An average visit to a primary care doctor addresses about three primary complaints, like back pain, blood pressure, fatigue, cough, and the like. Each of those problems may have a pretty complex workup and therapeutic plan, so it is no surprise that people often leave their doctor’s office with a muddled idea of what they’re supposed to do next. Forty to eighty percent of what is discussed in doctor’s visits is forgotten immediately, and almost half of the information retained is incorrect. To fight this problem, Medicare (CMS) requires that doctors supply a summary of the visit on paper within three business days of the visit, but the summaries generated by many electronic health records are jumbled messes of computer-generated tech-speak gobbledygook. Some patients go so far as to secretly record medical visits, a practice that has been condemned by people within and outside the medical community. But, sensing an opportunity, clever apps to facilitate consensual recordings, like Abridge, have cropped up.
But less tech-oriented doctors are interested in a more analog method called “teach-back.” You may know this better as how you make sure your teenagers have heard you when you ask them to mow the lawn; the phrase “repeat what I just said” may ring a bell. But don’t be insulted if your doctor uses the same technique with you. Entire websites and continuing medical education enterprises have been built on teaching it.
Recently, investigators writing in the Journal of Primary Care & Community Health analyzed six years of data on 2,901 patients with diabetes from the Medical Expenditure Panel Survey (MEPS), a data collection of access, utilization, and payments for American patients. They were able to link the MEPS data to data on hospital inpatient stays. They specifically looked for two pieces of information about doctor visits: 1) did the patient receive medical instruction which was easy to understand, and 2) was the patient asked to describe how to follow the instructions given. If both answers were “yes,” the patient was designated as having had a “teach-back experience.”
To determine the quality of the patient-doctor interaction that went along with these teach-backs, they looked for several questions that looked into patients’ perceptions of the provider’s listening, respect, time utilization, and the patient’s “global satisfaction.” And, if the survey data showed that the provider helped decide between treatment options and showed respect for the patient’s preference, “shared decision-making” was believed to have taken place.
Finally, patients were asked about their perceived confidence in their diabetes treatment plan, and the likelihood of having complications (like eye, heart, or kidney problems) or hospitalization related to diabetes within two years was calculated.
What the investigators found was encouraging. Patient teach-back experiences were associated with a lower risk of hospitalization, a higher perceived interaction quality with the provider, more shared decision-making, and a higher likelihood of lifestyle advice having been given. Patients who’d “taught back” to their provider were more confident in their treatment plan.
So the next time you get a set of instructions from your doctor, take a second and ask her, “Let me repeat that back to you in my own words.” If she affirms that what you just said is true, you’re in good shape. If what you say back to her doesn’t quite match what she intended, you’ll both walk out of the visit having learned something.
As the Medical Director of the Kansas Business Group on Health, I’m sometimes asked to weigh in on hot topics that might affect employers or employees. This is a reprint of a blog post from KBGH.