What is the one of the best ways to clarify what the patient is trying to say?

The majority of my clinical care transformed from face-to-face encounters into telephone encounters amidst the COVID-19 pandemic. To keep healthy people out of the clinic, our organization began requiring that we handle all non-urgent visits as telephone encounters. I have now had a few weeks to experience this change in the way I take care of patients, and I've noticed some recurring communication challenges.

My main difficulty is assessing patients' reactions to what I'm saying. Do they accept my analysis of the situation? Is there some hesitation about the plan? Do they understand what I am explaining? I've also found it can be hard to end these phone calls. Without nonverbal cues, the pacing of our conversation lags, and it can be difficult to move toward a resolution. Who knew that I depended so much on nonverbal communication during patient visits? Showing empathy, which has always come naturally to me during face-to-face visits, has also required extra attention during these new visits.

Recognizing that it might take more than instinct to communicate effectively during a telephone visit, I set out to learn more, both from the medical literature and from the call center industry.– Here are some tips we can all use to enhance our telephone communication skills.

1. Speak slowly and clearly, and don't use medical jargon. In person we can usually tell if patients understand us, but over the phone it is not as obvious. To optimize comprehension during phone visits, we must be extra thoughtful about how we speak.

2. Listen actively. It may seem cumbersome, but during phone visits it is particularly important to clarify what patients say. We may need to ask them to repeat themselves, ask a few clarifying questions, or restate what we heard, beginning with, “So I want to be sure I am understanding what you are saying. I heard you say that ….”

3. Develop rapport. It is important to spend a few minutes at the beginning of the call establishing rapport, just as we do upon entering the exam room. Be sure to explain why the in-person visit (which some patients have waited months for) now has to be a telephone visit. Focus on why we want to keep patients out of the clinic right now.

4. Give each call your full attention to help the patient know you are listening. We must resist doing anything else while talking on the phone. Try not to check your e-mail or read that text that just came through. Your divided attention is more obvious to the patient than you think.

5. Be clear about the plan. Review what you discussed during the call, and establish what will happen after you hang up. If you have the capability, send an after-visit summary through the portal so the patient will have something in writing from the phone visit.

If we listen carefully and communicate clearly, we can optimize the effectiveness of telephone visits for us and for our patients.

In the humorous American television program Seinfeld, the characters often find themselves in strange situations because of small communication failures. These little misunderstandings grow to the point of total confusion.

For example, in one show, Jerry and George take a limousine, or limo, meant for other passengers. They act like they are those passengers by using their names.

Listen to George express excitement about what they have done:

This is incredible! This is one of the greatest things I've ever done in my life! I'm going to call my mother.

What for?

To tell her I'm in a limo.

Hello, ma. It's me. Guess where I am –​ in the back of a limo! No, nobody died.

Some of the planned passengers later unexpectedly get in the limo and begin to make unusual comments. Jerry and George are unsure what these comments mean. But they soon find out they are among very, very bad people.

On television, communication failures can make for funny stories. But in real life, you probably want to avoid such confusion.

In today’s program, we will tell you how to get clarification on what someone has said or written.

When you ask someone for clarification, you are asking them to say something in a different way or provide more information so that you understand them better. This is different from asking a person to repeat something.

The person might not have explained themselves clearly, for example. Or maybe they used difficult language. Or maybe you think you know what the person means but want to make sure that you are correct.

Here is how you can respectfully get the information that you need.

Express lack of understanding

The first step is to tell the person that you are not sure that you have understood them fully. Let’s listen to a few useful phrases:

• I’m sorry but I’m not sure (that) I understand.
• Sorry, I’m not sure (that) I know what you mean.
• Sorry but I don’t quite follow you.

Using the word “that” in two of the phrases is more suited for formal written communication, such as work-related emails.

Other times, you may understand part of what someone has said but need clarity on another part. In such situations, you can be more exact. Let’s hear a few examples:

• I’m sorry but I’m not sure I understand what you mean by "tech giants."
• Sorry but I don’t quite follow what you’re saying about the new policy.

Ask for clarification

After you express your lack of understanding, the next step is to ask the person to clarify what they have said. Here are some phrases you can use.

For many of them, you can use “can” or “could,” with could being a little more formal:

• Could you say it in another way?
• Can you clarify that for me?
• Could you rephrase that?

• When you say…, do you mean…?

The phrase “When you say…, do you mean…?” of course is not a complete sentence. Here is how it sounds when complete:

• When you say workers are on furlough, do you mean they’re temporarily laid off from work?

Other times, you may simply need more information or a helpful example. In such situations, the following are useful:

• Could you be more specific?
• Can you give me an example?
• Could you elaborate on that?

“Could you elaborate on that?” is usually more suited to formal situations, such as in the workplace.

Put it together

OK, we have talked about the two steps. But we haven't yet put them together. Let’s do that now. Listen to someone expressing lack of understanding and asking for clarification:

• I’m sorry but I’m not sure I understand. When you say workers are on furlough, do you mean they’re temporarily laid off from work?

Here’s another example:

• Sorry but I don’t quite follow what you’re saying about the new policy. Could you be more specific about gift card restrictions?

Confirm understanding

There are some social or professional situations in which you may want to avoid directly saying you haven’t understood. In such cases, you can check your understanding by rephrasing what the person said. For instance, you might say, “Let me see if I understood you correctly. You are saying that…”

• Let me see if I understood you correctly. You’re saying that airport security workers are now working without pay?

Here is a very similar phrase: “If I understand you correctly, you’re saying that…”

• If I understand you correctly, you’re saying that airport security workers are now working without pay?

Another phrase you might use is, “So, what you’re saying is…”

• So, what you’re saying is (that) some hotels offer discounts to guests for not using their cellphones?

Or, you might say, “So, in other words…,” which we usually use when we are restating something in a simpler way:

• So, in other words, complex carbohydrates are starches that have not been refined.

Offer thanks

After the person clarifies themselves, you can let them know that you now understand and are thankful. Have a listen:

• I got it. Thank you!
• Ah, I see. Thanks for clarifying.
• Now I understand. Thanks a lot.

Clarify your ideas

There are other times when someone will ask you for clarification. In such cases, phrases like these can introduce what you want to say:

• In other words,…
• Let me clarify that.
• To put it another way,…

Of course, there are many ways to ask for or offer clarification, but we hope these examples help.

I’m Alice Bryant.

Alice Bryant wrote this story for Learning English. Ashley Thompson was the editor.

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Practice

Now, you try it! Practice what you learned today. You can do one or all of the situations below. Write your responses in the comments section.

Situation 1

You are in a bank and you want to open a new account. The bank representative is describing the different types of accounts and telling you about online banking. You are not sure you understand his explanation of online banking. Express your lack of understanding and ask for clarification.

Situation 2

You missed an important assignment in one of your university classes. Your professor is telling you about things you can do to improve your grade. But she is not giving a lot of detail and hasn’t said how much each thing will raise your grade. Ask her for more information.

Situation 3

You are at a doctor’s office telling your doctor about a health problem. Your doctor gives you several suggestions to improve the problem. You think you understand but you want to make sure. Check that you’ve understood what your doctor has said.

Which technique would the nurse use to actively listen to a patient?

Which of the following is the best definition of a message?

Which of the following would be an appropriate method of conveying empathy when obtaining a patient's medical history?

Which of the following is the best definition for health communication?