Communication is an essential aspect of medicine. Doctors can’t make the correct diagnosis if they don’t understand what the patient is telling them about the problem. Patients may not follow through on the treatment plan if the doctor doesn’t communicate it clearly. Language barriers are sometimes to blame, of course, but basic communication skills may also be lacking. Could patients benefit if doctors learn to teach?
Where Doctors Learn to Teach:
A program at Boston University Chobanian & Avedisian School of Medicine has tested this idea and found it useful (Medical Science Educator, Dec. 14, 2023). Educational Fellows are medical students who act as teaching assistants in the Physician Associate curriculum. This “near-peer” practice offers med students a framework for best practices in both teaching and learning. As a result, the future doctors learn to teach.
The doctors directing the program believe that these individuals then do a better job explaining diagnoses and proposed treatments to patients. One of the communication skills that they could utilize in clinic is actually called “teach-back.” For the doctor, it consists of summarizing the patient’s concerns and asking if they have missed any important points. They also can use this technique by asking the patient to verbalize the treatment plan. If these med students become surgeons, they should be better equipped to explain complex procedures and assess whether the patient has understood the proposed intervention.
Communication Gaps Put Patients at Risk:
Presumably the innovators at Boston University are aware of decades-old research showing that poor communication can interfere with good health care. A study in Connecticut found that about 60 percent of elderly heart failure patients did not have adequate information when they left the hospital on how to take their medicines (Journal of General Internal Medicine, Nov. 2012). In addition, nearly one fourth of them were given the wrong prescription or the wrong instructions when they were discharged. Better communication might help people stay healthier at home after leaving the hospital.
When Will Doctors Learn to Teach?
We would hope that hospitals have learned to communicate more clearly when patients leave the hospital. A study published last year suggests we may be overly optimistic. A quality improvement study conducted between 2018 and 2019 in two large city hospitals analyzed the education patients received about their conditions prior to discharge (JAMA Internal Medicine, May 1, 2023). Although 33 patients participated in this study, only one patient was asked to teach back his understanding of the discharge plan. Health care providers failed to tell four-fifths of patients about red-flag signs that should trigger a call or emergency visit. Not surprisingly, the investigators conclude that the hospital discharge process should be improved. Perhaps that will be easier once doctors learn to teach.
Some hospitals have already begun to use teach-back communication skills as an essential part of their error reduction programs. Others have been experimenting with OpenNotes, in which patients can read what the doctor has written about them.
Learn More:
If you would like to learn more about the questions to ask and how to get the information you need at critical junctures such as discharge from the hospital, we suggest our book, Top Screwups Doctors Make and How to Avoid Them. In it, we discuss how to stay safe in a wide range of health care situations. After all, doctors are not the only ones who could make a mistake! The book is available in libraries, bookstores and online.
In addition, you may wish to listen to our interview on this topic with Dr. Danielle Ofri. It is Show 1088: How Good Communication Makes Health Care Better. Dr. Ofri communicates extremely well.
