Teach-Back Talks by Dr. Tim Goodheart

Teach-Back Talks 

This patient communication technique can reduce confusion and conflicts

by Dr. Tim Goodheart

Multiple studies have shown that 40%–80% of the medical and dental information patients receive is misunderstood, misinterpreted or immediately forgotten. Dentists and staff share information and instructions with patients all day long, and the idea that half or more of this information is improperly understood or forgotten is, at the 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 easiest 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.”

Making sure they’re “getting it”
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 believe it is widely used. Teach-back is an easy way to confirm that you’ve explained to the patient what they need to know, and that they have heard and understood you. Patient understanding is confirmed when they explain it back to you.

Additionally, teach-back can help dentists and staff identify which explanations and strategies are working best and which aren’t working well at all. It provides dentists and staff rapid feedback to know if they’re using too much lingo or being too vague, scientific or unclear, which allows us to immediately correct potential misunderstandings. We end up with fewer miscommunications, fewer errors and fewer ways for things to go off the rails.

Teach-back can be used in communicating treatment procedures and consents, home care and postoperative instructions, guidelines for taking medications, providing information to parents or caregivers responsible for elderly patients … the list is almost endless.

It’s easy for staff and doctor to learn, helps reduce our stress and lets patients participate and shoulder some of the load of their own care. We can reduce the instances of patients claiming they were not told something or that they didn’t 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 aren’t really understanding even though they’re saying, “Yes, uh-huh, yes, yes.” We think they’re 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 nonshaming way.
  • Teach-back is not a test of the patient, but a test of you and your communication skills.
  • It’s a chance to check for understanding before the patient leaves and to reteach or review any information, as needed.
Some examples of how you can use teach-back:
  • “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?”
  • “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?”
  • “Sometimes I feel like I’m not as clear in explaining things as I could be. Could you help me out and explain back to me what we’ve talked about today, so I can know I’m doing OK?”
This also creates an opportunity for more communication and dialogue. Perhaps an issue will come up you didn’t talk about and the patient has questions. It gives you a chance to rephrase information that the patient does not 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 videos that show the teach-back method in medical-based scenarios; it doesn’t take a lot of imagination to figure out how to apply the technique to our dental world.

Some might be thinking, “This is silly” or maybe, “I’m going to offend my patients.” I heard that from a couple of my team members, especially the “offending them” thing. 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.

Things to keep in mind
  • Any and all staff can use this technique whenever there are directions, instructions or information to pass on to a patient.
  • Use it with everyone, not just patients who seem to be struggling with your explanation. As I mentioned earlier, even people who appear to be following along often are not.
  • Studies show that many U.S. residents are illiterate or read at a low grade level. It’s not fair to just hand a pamphlet to people; they may not have the ability to read and comprehend. Very few, if any, people are going to tell us they don’t read well or understand what we’re telling them. We have the responsibility to provide the patient with information they can comprehend and understand.
  • Teach-back will help push dentists and team members toward simple, clear, plain and effective language in talking with patients.

A few last suggestions
  • Don’t 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’s called “chunk and check.” Teach two or three 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 like a schoolmaster trying to pound knowledge into a student, then you’ll 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. What better informed consent than the patient repeating back the information they need to know?

Examples of teach-back being useful
  • 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: “Haley tells me 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?”
  • For crown-and-bridge patients, after reviewing postoperative 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. Doing this can help to avoid the “Doc, your temporary came off” calls.
  • It’s particularly useful for medication and prescriptions, so patients know and understand how they are to take their medication.

These are just a brief couple of examples of routine things we all do each day; there are dozens more.

I’ve also used teach-back for pre- and postinsertion of full dentures and partials, postop of extractions, periodontal therapy instructions … any time you have information you 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 details. I think it’s a technique that absolutely has a place in dentistry. It’s simple for everyone 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.

In the end: Why use teach-back? “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 Risk, AMA, 2007)

Author Bio
Tim_Goodheart Dr. Tim Goodheart, a member of Dentaltown’s editorial advisory board, has owned a private practice in Raytown, Missouri, since 1994.
After graduating from the University of Missouri—Kansas City School of Dentistry, Goodheart completed a general practice residency at the VA Medical Center in Kansas City. He also earned an MBA from the Oklahoma State University Spears School of Business.
He is a fellow of the Academy of General Dentistry, a member of the American Dental Association and, as “Timmy G aka Nowhere Man,” an administrator and frequent poster on Dentaltown’s message boards. Email: tgoodheart@goodheartdental.com
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