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March 2015 Bulletin: Malpractice

Patient Communication: Closing the Loop

Denise Condron

— Denise Condron, Director of Loss Prevention, CMIC Group

Patients remember and understand as little as 50% of what is explained to them by the provider1. Patients with low levels of health literacy are especially likely to have difficulty understanding and remembering medical information. These types of patients may have difficulty reading labels on a prescription bottle, interpreting blood glucose values or understanding educational materials or preoperative instructions.

Ensuring understanding and the ability to recall information should be addressed with patients at every visit. Using the Ask-Tell-Ask method2 is an excellent tool for assessing a patient’s ability to understand and recall information.

  • Ask – Anticipate Questions – Answering assumed questions is important when communicating with patients. In a self-study course on Cultural Competency, available on the CMIC Group website (, we discuss the Ask Me 3 method. The Ask Me 3 method promotes three simple questions:
  • a. What is my main problem?
    b. What do I need to do?
    c. Why is it important for me to do this?
    By developing a protocol to ask these questions, you will soon find them as routine as conducting a review of systems. Another important part of the Ask – is assessment, what does the patient already know? Assess their knowledge by asking a question such as “What do you know about Sleep Apnea?” allows the patient to explain to you what they know and fill in the gaps as you see fit.
  • Tell – Explain the Concept – in simple language explain to the patient 3 key points. If you are giving the patient unexpected or bad news, give them a forewarning such as “I have some difficult news to share with you about the results of the lab tests.”
  • Ask – Close the Loop – Say to the patient: I have given you a lot of information that is difficult for anyone to remember. I know your________ will have questions; can we review what you understand about today’s visit to make sure we are on the same page? Having the patient repeat back to you the key points of the office visit is essential to assessing their understanding.

The patient encounter should be an interactive process, a process of sharing information. This means that the information and plan should be explained to and understood by the patient. You will need to tailor the process for each individual patient in order to be most effective. By remembering that patients only remember half of all the information given to them during an encounter, it is very important to practice the methods above in order to increase patient understanding and retention of information.

1 Bertakis KD, The Communication of information from physician to patient: a method for increasing patient safety and satisfaction. J Fam Practice. 1977;5:217-222.
2 Partnership for Clear Health Communication

CMIC Group includes both CMIC and its sponsored company, CMIC Risk Retention Group (CMIC RRG). CMIC Group is a leader in developing innovative insurance programs, services and solutions for physicians, doctors, healthcare providers, hospitals, and facilities dating back to the origins of CMIC in 1984. For more information visit CMIC’s website at

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