Most patients forget more than half of the information health professionals give them. Often what they do remember is wrong.
Many people find it hard to talk to health care professionals and follow their advice.
Health professionals tend to over-estimate how much patients understand, and under-estimate how hard patients find it to ask questions.
There are simple things you can do to help patients understand and remember much more of what you say.
Communicating about health is hard
One of the key roles of health professionals is to give patients information about their health condition, treatment options and what the next steps are.
Patients are often presented with a large amount of information to process and understand. People can struggle to understand new medical information and make the decisions required when they:
have poor understanding of medical concepts, and
are given large amounts of complex information in a short timeframe.
Unfortunately, the nature of clinical settings means this is the reality of how most information is presented to consumers.
Research shows that most patients, regardless of their health literacy skills, remember approximately 20-60% of information provided in a clinical setting. Almost half of the information that is remembered is incorrect[i]. The more information presented, the lower the proportion correctly recalled[ii].
Consumers with low health literacy are at greatest risk of not remembering spoken information or instructions[iii].
Poor recall is more common when health care professionals:
discuss a large number of topics and a lot of information, and
talk much more than the patient (“verbal dominance”).[iv]
Many consumers find it hard to discuss health matters and follow advice provided by health care professionals. This can be because they:
are not familiar with words and terms used in health care,
have limited health knowledge, for example about how their body works,
are afraid of appearing ignorant or stupid, or
have trouble understanding new information and concepts.
This can make it hard to take medications safely, prepare for diagnostic tests or surgical procedures, understand the importance and sequence of follow-up tests and appointments, and understand how to apply suggested life-style changes to their unique circumstances.
how difficult it is for people to understand what they are told about their health and wellbeing, including advice and instructions
how reluctant people are to ask questions about their health and healthcare
how important it is for people to ask questions about their health and healthcare.
Most consumers will be reluctant to tell you that they don’t understand the health information you give them. They may fear that you will judge them negatively for their lack of understanding, or worry that it will have a negative effect on their relationship with you – for example, that you may exclude them from shared decision making.[vi]
What do they already know?
The first step in informing or educating consumers about their health condition is to find out what they already know or believe and build on their existing understanding. Sometimes people will have incorrect knowledge or beliefs about their health condition. Before you can give them new information, you need to deal with the incorrect knowledge, recognising that they may have “known” it for a long time and there may be valid reasons for them to have that understanding or belief about their health. If you try to add new information that doesn’t fit with their existing “knowledge” or beliefs, they will be more likely to disregard or reject the correct information because it doesn’t fit with their understanding.
To help improve communication, try to:
remember that most people are unfamiliar with healthcare terminology and have limited understanding of medical concepts
find out what the patient knows or understands about their health
address each patient’s level of understanding or misunderstanding
recognise the cultural or religious factors that may influence the patient’s understanding and decision making
use a range of communication strategies
tailor information to the individual
consider that consumers often don’t understand the healthcare system
confirm that the patient has understood all the information provided
encourage patients to ask questions – practise open ended questioning
undertake education to improve health literacy skills when communicating with patients.
Relatively simple changes can make your communication much more effective.
Tips, Tricks and Techniques
Set the scene
Introduce yourself and explain your role.
Remember non-verbal communication – your body language, face and gestures also communicate.
Sit down if the other person is sitting; stand if they are standing.
Respect the person
Speak clearly, with a friendly, respectful tone.
Give the person a sense of control. For example, ask “is it okay if I ask some questions about what’s been happening?”.
Make sure you consider cultural or language barriers to good communication.
Check what the consumer understands about the issue so you can tailor the information to their needs and build on their knowledge.
Speak slowly and pause after key points. This makes it easier for people to absorb the information you are providing, reflect on it and ask questions.
Use plain language
As a general rule, be guided by the words the consumer uses to describe their condition.
Use the same words consistently
Avoid acronyms. If you must use one, explain its meaning when you first use it.
Limit your messages
People generally only remember three to five points from a conversation. So, if possible, discuss only three to five points at a time.
Try the Chunk and Check method to maximise peoples understanding and recall of key points.
Use descriptions people can relate to
For example, suggest “feel for lumps about the size of a pea” rather than “feel for lumps about 5 to 6 millimetres in diameter”, or
“Try for a serve of meat that is the size of your palm” rather than “Have a 100g serving of meat”
Use open-ended questions
This can be hard and needs practice. Ask “How much time do you spend sitting most days?” rather than” Do you spend a lot of time sitting?”
Try the Teach Back method.
Ask: “what else would you like to know?” rather than “do you have any questions?”
Use visual aids
Draw simple pictures, use models or demonstrations.
Provide written information as a back-up
Most people prefer to get key information from their doctor or other health professional, backed up by written information.
Written information is a useful reminder of your main points and can be helpful for carers and family members who aren’t at the appointment.
Go through the written information with them and add notes, circle things, or use a highlighter, to reinforce important details.
Explore more about communicating with consumers on the following pages:
This website provides information on how to appropriately engage with Aboriginal and Torres Strait Islander people and communities. The Culture Ways section provides information on the holistic nature of the Aboriginal and Torres Strait Islander concept of health and covers key concepts – like traditional healing and medicine, Men’s Business and Women’s Business. The Working with Community section focuses on how non-Indigenous people can respectfully work with Aboriginal and Torres Strait Islander people and communities, and looks at various cross-cultural issues, cultural learning and respect, ethics, and best-practice.
[ii] McCarthy, D. M., Waite, K. R., Curtis, L. M., Engel, K. G., Baker, D. W., & Wolf, M. S. (2012). What did the doctor say? Health literacy and recall of medical instructions. Medical care, 50(4), 277–282. https://doi.org/10.1097/MLR.0b013e318241e8e1
[iii] Schillinger D, Bindman A, Wang F, Stewart A, Piette J: Functional health literacy and the quality of physician-patient communication among diabetes patients. Patient Education & Counselling 2004, 52(3):315-323
[iv] Laws MB, Lee Y, Taubin T, Rogers WH, Wilson IB (2018) Factors associated with patient recall of key information in ambulatory specialty care visits: Results of an innovative methodology. PLOS ONE 13(2): e0191940. https://doi.org/10.1371/journal.pone.0191940
[vi] Easton, P., Entwistle, V.A. & Williams, B. How the stigma of low literacy can impair patient-professional spoken interactions and affect health: insights from a qualitative investigation. BMC Health Serv Res13, 319 (2013). https://doi.org/10.1186/1472-6963-13-319