Researchers tested three types of inquiry about the patient’s understanding:
1. Yes-No
2. Tell Back-Directive
3. Tell Back-Collaborative
The Yes-No approach asked closed-ended questions to assess patient understanding. (Example: “I’ve given you a lot of information. Do you understand?”)
The Tell Back-Directive method used open-ended questions that were physician-centered and paternalistic in that it was clear authority and control still remained with the physician. (Example: “It’s really important that you do this exactly the way I explained. What do you understand?”)
The Tell Back-Collaborative approach used openended questions that were patient centered, making it clear that power and responsibility were shared between the health care provider and patient. (Example: I imagine you are really worried about your blood pressure. I’ve given you a lot of information. It would be helpful to me to hear your understanding about your clot and its treatment.)
Patients showed a significant preference for the Tell Back-Collaborative inquiry over other tested approaches. Because of the potential for embarrassment if patient misunderstandings are exposed, one might anticipate health care providers’ reluctance to put patients “on the spot” with open-ended questions.
But a collaborative approach to Tell Back allows the patient to save face for misunderstandings by acknowledging the large amount of information being provided. Patients might also view the request for Tell Back as evidence of the health care provider’s care and concern for them personally, or evidence of the provider’s attention to detail and competence.
So, when counseling patients about their medications, instead of asking “Do you have any questions?” or “Do you understand?” ask them to restate their understanding of the information you provided in their own words within a shame-free, blame-free environment.