“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?”
Now it’s the patient’s turn. In repeating back what they have heard and retained, you now can immediately know how successful you’ve been in communicating with them.
Perhaps an issue will come up you did not talk about and the pa- tient has questions. It gives you a chance to re-phrase information that the patient cannot repeat accurately. 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.
Some of you may be thinking “This is silly.” Or maybe, “I’m going to offend my patients.” I heard that from my staff in the beginning. Your attitude and approach will absolutely 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. The key is that this has to be in a non-shaming manner. 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 directions or concepts.
Use it with everyone, not just the person that seems to be struggling with your explanation. As I mentioned above, even the people who appear to be following along, often are not.
Any and all staff can use this technique, any time there are di- rections, instructions or information to pass on to the patient.
Studies show that a fair portion of people in the U.S. are, sadly, functionally illiterate or read at a low grade level. People develop great coping skills and hide this. It’s not fair to just hand out a lengthy pamphlet or sheet to people, as they may not have the abil- ity to read and comprehend. Likely, very few 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 staff toward simple, clear and effective language in talking with our patients.
A few suggestions regarding Teach-Back:
Do not ask yes/no questions such as “Do you understand?” or “Does that make sense?” Many people will be too embarrassed to ask you to repeat instructions.
For more than one concept or highly detailed information use what is 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 as a school- master 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 ISSUE 5 | SEP/OCT 2014 | focus 45
tool for risk management, informed consent and chart docu- mentation. Use it to your advantage. What better informed consent then the patient repeating back the information they’ve been told and need to know?
Here are just a few examples in which I’ve found Teach-Back to be useful.
Home Care. When the hygienist cues me before I do the hy- giene 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 than she’d like. So that I can know that she’s telling you what you need to know about brushing and cleaning your mouth to make things bet- ter, can you tell me what you and she discussed about cleaning your teeth at home?
For the C/B patient, after reviewing post-op instructions. “So that I can make sure I did a good job of explaining your tempo- rary 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 “My temporary came off” calls.
It’s particularly useful for medication and prescriptions so the patient knows and understands how they are to take their medication.
I’ve also used Teach-Back for pre and post insertion of full dentures and partials, post-op with extractions, periodontal therapy instruc- tions—any time you have information to want to get to the patient and be confident they’ve heard you. Obviously there are dozens more situations for Teach-Back use.
I think it’s a technique that absolutely has a place in dentistry. It’s simple for all to use—dentists, assistants, hygienists—and with just a little imagination, it’s easily used in many situations in the dental office. I hope with this short article I’ve gotten at least a few of you interested in using Teach-Back. There are many sources of great information on the Internet found with a simple search.
In summary … “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 f
DR. TIM GOODHEART (UMKC 93) has a general dental practice in Raytown. He can be reached at 816-353-0673 or
tg4dk@sbcglobal.net.
REFERENCES
www.HealthcareInsight.org Aug 2012.
www.ihconline.org, Why Teach-Back, Iowa Healthcare Collaborative, June 2013.
www.teachbacktraining.org, Always Use Teach-Back, 2014.
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56