Help Patients Understand Your Instructions with the ‘Teach-Back’, ‘Show-Me’, and ‘Ask Me 3’ Method

A growing body of research demonstrates that patients recall and comprehend less than half of what clinicians explain to them. A good way to help confirm your patients’ actual level of understanding is to incorporate the ‘teach back’ (also referred to as the ‘show me’ or ‘closing the loop’ method). The ‘teach-back’ method involves asking your patients to repeat in their own words what they need to do when they leave your office. It helps confirm the patient understands the information the care provider has imparted.

Steps to conduct the ‘teach-back’ method:

• Clinician explains or demonstrates the concept
• Clinician assesses patient recall and comprehension by asking the patient to demonstrate
• Clinician clarifies and tailors the explanation
• Clinician re-assesses recall and comprehension
• Patient recalls and comprehends by demonstrating

This error reduction method will let you know immediately if there is any misunderstanding of your medical instructions and help improve patient understanding and adherence to disease management. For example, you could say, “Can you show me how you are going to do this when you get home?” If your patient is not able to repeat the information accurately, try to rephrase your instructions.

The Agency for Healthcare Research and Quality (AHRQ) has valuable tools on the ‘teach-back’ method. AHRQ reports studies have shown that 40-80 percent of the medical information patients are told during office visits is forgotten immediately and nearly half of the information retained is incorrect.[1]

How the ‘teach back’ method helps:

• The ‘teach-back’ method is not a test of the patient’s knowledge. It is a test of how well you explained the concept.
• How will you ask your patients to teach back the information? For example: “Can you describe three things you agreed to do to manage your hypertension?”
• Give small segments of information and don’t wait until the end of the visit to initiate ‘teach-back’.
• If there is a misunderstanding, explain things again using a different approach. Ask patients to teach back until they are able to correctly describe the information.

It is also recommended that you use the ‘show me’ method, which confirms the patient understands the information the care provider has imparted. It closes the communication gap between the provider and patient by using a patient-centered communication approach.

You can also encourage your patients to use the ‘Ask Me 3’ approach, which is a patient education ‘teach-back’ program that encourages patients to ask their health care providers three questions. The National Patient Safety Foundation encourages patients to understand the answers to these three questions and for clinicians to answer those questions at every visit:

1. What is my main problem?
2. What do I need to do?
3. Why is it important for me to do that?

Understanding health instructions helps people to make fewer mistakes and manage chronic health conditions. You can download “Ask Me 3” materials free of charge here.

Regardless of a patient’s health literacy level, promote the use of teach-back to your staff to ensure that patients understand the information they have been given. Successful education can improve health outcomes, decrease health care costs, reduce hospital readmission, and improve patient satisfaction.

Author Diana Douglas (CPHRM) is Vice President of Risk Management and Patient Safety for the Cooperative of American Physicians, Inc. (CAP).

If you have questions about this article, please contact us. This information should not be considered legal advice applicable to a specific situation. Legal guidance for individual matters should be obtained from a retained attorney.