You have just delivered post-operative instructions to an elderly patient. What is the BEST way to confirm the instructions were understood?

Correct answer: C. Ask the patient to repeat the instructions back in their own words (teach-back)

• A. 'Do you have any questions?' is a closed, face-saving question. Patients routinely answer no out of politeness or embarrassment even when they have understood nothing.
• B. A signature documents that instructions were given. It is a medico-legal record, not evidence of comprehension.
• C. CORRECT. TEACH-BACK (also called 'closing the loop') is the evidence-based method for verifying comprehension. Asking the patient to restate the instructions in their own words is the only technique that actually demonstrates understanding rather than assuming it, and it is particularly important in older adults, in whom hearing loss, mild cognitive impairment and polypharmacy all reduce retention. If the patient cannot restate it, you re-explain and check again — the burden of clear communication sits with the clinician, not the patient.
• D. Simply repeating more loudly is patronising and does not test whether the message landed. It also wrongly assumes the barrier is hearing rather than comprehension.

Note: ⚑ The source contributor chose 'positive feedback' and suspected it was wrong. Positive reinforcement is a useful adjunct once the patient teaches back correctly, but the verification step itself is teach-back.