Communicating with patients
Introduced| English | Meaning |
|---|---|
| teach-back | Asking patients to explain in their own words what they have been told. |
| shared decision-making | Doctor and patient choosing together using evidence and the patient's values. |
The same news, told two ways
- One doctor gives a biopsy result standing in a corridor, in technical words, in ten seconds. Another sits down in a quiet room, asks what the patient already knows, and pauses after the news.
- The facts are identical. What the patient understands and remembers is not. Hard conversations go better with a structure.
SPIKES for difficult news
- Setting: private, seated, no interruptions. Perception: "What do you understand about why we did the tests?" Invitation: "How much detail would you like?"
- Knowledge: a warning shot, then plain words, then a pause. Emotion: respond to feelings before facts. Strategy and summary: options, uncertainty and the next appointment.
Put the SPIKES steps in order.
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Find out where the patient is before giving news, and respond to emotion before moving to plans.
Match each sentence to its SPIKES step.
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Each sentence does one job; the order keeps the patient a partner in the conversation.
Why a structure helps
- Under stress, both patient and doctor hold less in working memory. A fixed sequence means no step depends on remembering it in the moment.
- A warning shot ("I'm afraid the results are not what we hoped") gives the patient a second to prepare before the content arrives.
- (Fictional role-play) Setting: door closed, phone off, sitting at the same level. Perception: "What is your understanding of the scan?" Invitation: "All the detail, or the outline?"
- Knowledge: warning shot, two plain sentences, pause. Emotion: silence, then "This isn't what you were hoping to hear." Strategy: options, what is uncertain, the next step.
A warning shot before bad news is unkind, because it adds suspense.
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It gives the patient a moment to prepare, so the news itself is easier to take in.
Teach-back checks the explainer
- Teach-back 反馈确认: "So I know I explained it well, what will you tell your family about the plan?" The patient's words show what actually got across.
- It checks the doctor's explanation, not the patient. "Do you understand?" mostly gets a polite "yes".
Which is a teach-back question?
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Teach-back asks the patient to say the plan in their own words, which shows what actually got across.
Shared decision-making
- In shared decision-making 共同决策 the clinician brings the evidence (benefits, harms, the number needed to treat) and the patient brings their values. The choice is made together.
- Give numbers as natural frequencies, because people reason better with counts: an NNT of 13 becomes "about 8 in 100 people like you benefit".
A treatment has a number needed to treat of 20. Out of 100 people like the patient, about how many benefit?
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NNT 20 means 1 in 20 benefit, so 100 ÷ 20 = 5 in 100.
In shared decision-making, the patient's main contribution is —
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The clinician brings the evidence; the patient brings what matters to them. The decision needs both.
Common slips
- Facts before perception. You may correct a picture the patient never had, or miss the one they do have.
- "Do you understand?" It measures politeness, not understanding; use teach-back.
- Options without evidence, or evidence without options. A shared decision needs both.
Recap
- SPIKES: Setting, Perception, Invitation, Knowledge, Emotion, Strategy and summary.
- Teach-back checks the explanation; "do you understand?" does not.
- Shared decisions combine evidence and the patient's values; give numbers as counts out of 100.