Language is key at the doctor’s office. Improving physician-patient communication can have huge benefits. In fact, an AHRQ study found that after implementing a health literacy initiative to improve providers skills at UAMS, patients self-management of disease, for instance, improved by almost 25%. Health literacy is the ability to access, understand, and use information to make health-related choices. It is a dynamic state. Providers skills and system support, including the use of plain language, play an essential part in successful communication. Not long ago, health literacy was viewed as general literacy applied to medical decisions, but even a person with a PhD can be overwhelmed by a diagnosis and the choices they have to make.
I am a health literacy expert helping providers improve their use of plain language. The interesting thing is that some of the same techniques I teach for doctors and other providers can be turned around and used by patients to advocate for themselves.
My favorite is the “teach-back” technique. It is an educational tool used by healthcare providers to help patients or care takers understand what is being explained to them. It is an interactive and far more effective version “Do you understand?”
Providers use this technique to assess a patient’s recall and understanding of concepts just discussed. If the patient is not teaching back correctly or completely, then the provider restates or and rephrases the message and asks the patient to “teach-back” again. This process continues until it is clear that the patient understands. Providers are encouraged to pay attention to body language, to not be satisfied with an answer that is just “ok,” and to reinforce the learning by repeating key content.
Well, a patient can also pay attention to those three factors and turn the teach-back around on doctors. When you, as a patient, feel frustrated that the doctor is dismissive of your symptoms, stop and repeat yourself. Don’t say to the doctor, “I feel this or that, you know?” Instead, ask them to describe your symptoms in their own words, “How would you describe what I just said?” Engage the doctor in your story the same way you would engage a friend in a conversation about your favorite TV show. Rephrase “What do you think about so and so doing this or that?” to “What do you think about my feeling this or that?” Of course, “this or that” means whatever symptom you are describing to the doctor: pain, discomfort, fatigue, sadness, anger, whatever it is.
You can also engage and take advantage of the doctor’s nerdy side. Ask, “Is there a name for this?” Doctors love to turn on their inner vademecum” (A vademecum is a sort of medical dictionary you often see at doctor’s offices that is kept at hand for consultation.) You may even volunteer a name or two if you have found terms you fear apply to you. (This said, don’t bring to the doctor every diagnosis name you can find for “cough, sore throat, and runny nose.” Share your honest concern.) As a patient, though, also resist the temptation to jump to conclusions about your symptoms from what you read online. Take a deep breath and share your anxiety with your doctor. You can even ask them to teach you back if they get that, “Have you seen other patients who feel this anxious about this symptom?”
As a side note, consider that hopping from doctor to doctor if your symptoms persist can hinder a diagnosis. Lasting symptoms can be a huge clue to figure out what is going on, and while doctors ask “How long have you had those symptoms?” the “show, don’t tell” approach might work in your favor.
Overall, remembering that health care is a dialogue and health literacy is a shared responsibility is a huge step towards better health outcomes. It helps providers up their communication skills, and patients feel empowered to take control of their care, especially when dealing with fear or uncertainty. Using the teach-back technique to confirm a doctor’s understanding of your concerns as a patient can be as effective as a doctor using the technique to confirm your understanding of their explanation or instructions.
