[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Behavioral science](https://durgical.com/en/behavioral-science/) › [Doctor–patient relationship and communication](https://durgical.com/en/behavioral-science/areas/communication/) › Communication skills: open questions, empathy and teach-back

# 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.

Updated Nov 5, 2026

## Key points

- An open question invites a story (‘How have you been since the last visit?’); a closed one is answered with yes, no or a fact.
- Reflection: giving back in other words what the patient said or felt; summary: ordering what was heard and asking for correction.
- NURSE for responding to emotion: Name, Understand, Respect, Support and Explore.
- Ask–tell–ask: find out what they know, give a short message, check what they understood.
- Teach-back: the patient explains in their own words what they will do; it tests the clarity of the explanation, not the patient.
- Empathy is not sympathy: it is understanding and naming the other person's feeling without judging it or taking it on as your own.

## 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?’ |

## Memory aid

Open, Reflect, Recap, Recheck: the loop closes with the last step, which is teach-back.

## 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.

[Add to my cards (4)](https://durgical.app/estudiar/?add=/en/behavioral-science/communication-skills-open-questions-empathy-and-teach-back/)

## Elsewhere in DurgiPedia

- [The medical interview: rapport, open questions and listening](https://durgical.com/en/clinical-exam/the-medical-interview-rapport-open-questions-and-listening/)
- [Interviewing in special situations: interpreters and breaking bad news](https://durgical.com/en/clinical-exam/interviewing-in-special-situations-interpreters-and-breaking-bad-news/)

## Connections

## Related 6

- [Breaking bad news: the SPIKES protocol](https://durgical.com/en/behavioral-science/breaking-bad-news-the-spikes-protocol/)
- [Motivational interviewing](https://durgical.com/en/behavioral-science/motivational-interviewing/)
- [Health literacy](https://durgical.com/en/behavioral-science/health-literacy/)
- [Models of the doctor–patient relationship and patient-centred care](https://durgical.com/en/behavioral-science/models-of-the-doctor-patient-relationship-and-patient-centred-care/)
- [Difficult encounters: anger, demands and boundaries](https://durgical.com/en/behavioral-science/difficult-encounters-anger-demands-and-boundaries/)
- [Crisis intervention and supportive psychotherapy](https://durgical.com/en/behavioral-science/crisis-intervention-and-supportive-psychotherapy/)

[← All of behavioral science](https://durgical.com/en/behavioral-science/)

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](https://www.cancer.gov/about-cancer/coping/adjusting-to-cancer/communication-hp-pdq) (National Cancer Institute (US), 2025); [Communicating with patients: MedlinePlus Medical Encyclopedia](https://medlineplus.gov/ency/patientinstructions/000456.htm) (National Library of Medicine (US), 2025).

## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake

Representative model, for educational purposes only.

---
Source: https://durgical.com/en/behavioral-science/communication-skills-open-questions-empathy-and-teach-back/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/behavioral-science/communication-skills-open-questions-empathy-and-teach-back/