Letting the patient speak

The young man and his newly transplanted liver are soon to be discharged from University Hospital, and Darnell Waun, a registered nurse and patient educator, is explaining the long list of medicines he must take — at precisely the right times. 

After the explanation, Waun asks: “So what time of day are you going to take your medications?”

“I’m going to take them at 8 o’clock,” the patient replies.

“In the morning?”

“In the morning, and 8 at night,” the patient answers correctly.

The conversation is a long one, and after dishing out each new dollop of information, Waun stops and asks another question designed to find out if the patient understands what he’s been told — a method known as “teach back.”

“The teach back is my way of validating that they heard what I wanted them to hear,” Waun said shortly before meeting with the patient. “I can’t assume that they did, just because they’re nodding.”

That understanding is especially critical for transplant patients. Waun doesn’t quiz them on everything he tells them, but he does have a priority list of four key areas they must understand when they leave, and that’s where the teach-back method comes in handy. Those four areas are: how to take their medicines, how to watch for rejection, how to prevent infections and how to call for help when there’s a problem. “These are the key points they must do or the transplant is going to be a failure,” Waun said.

Even if most patient conversations aren’t a matter of life and death, as Waun’s are, teach back can be an effective tool in almost any situation — and especially in cases where language or education is a barrier to understanding.

Dr. Barry Weiss, professor of family and community medicine at the University of Arizona, who gave the keynote address at the San Antonio Health Literacy Conference last year, included a section on the teach-back method in his book, “Health literacy and patient safety: Help patients understand,” a publication of the AMA Foundation.

“The teach-back technique should replace the more common practice of simply asking a patient, ‘Do you understand what I have told you?’” Weiss wrote. “Experience shows that patients often answer ‘yes’ to such questions, even when they understand nothing.”

Sadly, patients too often walk away from conversations with providers with little understanding — or recollection — of what was said. That can lead to delayed recovery, unnecessary readmissions and dissatisfaction with care.

It helps if both the provider and patient understand that teach back isn’t a test, but rather a way to know if the provider’s explanation was clear. That way, patient and provider are working together towards a goal. The provider can identify the gaps in the quality of the explanation by hearing the quality of the answers from patients.

As for Waun, he has a unique empathy with his patients — and a little extra motivation for helping them succeed. A few years ago, he was in their shoes — undergoing a liver transplant while in the Air Force. He tells patients up front of their shared experience, and that failure to comply with their treatment regimen could be deadly for both.

“So I am teaching them the very lifestyle I go out and live,” Waun said. “I enjoy a great deal of credibility with our recipients in the room.”