A Better Question Than “Do You Understand?”

Featured image: National Cancer Institute, public domain, via Wikimedia Commons.

There is a small communication habit in healthcare that changes what it means to ask whether someone understands you.

Instead of asking:

“Do you understand?”

ask the person to explain back, in their own words, what they are going to do.

Imagine you’re helping someone repair a plumbing leak and tell them:

“Turn off the water before you disconnect that fitting.”

They answer, “Got it.”

That sounds like confirmation, but you still don’t know what they understood.

Instead, ask:

“Before you start, walk me through what you’re going to do.”

If they answer, “I’ll loosen the fitting, then shut off the water before I take it all the way off,” you have discovered the misunderstanding while the floor is still dry.

Healthcare calls this teach-back.

The Agency for Healthcare Research and Quality recommends it when clinicians need to confirm that patients understand instructions. Rather than asking whether the explanation was clear, the clinician asks the patient to describe the information in their own words.

That difference matters because “Do you understand?” asks someone to evaluate their own understanding.

People are not particularly well positioned to do that when the problem is precisely that they misunderstood something.

They may have heard every word. They may feel completely confident. Their interpretation may simply be different from yours.

Teach-back asks a different question:

What understanding did my explanation actually produce?

That’s useful far beyond healthcare.

Suppose a manager explains an unfamiliar task and asks, “Make sense?”

“Yes.”

There is almost no information in that answer.

“Tell me how you’re planning to approach it” reveals considerably more. It may expose a different definition of “finished,” an assumption the manager didn’t realize was unstated, or a step the employee interpreted differently.

The same thing can happen when showing someone how to use a tool, giving directions, handing off a technical procedure, or explaining something to a child.

Interestingly, repeating something in your own words is not always the best check.

Aviation provides a useful counterexample.

When an air traffic controller tells a pilot to climb to a particular altitude, the important question usually isn’t whether the pilot has developed the correct conceptual interpretation of the instruction. The important question is whether a very specific number survived the transmission correctly.

So pilots read important instructions back.

If the controller says “climb to flight level 330,” hearing “flight level 330” returned is useful precisely because the repetition is exact. The FAA’s readback/hearback procedures use that loop to help catch errors in critical instructions.

Healthcare has a different communication problem.

If a clinician explains how and when to take a medication, simply having the patient repeat the clinician’s exact sentence may show that the words were heard without showing that the instructions were understood.

That’s why teach-back specifically asks for the explanation in the patient’s own words.

Sources and further reading

Agency for Healthcare Research and Quality, Teach-Back

Agency for Healthcare Research and Quality, TeamSTEPPS Communication Tools

Federal Aviation Administration, Pilot Acknowledgment/Read Back

Talevski et al., Teach-back: A systematic review of implementation and impacts