Teach Back as an Effective Patient Education Tool

June 26, 2014


by Edward Leigh, MA

A patient tells you they understand everything you said about their treatment plan.  You feel good about this patient visit and are ready to close the meeting.  The patient stated they understood, but did they really?

Problem with “Do you understand?” question

There are serious issues associated with the question, “Do you understand?”  Just because the patient says, “Yes,” does not mean they truly understand.  How can you be sure they understand? Use the powerful “teach back” method.

Teach back is a powerful communication tool to assess a patient’s understanding. After the professional shares new medical information with the patient, the patient is asked to “teach back” what they just heard, verbally or in the form of a demonstration. This allows the professional to correct misunderstandings and provide additional information, if necessary. (In some cases, the patient’s caregiver may be the person “teaching back” the information.)

Factors to consider

If the teach back strategy is not properly set up it could actually backfire leading to a worse patient experience.

Patients may feel you are questioning their intellectual abilities. I have interviewed thousands of patients regarding their experiences with healthcare professionals.  For example, I asked one patient if she was familiar with teach back. She stated she was not familiar with the strategy. She also asked, “Is that for people with learning disabilities?” Upon further discussion, she said if a healthcare professional asked her to repeat back what she heard, she would feel that they think of her as dumb. This example illustrates that the set up to the discussion is critical.  It is vital that patients know the strategy is useful for everyone.

This strategy is not a like a pop quiz you had in school. Don’t simply tell a patient, “Repeat back what I just said!”  This comment will put them on the spot and cause anxiety.  They will feel like a school kid who was just told to clear their desk for an unannounced pop quiz.

To avoid these potential issues, ask the patient certain types of questions. View sample questions in the next section.

Sample of open-ended questions to assess understanding

There are many ways to assess patient understanding via teach back. The questions below provide a friendly and comfortable manner to assess understanding.

Focus on “I” Language. It is important to remember teach back is a way to test our abilities at explaining. In other words, we are actually testing ourselves, not the patients. Using “I” language takes the stress off the patient.

  • “I want to be sure I explained everything clearly. Can you explain it back to me so I can be sure I did?”
  • “Please show me how you will use the device, so I can be sure I have given you clear instructions.”

Focus on how they would tell other people in their lives.

  • “How would you describe your health condition to a friend?”
  • “When you get home and your spouse asks about your treatment plan – what will say?”

Possible reasons for patients not being able to teach back

If the patient is not able to repeat back their medical situation this may be an indication the professional needs to rework their teaching approaches. There could be several factors reducing the ability of a patient to teach back.

Excessive use of medical jargon. If patients do not understand what professionals are saying, they will not be able to repeat back what was said to them. Use everyday language.  For example, do not say, “NPO after midnight.” Rather, state, “Do not eat or drink anything after midnight.”

Too much information presented too quickly.  The “chunk & check” strategy is a tool to avoid this scenario. Provide a “chunk” of information and then “check” with the patient for understanding.

Patient anxiety.  Regardless of how skilled the professional is at explaining to the patient their medical situation, if the patient is very tense, the material will not be absorbed.  In this case, use empathy. Mention that you understand their feelings of anxiety.  You may want to engage in brief deep breathing exercises with the patient to help them feel calmer so they are better able to take in the information.  The exhale should be longer to achieve maximum relaxation. For example, inhale on a count of four and exhale on a count of six. A few deep breathes goes a long way!

If the patient was not able to repeat back, do not repeat – re-phrase.

Benefits of teach back

Improves outcomes. According to the Joint Commission, research indicates that the teach back technique is effective, not just for improving patients’ understanding, but also for improving outcomes. For example, patients with diabetes whose physicians assess their comprehension and recall with the teach back technique have significantly better diabetes control than patients whose physicians do not use the technique. (Schillinger D, et al. Closing the loop: physician communication with diabetic patients who have low health literacy. Arch Intern Med. 2003;163:83-90.)

Can ultimately save time. Professionals often feel they have no time for the teach back method.  It actually does not take very long to assess a patient’s understanding.  Think of how much time it will take if the patient has to call back or visit again.

Enhances patient safety. If a patient does not understand their medical issue, they are at risk. A patient’s medical situation is not nice-to-know information, it is need-to-know information!

Unity Point Health, Des Moines University and other organizations collaborated to develop an excellent Teach Back Toolkit.  Click on the link for more information on this very helpful toolkit.


After giving it – be sure they get it!


Edward Leigh, MA, is the Founder and Director of the Center for Healthcare Communication. The Center focuses on increasing patient satisfaction, improving compliance and decreasing the risk of medical errors. The Center offers high-impact training, consulting and one-on-one coaching. Edward Leigh’s new book, Engaging Your Patients, is due out in late 2014.  http://www.CommunicatingWithPatients.com or 1-800-677-3256

Effective Use of PowerPoint in Medical Presentations

February 12, 2014


by Edward Leigh, MA

During the morning break from an all-day physician workshop, a participant approached me (while smiling) and stated, “I’m angry at you!”  He then went on to say, “I come to these seminars and always sit in the back. I open up my laptop to get work done, but you made me listen. You made me work. This is the best seminar I have attended in I don’t know how long.”  I am not sharing this story so I could simply tell you how wonderful I am at presenting programs. Rather, I am sharing the story to reveal a significant problem in medical education. The red flag here is the dependence on PowerPoint as a teaching tool. Effective learning must be an active engaging process that stimulates the learners’ minds, not a passive process of simply looking at slides.

Before you create your first slide – answer this question.  What’s your point?  What are the goals of your session?  When I coach people on their presentation skills, I always ask this question, “A month from now, what  two to three points do you want people remember from your presentation?  I am talking about the big picture take home points.” People struggle with this question often telling me they have dozens of points.  Think about your big overall goals and build your slides from that information.

PowerPoint is ONE component of a dynamic presentation. In addition to the slides, we must have a great opening, powerful close, audience involvement and THE key attribute – enthusiasm! This is your subject and you must show your passion! PowerPoint is an aide to us, we are not an aide to it. The slides are part of our program, but they should never become THE program. You and your knowledge base are the stars of the show.  In the very unexpected event of the PowerPoint not working, could you still present your program and engage the audience?

Avoid all-text slide presentations. This scenario creates an uninspiring presentation that leads to audience boredom.  Incorporate photos and charts to make the program come alive.  Periodically, add graphic elements between text slides to keep the audience interested in your presentation. A medical student told me he attended a presentation by a visiting professor, who spoke in a monotone voice and had text-only slides. When the professor was done speaking, the audience didn’t clap at first because they didn’t realize he completed his presentation! When an audience is so tuned out they don’t realize a presentation is over, that’s really bad news!

6 x 6 rule.  No more than six lines per slide.  No more than six words per line.  It is important to think in terms of “less is more.”  Each slide should contain ONE main idea.  I have attended medical presentations in which the slides were so busy and complicated most audience members were completely baffled, which led to a lot of frustration.  When coaching people on their presentation skills, the biggest issue I find is information overload.

No one learns when they are sleeping. Providing the slides to audience members and then simply reading the slides verbatim is not only a poor educational tool, it is also incredibly tedious. While attending typical medical programs, I often look around at the audience. I see few people truly engaged. Many people looking are at their smart phones, reading something else, quietly talking to a neighbor, or worse, sleeping. Since the audience can read, the presenter is not necessary. The audience members could read the slides on their own. To be truly effective, speakers must bring something more to the presentation.

Moving from passive to active audience members.  Yes, you can engage audience members with PowerPoint!  This can be done in a variety of ways. Put a question on a slide and ask the audience to briefly discuss the question with a neighbor. Then ask for responses. Show a picture and ask the audience, “What is going on here?”  These very quick engagement tools perk up the audience! Go from dull to dazzling! When I incorporate questions in my slides, I do not put the answer in the written slides. They have to attend the session and listen to get the answer!

Be consistent with fonts, colors and backgrounds.  You want the audience to focus on your content, not your ever-changing visuals.  Also, the addition of animation and sound adds variety, but should not be used excessively. They key to an excellent presentation is balance. Also, be sure there is a significant contrast between the text color and the background color. For example, dark text on a dark background is very hard to read.

Use a text size of at least 24 point.  I prefer a font size of 28 to 32 for text and 36 to 44 for titles. Try this readability test; put your slides on the screen and stand in the back of the room in which you will be presenting. Can you read the slides? I have been to many presentations in which the speakers say, “I know you can’t read this, but …” If the audience can’t read it, don’t show it.

Arrive at the program venue early to check the slides.  It is important to arrive to a presentation location early for many reasons, including checking the AV equipment. Before the audience members arrive, check to be sure your slides are working properly.  Unfortunately, I have seen many presentations start with this statement, “Does anyone know how to work this?” As a backup, even if I email my slides to the meeting planner, I always carry the slides with me on a flash drive. It is also a good idea to arrive early to meet audience members; this is helpful to gain insight as to their needs / questions.  Through my pre-program chats, I have also received excellent ideas that I incorporated into the session. Audience members love this recognition! For example, I have stated, “Just before the program, I spoke to Steve who mentioned a great idea to help patients …” I have Steve waive his hand so the audience could acknowledge his great idea.

Separation of handout from slides. I speak at hundreds of medical conferences, and I am usually the only presenter that separates the slides from the handout. The handout is given to participants; the handout has all the information well organized into sections. The slides are highlights of key points, including graphics.  There are also surprise questions and mini quizzes. The audience is constantly engaged.  Granted, it takes more work to present in this manner.  However, it is time well spent since I know people are engaged and learning. We do what’s best for our audiences, not what’s easiest for us.

Make PowerPoint work for you to create memorable presentations. You are brilliant, you are the expert – that is the reason you are making the presentation. The spotlight should be on you and your vast knowledge, not the slides.


Edward Leigh, MA, is the Founder and Director of the Center for Healthcare Communication. The Center focuses on increasing patient satisfaction, improving compliance and decreasing the risk of medical errors. The Center offers high-impact training, consulting and one-on-one coaching. Edward Leigh’s new book, Engaging Your Patients, is due out in the Spring of 2014. http://www.CommunicatingWithPatients.com or 1-800-677-3256

High Physician Satisfaction Equals High Patient Satisfaction: The Winning Strategies of the Organization, Emergency Medicine Physicians

March 22, 2013


By Edward Leigh, MA

Research has documented that engaged physicians results in engaged patients.  For example, Dr. Jennifer Haas and her research associates found a positive correlation between physician satisfaction and patient satisfaction.  (Dr. Haas and her colleagues work on this subject was published in the Journal of General Internal Medicine article, “Is the professional satisfaction of general internists associated with patient satisfaction?”) Emergency Medicine Physicians (EMP), a leading provider of emergency medical services, prove that high physician satisfaction translates into high patient satisfaction.  The EMP website states, “As a new emergency medicine physician, you’ll be welcomed like family. We’ll take you under our wings in the ED, and out on the town when your shift is over. We believe our tight-knit culture creates the best patient care—because when you love what you do, it shows.”  And it does show!

When I first visited the EMP website, I knew in a moment that I had to write an article about this organization!  Based on their outstanding services, EMP has won multiple accolades, including Modern Healthcare’s Best Places to Work Award, the Press Ganey Summit Award and Smart Business Magazine’s World Class Customer Service Award.

Here are some highlights of what makes EMP an engaging organization for their physicians.

Fun Factor.  Work should be an enjoyable experience.  When looking at their website, it is obvious that this organization clearly understands that having fun is good business. Who wants to work for a dull company?  The website opens with these words, “Enjoy the ride.”  When physicians enjoy the ride so will patients!  The website also has beach photos and humorous videos. The videos include a contest to see which residency program can come up with the most creative video. The organization is like a friendly neighbor welcoming you to their home.

24/7 support from colleagues.  EMP’s supportive culture encourages collaboration in decision making and clinical diagnosis. All physicians have access to run a case by an on-call senior clinical emergency medicine physician 24/7.

Robust education and development. EMP strongly believes in the value of information.  All new physicians travel to the company headquarters and participate in a two-day orientation. Physicians also have the opportunity to participate in EMP’s Patient Satisfaction Academy and Clinical Efficiency Academy.

Work life balance. To help new EMP doctors become acclimated, they design their first year’s schedule.  Even after the first year, EMP accommodates individual needs and requests to create an emergency medicine schedule that works for each person.  EMP understands the important need to maintain a healthy work life balance.

When it’s suits vs. scrubs, scrubs win.  At EMP, doctors thrive in an organization that’s owned and managed by emergency medicine physicians who understand their needs. The focus is on empowerment, not just employment.

Creating an excellent physician experience is an integral part of EMP’s culture.  It is this key component of their culture that drives their excellent patient experiences.

Emergency Medicine Physicians can be reached at 1-800-828-0898 or http://www.emp.com

(I would like to give a special thanks to EMP’s Chief Medical Officer, Dr. Kevin Klauer, for his help in preparing this article.)


Edward Leigh, MA, is the Founder and Director of the Center for Healthcare Communication. The Center focuses on increasing patient satisfaction, improving compliance and decreasing the risk of medical errors. The Center offers high-impact training, consulting and one-on-one coaching. Edward Leigh’s new book, Engaging Your Patients, is due out in the Spring of 2013. http://www.CommunicatingWithPatients.com or 1-800-677-3256

Opening a Patient Interview: Part II, Your Powerful First Few Questions

March 6, 2013

by Edward Leigh, MA


After you have greeted the patient / guest(s) and introduced yourself, now it is time for your opening questions / statements.

Start with a general question. The literature suggests that even if you know the exact reason for the patient’s visit (e.g., “upset stomach”), it best to still keep the opening question general, such as, “Tell me what brought you here.”  The initially stated chief compliant may not be the underlying reason for the visit.  This is especially true if the underlying reason for the visit is of a sensitive nature (e.g., substance abuse or sexuality issue).

BEFORE asking any details of the first issue, ask the patient, “What else?”  There may be no other issues, however asking this question in the beginning will reveal all the issues to avoid the dreaded late-occurring “Oh by the way” issues.  Excellent article on the subject:

“Two words to improve physician-patient communication: what else?” Link below http://www.meddean.luc.edu/lumen/meded/ipm/IPM1/TwoWordsBarrierArticle.pdf


Clinician: “Tell me what brings you here?”

Patient: “I have been having stomach pains.”

Clinician: “What else?”

Patient: “Well, sometimes, my toes feel numb.”

(If the patient has no other issues, then ask about the stomach pains.)

Too many issues and not enough time. If the patient has multiple issues and there is not sufficient time to discuss everything, this situation has to be handled delicately to retain an excellent patient experience. Do not say, “I don’t have time to discuss all those items.”  Instead, use an “I wish” statement, such as by stating, “I wish we had time to discuss everything that is going on.  How about if we discuss two issues and schedule an appointment to discuss the other items? How does that sound?”

Mute Yourself.  Once you begin the information-gathering phase, DO NOT interrupt. MUTE YOURSELF! Give the patient 1-2 minutes to fully tell you their story and then ask for details. In the classic study by Beckman and Frankel, they found that physicians prevented patients from completing an opening statement 77% of the time and interrupted their patients in a mean time of 18 seconds. (Beckman HB, Frankel RM. The effect of physician behavior on the collection of data. Ann Intern Med. 1984;101:692–6.)

Start your patient interview with impact through the use of powerful questions!


Edward Leigh, MA, is the Founder and Director of the Center for Healthcare Communication. The Center focuses on increasing patient satisfaction and decreasing the risk of medical errors. The Center offers high-impact training, consulting and one-on-one coaching. Edward Leigh’s new book, Engaging Your Patients, is due out in the Spring of 2013. http://www.CommunicatingWithPatients.com or 1-800-677-3256

Opening a Patient Interview: Part I, What to Say BEFORE Your First Medical Question

March 5, 2013

by Edward Leigh, MA


The first few moments of the patient interview sets the tone for the patient experience — what happens in the first 10-20 seconds makes or breaks the experience.

Sequence of events for seeing a NEW patient: (in chronological order)

(Before you walk in the room, take a deep breath to recharge yourself! One more item, if you just had an onion-filled sandwich, please pop a mint in your mouth!)

Say patient’s name (e.g., “Hello, Mrs. Smith”). If you are unsure of pronunciation — ask FIRST before attempting to state name.  You may also want to check with colleagues about pronunciation before entering the patient’s room.

State your name & role (e.g., “Hello, I am Mary Smith. I will be your nurse.”).  Recent research has shown that patients prefer hearing both the first AND last names of the professional.

Meet the guests.  If possible, ask patient to introduce you so you can learn relationships (e.g., “This is my daughter, Carol.”). Repeat name after meeting (e.g., “Hello Carol, a pleasure to meet you.”). Remind them to feel free to add information and ask questions. It is vital to establish a great relationship with the patent’s guests.

Provide your photo / business card, if applicable. It is important to provide the card at the beginning, otherwise part way through the interview, the patient may state, “So who are you?”  I have seen this happen many times.

Signpost.  This word means to tell people what’s coming next in the interview (i.e., providing direction). Explain to them what will be happening relieves their anxiety. For example, you can say, “Today, we’ll first talk about what brought you in, then I will examine you and discuss treatment options.”

What about the handshake?  There are many opinions on this subject, often divergent. Should you shake the patient’s outstretched hand? Should you initiate the handshaking gesture? Gregory Makoul and his colleagues at Northwestern University’s School of Medicine in Chicago wrote an article in the Archives of Internal Medicine on this subject. Of the patients surveyed, 78.1 per cent wanted physicians to shake their hands. This study seemed to indicate the handshaking is desired among physicians, however it is unclear if this behavior is desired among other healthcare professionals.  I look at this topic on a case by case basis. For example, a handshake would be more of an expected gesture for a middle-aged man as opposed to a teenaged girl. Overall, from a patient experience perspective, I would suggest shaking hands. A physician recently asked me, “I always gel up before seeing each patient. If I see a patient who I suspect has the flu, if they initiate a handshake, what should I do?”  I suggested they shake the patient’s hand and then quickly gel up again. Not shaking an outstretched patient’s hand will severely damage the relationship.

Look for Part II soon … “Your Powerful First Few Questions.”

Edward Leigh, MA, is the Founder and Director of the Center for Healthcare Communication.  The Center focuses on increasing patient satisfaction and decreasing the risk of medical errors. The Center offers high-impact training, consulting and one-on-one coaching. Edward Leigh’s new book is Engaging Your Patients is due out in the Spring of 2013. http://www.CommunicatingWithPatients.com or 1-800-677-3256

Virginia Tech Carilion School of Medicine Assesses Students Communication Skills Before Admitting

October 13, 2011

By Edward Leigh, MA

Have great grades?  Excel in science?  Thinking of medical school?  Think again!  Medical schools are now realizing that excellent academics are not enough to become a great doctor.  Communication skills and the ability to work in teams are vital.

Virginia Tech Carilion, located in Roanoke, Virginia, is one of the newest US medical schools (the school opened in August 2010).  Their medical school admission interviews go beyond the typical questions, “Why do you want to be a doctor?” The medical school has added a communication component to their admission interview process.  Great grades alone will not prepare prospective students for this part of the interview process; great “people skills” are needed.

Communication skills are more than “bedside manner.”  These skills also directly impact patient safety. According to the Joint Commission, “An estimated 80 percent of serious medical errors involve miscommunication between caregivers when patients are transferred or handed-off.”

This is how the medical school interview process incorporates communication skills:
• Candidates stand with their backs to doors.
• A bell rings and they turn around and read a sheet of paper taped to a door. The paper will have a scenario that requires communication and teamwork skills. (The school requests that the actual scenarios be kept secret.)
• After two minutes, the bell rings again and the candidate enters the room to discuss the ethical issue with an interviewer.
• The candidate has eight minutes to discuss that room’s issue. The interviewer scores each candidate with a number and sometimes a brief note.
• The process is then repeated several times.

The school administrators created questions that determine how well candidates think on their feet and their ability to work in teams. The interviews closely assess how well they respond when someone disagrees with them.  This is a critical skill in working with teams.

According to the school, “Candidates who jump to improper conclusions, fail to listen or are overly opinionated fare poorly because such behavior undermines teams. Those who respond appropriately to the emotional tenor of the interviewer or ask for more information do well in the new admissions process because such tendencies are helpful not only with colleagues but also with patients.”

“We are trying to weed out the students who look great on paper but haven’t developed the people or communication skills we think are important,” said Dr. Stephen Workman, associate dean for admissions and administration at Virginia Tech Carilion.

Dr. Harold Reiter, a professor at McMaster University in Hamilton, Ontario, developed the system. He states, “Candidate scores on multiple mini interviews have proved highly predictive of scores on medical licensing exams three to five years later that test doctors’ decision-making, patient interactions and cultural competency.”

The emphasis on communication and teamwork does not end with the medical school interviews.  Medical students at Virginia Tech Carilion are required to take team-based classes.  The school also requires students to become involved in community projects.

The mini interviews help shift the discussion away from personal narratives (that are usually rehearsed) to focus on the student’s problem solving abilities.

For more information about Virginia Tech Carilion’s innovative medical school application process, please contact Dr. Stephen Workman at SMWorkman@carilionclinic.org


Edward Leigh, MA, is the Founder and Director of the Center for Healthcare Communication.  The Center focuses on increasing patient satisfaction and decreasing the risk of medical errors. The Center offers high-impact training, consulting and one-on-one coaching. Edward Leigh’s newest book is Engaging Your Patients (due out in early 2012).
http://www.CommunicatingWithPatients.com or 1-800-677-3256

How to Plan a Successful Patient Satisfaction Fair

June 14, 2011

Wheeling Hospital held their first annual patient satisfaction fair to educate employees on current process improvement projects related to enhancing patient care. The fair was developed to encourage interdepartmental communication as it relates to patient-centered care. The medical center felt it was very important that each department knew the activities of other departments to enhance teamwork.

Heidi Porter, the Director of Quality Management, shared tips on how your medical center can plan its own patient satisfaction fair.

Educate employees on patient satisfaction.  Plan educational events to help employees improve the patient experience.  Wheeling Hospital had several educational opportunities for employees. The hospital emphasized the focus on patient satisfaction is not just for “bottom line” reasons. Yes, based on changes in healthcare, reimbursement does tie into patient satisfaction scores (e.g., HCAHPS). However, it is important to emphasize to employees this focus on patient satisfaction is related to delivering outstanding care and improving patient safety.

Form a Patient Satisfaction Committee. Wheeling Hospital formed a patient satisfaction committee that meets monthly to focus on improving the patient experience.  One of their projects is the fair.

Be sure every department has a display / booth. Each one of Wheeling Hospital’s thirty departments were asked to create a display and discuss their patient satisfaction initiatives. For example, the radiology department discussed using contrast material that tasted better to patients since this was often an issue. The lab discussed scripts to use to be sure patients understand their lab reports.

Involve everyone in each department.  The people staffing the booths were not always directors.  Many front line staff were present, especially since they are the people who have the most direct patient contact.

Have materials at the booth. Nearly every booth had written information on their various projects. This is important so fair attendees have information to review.

Plan ahead.  Wheeling Hospital planned the event well in advance to create a successful event.  Time is needed to make sure all the necessary arrangements are in place.

A patient satisfaction fair is an excellent opportunity for each department to share their projects.  Make plans to have a fair at your medical center.  Heidi Porter has graciously agreed to answer questions about starting your own fair.  Heidi can be reached HPorter@wheelinghospital.org


Edward Leigh, MA, is the Founder and Director of the Center for Healthcare Communication.  The Center focuses on increasing patient satisfaction and decreasing the risk of medical errors. We offer high-impact training, consulting and one-on-one coaching. Contact us today!
http://www.CommunicatingWithPatients.com or 1-800-677-3256

My Mother’s Recent Emergency Department Experience: Lessons for Learning

March 7, 2011

My mother, Julia, is part of a clinical trial, which involves monthly infusions.  The clinical trial protocol requires periodic blood work, scans, x-rays, etc.  Last week, the physician leading the clinical trial called me at my office and said that my mother has atrial fibrillation and they will not proceed with the monthly infusion. They also noticed that one of my mother’s legs was red and swollen; they were concerned about a possible blood clot. They suggested calling an ambulance and having my mother taken to the closest Emergency Department (ED). I agreed to this action. They then called the ED to inform them of the atrial fibrillation and possible clot.

I called the ED to mention that my mother is on her way and also told them that before leaving my office I will fax over my mother’s medical history information. I have a two-page summary of my mother’s pertinent medical information (e.g., medications, hospitalizations, allergies, etc.).  I told the ED that my brother and I would be there shortly.

Overall, everyone at the hospital was very friendly. However, there were several parts of the experience that could have been improved. This article is a summary of the issues with suggested changes.

Problems with hand off. When my brother and I arrived at the ED, we went to my mother’s room and the nurse told us that their tests did not find atrial fibrillation and that my mother was going to be discharged now.  I asked about the issue with mom’s leg.  They said, “What issue?” In spite of the fact that the clinical trial physician clearly stated the leg needs to be evaluated for a possible DVT, that information never made it to the ED records.  After discussing the leg issue, my mother was scheduled for an ultrasound.  (As an FYI, the ultrasound revealed no clots.) To avoid these botched communication episodes that could seriously harm patients, professionals should engage in “repeat back.” After the information is shared the receiver must “repeat back” the information to verify accuracy.

No partnership statements.  The relationship between the patient and professional is not about giving orders; it is about forming a partnership. Upon admission to the ED, all patients should be asked, “What would make this an excellent experience for you?” What does great care mean to you?” We need to immediately understand the patients’ needs. If we are to be truly patient centered, we need to understand the needs of the patient.  In order to work as a team, we need to understand the patients’ needs.  Working as partners leads to quality improvement and better clinical outcomes.  Of course, this partnership approach leads to higher patient satisfaction.

Use of medical jargon. The people at the ED did not know I was a healthcare professional. They often used medical jargon that I understood, but what if I was not in the field?  When they scheduled the ultrasound, we were told Mom was being evaluated for a DVT. The abbreviation, DVT, was never explained. This is a serious problem in healthcare — the constant use of medical jargon that patients often do not understand.  This is known as a problem with “health literacy.” (The term literacy could mean problems with reading, however it often refers to the ability to understand the language of medicine.)

No signposting. This is a communication strategy in which people are given an overview of what will take place during their stay.  Streets have posts with signs on them (street names) hence the term “signposting.”  These posts with signs give people direction; that is exactly what we want to do with patients, give them direction.  In other words, tell then what will be coming up in regard to their care. This could as simple as saying, “First we will assign you to a room, run some tests and have you seen by one of our highly-qualified doctors. Based on the results of the tests, we will let you know how long you will be here.”  Patients should also be told that we are here to help you and make your stay as pleasant as possible.  There was one significant fact not revealed to our family that could lead to serious damage with patient satisfaction scores.  After being in the ED for approximately 1 1/2 hours, I asked our nurse, “When do you think my mother will have the ultrasound?” She then smiled as though she was about to laugh!  She said the average time for an ultrasound is 4 1/2 hours, but it could be up to 8 hours! This fact should have immediately been told to us.  (As an FYI, we had the ultrasound done in about 3 hours.)

Lack of hourly rounding.  After my mother was in the ED an hour, I expected someone from the medical center to check in on Mom.  No one came to see how Mom was doing.  Hourly rounding is a critical tool for many reasons.  This process helps prevent potential falls by asking patients if they need anything, such as a trip to the bathroom.  Many patients are seriously injured each year because they have to use the restroom and no one is coming to check on them. They try to get up on their own and sometimes fall.  The rounding also has a psychological benefit in that you are reassuring patients that you are thinking of them and working on their care.

No empathy. Going to an ED is a very stressful experience. During my mother’s time in the ED not one person directly stated an empathic response.  I would have liked to hear at least one person say, “I know it is scary being here. However we are here to help you.”  This comment should often be followed by a partnership statement, such as, “We will work together with you to find out what is going on as soon as we could. We will periodically check on you, but if you ever need anything, please feel free to let us know. We are here for you.”

Directions — don’t just tell, show!  When I arrived at the ED, I asked the person at the front desk what room my Mom was in and they told me. I asked for directions. The directions were very complicated due to ongoing construction. The person at the desk said something to this effect, “Go down this hall, turn right at the first hallway, then make an immediately left, go down the corridor until you get to a desk, then make a slight right, etc. What? Huh?  I then asked, “Could you have someone take me there?”  They agreed. When people ask directions, don’t simply give directions; take them to their requested destination.  This is an excellent customer service tip all hospital staff should incorporate into their work with patients and their family members.

Teach back technique not utilized.  After the ultrasound was completed, we were given discharge instructions.  Being in healthcare, I understood all the directions, however what if I was not in the field? Saying to a patient, “Do you understand?” is not sufficient.  In order to determine if they indeed understand, you must use the communication technique called, “teach back.” Ask the patient to summarize the information you provided. This could be as simple as asking, “Tell me what you will do when you get home.”

In summary, all of the hospital staff members were quite pleasant.  However, there were some very significant problems that could have negatively impacted my mother’s health. Based on a poor hand off, the ED was unaware of the leg issue.  Fortunately, my mother did not have a DVT. But what if she did?  This medical center needs to have staff development training covering communications skills, rounding techniques, educational strategies and customer service. These techniques are more than “bedside manner” tips; rather they are skills to avoid potentially serious medical errors.


Edward Leigh, MA, is the Founder and Director of the Center for Healthcare Communication.  The Center focuses on increasing patient satisfaction and decreasing the risk of medical errors. We offer high-impact training, consulting and one-on-one coaching. Contact us today!  http://www.CommunicatingWithPatients.com or 1-800-677-3256

Edward Leigh’s new book, Engaging Your Patients, is due out in June 2011!

Stop Devaluing Your Patients! The Illusion of “Patient Centered” Care

October 25, 2010

In healthcare, we always talk about, “patient-centered care.”  I do believe healthcare organizations have the best intentions, however, in reality, I find just the opposite both in my work as a healthcare speaker / consultant and with my own experiences as a patient.

“Just a Patient”

I have been a healthcare professional for over 20 years, however in 1999 I became a patient after being diagnosed with Stage III Colon cancer (I am well today). After treatment was completed, I recall going to my oncologist’s office for a follow up visit. I was wearing a suit as I was on my way to a client meeting. In the office, I was talking to a pharmaceutical representative. During my conversation, a nurse ran up to the representative and said to him, “You don’t need to talk to him. He is just a patient.”  Immediately another nurse (who knew me), ran up to the nurse who made the comment and said, “I can’t believe you said that him! He teaches healthcare professionals how to communicate with patients and now he will use us as a bad example!”  The second nurse then said to me, “You aren’t going to mention this story, are you?”  I told her, “Of course I will not mention the story.”  Ha!

Are the people you serve, “Just patients?”

Discouraging Patients from Taking an Active Role in Their Care

In healthcare, we discuss patients being their own advocates and taking an active role in their care.  Once again, what is said and reality are often not the same.  In my work at coaching healthcare professionals, I have seen patients bring print outs from their Internet research, only to be told, “Don’t worry about the Internet, I know what is best.”

When patients come to you with Internet print outs, the first words out of your mouth should be, “THANK YOU!”  We need to encourage people to take an active role in their health, not discourage them.  The conversation should then follow up with a discussion of legitimate websites (e.g., NIH) versus quack websites.

Patients Matter

When I speak at healthcare events, I always position myself as a healthcare professional who also happened to be a patient.  For one event, I made the mistake of first discussing my patient experiences and then I saw just how poorly patients are seen in the healthcare system.  The meeting coordinator said to me, “How nice you want to share your story. However, this is a program for professionals only. No patients are invited.”  Even though I explained I was a healthcare professional, once they saw me as a patient, I immediately had no value. I felt like I was verbally patted on the head and told to “run along.”

Let’s stop talking about putting patients first and just do it!


Edward Leigh, MA, is the Founder and Director of the Center for Healthcare Communication.  The Center focuses on increasing patient satisfaction and decreasing the risk of medical errors. We offer high-impact training, consulting and one-on-one coaching. Contact us today!
http://www.CommunicatingWithPatients.com or 1-800-677-3256

Match Your Patients Energy Level

October 21, 2010


When people come into the healthcare system, it is a safe bet that they are not doing cartwheels in your hallways. They don’t feel well and their energy levels are probably low.  However, if we are high energy (which is great!), that would actually overwhelm people. Patients may be turned off by healthcare professionals that are busting at the seams with enthusiasm. A friend of mine told me her daughter who was hospitalized with pregnancy complications. Her daughter was in significant pain.  The daughter mentioned one nurse who used to bounce in the room full of energy; the daughter found this boundless energy too much for her.

It would seem to make sense that energy and enthusiasm are excellent characteristics of a healthcare professional.  They are!  However, when establishing rapport with patients we have to think about matching energy levels.  If our energy level is very high and  the patent’s energy is very low, we could experience a communication disconnect. This is exactly what happened with my friend’s daughter. The nurse though being high energy would be a good way to establish rapport.

We need to meet patients where they are. We need to meet then at their level of energy. Does this mean that if a patient is depressed and low energy we need to become depressed? Of course not!  However, what we need to do is lower our energy a bit so we do not cause a communication disconnect.

Mirroring and matching are techniques used to establish rapport at the unconscious level. This is created by becoming like the person with whom you need to make a connection. We need to make a connection with patients! When talking to patients look at their gestures and vocal inflexions. In a subtle way try to “match” these behaviors.  Subtle is the key word; we do not want to make it obvious or the patient may think we are mocking  them. People feel more comfortable with people who act like them.  For example, if your patient uses a lot of certain hand gestures, you may need to increase your level of these hand gestures.

If you look at people in the workplace or social situations who seem to be very engaged, notice they most likely have similar body language and tone of voice.  They are in sync.  We need to be in sync with our patients through the the strategies of matching and mirroring.

Edward Leigh, MA, is the Founder and Director of the Center for Healthcare Communication.  The Center focuses on increasing patient satisfaction and decreasing the risk of medical errors. We offer high-impact training, consulting and one-on-one coaching. Contact us today!
http://www.CommunicatingWithPatients.com or 1-800-677-3256