of a patient claiming they were not told something or that they did not understand.

I've been using teach-back in my office for several months now and I'm consistently amazed at how many times people flat-out aren't listening or are not really understanding even though they are saying "Yes, uh-huh, yes, yes".We think they are getting it when they are not.

What is Teach-Back?

Teach-back is:

• Asking patients to repeat in their own words what they need to know or do and doing so in a non-shaming way.
• Teach-back is NOT a test of the patient but is a test of YOU and your communication skills.
• It's a chance to check for understanding BEFORE the patient leaves and re-teach or review any information, as needed.

Here are some examples of how you can use Teach-Back:

"I want to be sure I explained everything clearly. Can you please explain back to me what you heard me say, so I can be sure I did a good job?"

"We've gone over a lot of information today. Just so I know I didn't miss anything let's review what we've discussed. Can you tell me what we've talked about so I know I've gotten it right?"

"Sometimes I feel like I'm not as clear in explaining things as I could be. Could you help me out and please explain back to me what we've talked about today, so I can know I'm doing okay?"

This also creates an opportunity for more communication and dialogue. Perhaps an issue will come up you did not talk about and the patient has questions. It gives you a chance to re-phrase information that the patient cannot repeat accurately or forgets. Lastly, if the patient still doesn't understand, you get the chance to try a different strategy. Perhaps involve a spouse, parent or other family member or use some other form of communication—models, drawings, etc.

There are many, many videos showing the teach-back method in medical based scenarios. There is also a great deal of printed information regarding teach-back methods that are easily found on any internet search.

Some might be thinking "This is silly." Or maybe "I'm going to offend my patients." I heard that from a couple of my staff, especially the "offending them" remark. Your attitude and approach will 100% make the difference in how this is received by the patient. It's important to relate that this is about how YOU are succeeding at communication, not the patient.

Here's what to keep in mind.

• This is not a test of the patient's knowledge. This is test of how well YOU explained the concept.
• Use it with everyone, not just the person that seems to be struggling with your explanation. As I mentioned above, even the people that appear to be following along, often are not.
• Any and all staff can use this technique. Any time there are directions, instructions or information to pass on to the patient.
• Studies show that a fair portion of people in the USA are sadly illiterate and many more read at a fairly low grade level. People develop great coping skills and hide this. It's not fair to just hand out a pamphlet or sheet to people, as they may not have the ability to read and comprehend. And obviously very few if any people are going to tell us they don't read well or understand what we are telling them. We have the responsibility to provide the patient information that they can comprehend and understand.
• Teach-back will help push dentists and our staff toward simple, clear, plain and effective language in talking with our patients.

A few last suggestions regarding Teach-Back:

• Do NOT ask yes/no questions such as "Do you understand?" or "Is there anything else?" Many people will be too embarrassed to stop you or ask you to repeat instructions.
• For more than one concept or really detailed information use what is called "CHUNK AND CHECK".Teach 2 or 3 main points, check for understanding with Teach-Back, then go on to the next concept.
• Use a caring tone and attitude. If you approach it as a schoolmaster trying to pound knowledge into a student, then you will offend and it will fail. That's a user error, not a technique problem.
• Document use and response of Teach-Back. This is a terrific tool for risk management, informed consent and chart documentation.Use it to your advantage. What better informed consent then the patient repeating back the information they need to know?

Just a few examples or ways I've found Teach-Back to be useful.

1. Home Care. When the hygienist cues me before I do the hygiene check that the patient is not doing well with home care and she has reviewed HCI I'll say something like:"So Haley tells me that your gums are a little redder then she'd like. So that I know that she's telling you what you need to know about brushing and cleaning your mouth to make that redness get better and go away, can you tell me what you and she talked about for cleaning your teeth at home?
2. For the C/B patient, after reviewing post-op instructions. "So that I can make sure I did a good job of explaining your temporary instructions, can you repeat back to me what you should and shouldn't do while the temporary is on?"Very often people won't get even half of this right. Do this can help to avoid the "Doctor--Your temporary came off" calls.
3. It's particularly useful for medication and prescriptions so the patient knows and understands how they are to take their medication.

This is just a very brief couple examples of routine things we all do each day. Obviously there are dozens more.

I've also used Teach-Back for pre and post insertion of full dentures and partials, post-op after extractions, periodontal therapy instructions—any time you have information to want to get to the patient and know they've heard you.

There is a ton of information about Teach-Back on the Web. A Google search will find more information. I think it's a technique that absolutely has a place in dentistry. It's simple, easy for all to use-dentists, assistants, hygienists- and with just a little imagination, easily used in many situations in the dental office. I hope with this short little article, I've gotten at least a few of you interested in using this.

I particularly like this quote:

"It is neither just, nor fair, to expect a patient to make appropriate health decisions and safely manage his/her care without first understanding the information needed to do so."

Reducing the RiskAMA, 2007