Communication skills: open questions, empathy and teach-back
- Technique
Listening well, naming emotions and checking that the patient understood are concrete skills that can be learned and practised.
What it is
Clinical communication skills are observable behaviours: asking, reflecting, summarizing, responding to emotion and checking understanding. They can be taught and measured, and training improves observed skills. This page covers the micro-skills and the NURSE, ask–tell–ask and teach-back frameworks; the structure of the interview is in Semiology.
Key facts
- Blocking behaviours: ‘why’ questions that sound like blame, false reassurance, premature advice, changing the subject, judgment and unexplained jargon.
- Nonverbal communication (posture, gaze, tone, distance) weighs as much as words, and how it is read varies with culture.
- Silence is a technique: it gives time to think and to feel.
- Show-me is teach-back for practical skills: the patient demonstrates how they use an inhaler or a glucose meter.
- Trials of communication-skills training improve confidence and observed skills; the effect on patient outcomes is less well shown.
How it is done
- Open with a broad question and listen to the first account without interrupting.
- Facilitate with gestures, pauses and short phrases (‘Go on’, ‘Tell me more’).
- Reflect content or emotion: ‘It sounds as if not being able to work is what weighs on you most’.
- Respond with NURSE when an emotion appears, before going on with facts.
- Summarize each block and ask: ‘Did I get that right? Anything to correct?’
- Inform with ask–tell–ask, in small pieces and without jargon.
- Close with teach-back: ‘To be sure I explained it well, how would you tell your family what we are going to do?’
NURSE responses to emotion, with an example
| Letter | What you do | Example |
|---|---|---|
| N: Name | Put a name to the emotion you notice | ‘It seems this worries you a lot.’ |
| U: Understand | Show that the reaction makes sense | ‘With everything you have been through this year, it makes sense to feel this way.’ |
| R: Respect | Acknowledge the patient's effort or strength | ‘You have looked after your mother very well all this time.’ |
| S: Support | Offer company and continuity | ‘We will keep seeing each other and sort this out step by step.’ |
| E: Explore | Invite them to say more about what they feel | ‘What worries you most about what I just told you?’ |
Test yourself
Think of the answer, then tap the question to see it.
What do the letters of NURSE stand for?
Name the emotion, Understand (validate), Respect, Support and Explore.
What does teach-back really test?
The clarity of the clinician's explanation; that is why it is framed as ‘to be sure I explained it well’, not as a test of the patient.
How does a reflection differ from a summary?
A reflection gives back a single idea or emotion in other words; a summary pulls several ideas together at the end of a block and asks for correction.
Why are questions that start with ‘why’ avoided?
They sound like blame, put the patient on the defensive and close the conversation; ‘What happened?’ or ‘Tell me how it went’ work better.
Elsewhere in DurgiPedia
- The medical interview: rapport, open questions and listening
- Interviewing in special situations: interpreters and breaking bad news
Connections
Educational content on behavior and the clinical relationship; not a diagnostic or treatment guide and no substitute for assessment by a health professional. If you or someone near you is at risk, seek help now from an emergency service or a mental-health helpline.
Sources: Communication in Cancer Care (PDQ®)–Health Professional Version (National Cancer Institute (US), 2025); Communicating with patients: MedlinePlus Medical Encyclopedia (National Library of Medicine (US), 2025).
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Representative model, for educational purposes only.