Communicating with patients
Introducido| English | Significado |
|---|---|
| teach-back | teach-back |
| shared decision-making | shared decision-making |
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.
Dificultad 3/5 · 200 monedas + un pequeño bono en el primer intento de hoy
Find out where the patient is before giving news, and respond to emotion before moving to plans.
Match each sentence to its SPIKES step.
Dificultad 2/5 · 140 monedas + un pequeño bono en el primer intento de hoy
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.
Dificultad 1/5 · 100 monedas + un pequeño bono en el primer intento de hoy
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?
Dificultad 1/5 · 100 monedas + un pequeño bono en el primer intento de hoy
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?
Dificultad 2/5 · 140 monedas + un pequeño bono en el primer intento de hoy
NNT 20 means 1 in 20 benefit, so 100 ÷ 20 = 5 in 100.
In shared decision-making, the patient's main contribution is —
Dificultad 1/5 · 100 monedas + un pequeño bono en el primer intento de hoy
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.