Originally published on Medscape, this article explores how a simple yet powerful communication technique can significantly improve patient understanding and recall.
Many doctors assume patients leave the office with a clear plan. In reality, half of European adults struggle with health information – and even well-informed patients forget much of what was said. This is especially critical when we prescribe new medications, adjust insulin, or explain red flag symptoms.
What Is the Teach-Back Method?
It simply asks patients to repeat the instructions in their own words – to make sure they understand what we said and to improve memory. It can be used for new prescriptions, diagnoses, prognosis, treatment options, etc.
Why Is It Important?
Patients don’t understand 50% of what you’ve just said. This “50% rule” is based on several studies on restating diagnoses and prescriptions. But even more will be forgotten as time passes.
What’s the Evidence?
The evidence is compelling – Teach-Back works. A 2020 Systematic Review showed benefits in 19 of 20 studies, which was confirmed by a June 2025 Systematic Review. It consistently improves knowledge retention, some clinical outcomes (e.g. adherence, HbA1c and hospital re-admissions) and may even decrease malpractice claims.
Two studies illustrate these findings: a prospective Dutch emergency department study (n=483) and a retrospective U.S. primary care study of diabetes patients (n=2,901). See this graph:
Teach-Back is now recommended by numerous professional bodies, including the American Academy of Family Physicians (AAFP), the Agency for Healthcare Research and Quality (AHRQ), and the UK’s National Institute for Health and Care Excellence (NICE).
How Quick Is It?
Time is always an important barrier. However, teach-back conversations are efficient. In the Dutch emergency department study, adding teach-back to a discharge conversation took, on average, only 99 seconds longer (3:11 min vs. 4:50 min). This investment can save significant time later by preventing confused phone calls and follow-up visits.
Getting Started: The 2-Step Process
Ask your patient to explain in their own words.
- “Just to check if I explained it clearly, how will you take the new tablet?”
- “I want to make sure I explained it well. When you get home, what will you tell your partner about our plan?”
- “We covered a lot today. What will you do if X happens?”
If the patient’s explanation is incorrect, re-explain and check again.
- “I did not explain that clearly enough. Let me try again in a different way.”
Important: The responsibility is on you, the explainer. Treat misunderstanding as a cue to improve your explanation and use a non-judgemental tone.
Practical Tips
- Start small. Try it with just 1-2 patients per day.
- Use “chunk-and-check.” One key point -> teach-back -> next point.
- Avoid closed questions. Asking “do you understand?” or “do you have more questions?” usually gets a “yes,” because of politeness.
- Encourage patients’ own words. This prevents them from repeating phrases they may not understand.
- Use it for everyone. While especially helpful for patients with low health literacy, even highly educated patients can be overwhelmed.
- Document it. “Teach-back done; patient repeated dose, follow-up, and red flags.”
- Teach it. If you work with students or residents.
By investing an extra 99 seconds to ensure your message was truly heard and understood, you can close the communication gap, improve patient outcomes, and enhance safety.
