Patient Care

Engaging Your Patients in Decision-Making Processes Yields Better Outcomes


Editor’s note: “Everything We Say and Do” is an informational series developed by SHM’s Patient Experience Committee to provide readers with thoughtful and actionable communication tactics that have great potential to positively impact patients’ experience of care. Each column will focus on how the contributor applies one of the “Key Communication” areas in practice.

View a chart outlining key communication tactics

What I Say and Do

Vicente J. Velez, MD, FHM

Vicente J. Velez, MD, FHM

I counsel and deliver the diagnosis or give recommendations through a dialogue, instead of a monologue, using active listening.

Why I Do It

The monologue, or lecture, is among the least effective ways to instill behavior change. Research studies have demonstrated that, after a monologue, only around 20% to 60% of medical information is remembered by the end of a visit. Out of what is remembered, less than 50% is accurate. Furthermore, 47% of Americans have health literacy levels below the intermediate range, defined as the ability to determine when to take a medication with food from reading the label.

Lecturing the patient without first understanding what the patient knows and finds important, and understanding the barriers to plan implementation, runs the risk of decreased comprehension, a lack of understanding, or a lack of personal relevance—all leading to decreased adherence. Doing the opposite, by involving the patient in decision making, inspires change that comes from within in the context of the patient’s own needs. This approach is more enduring, emphasizes self-accountability, and ultimately leads to better outcomes.

How I Do It

I open up a dialogue using the Cleveland Clinic’s ARIA approach as adapted from the REDE model of healthcare communication.1

  • First, assess: What does the patient know about diagnosis and treatment? How much and what type of education does the patient desire/need? What are the patient’s treatment preferences and health literacy?
  • Second, reflect on what the patient just said. Validate meaning and emotion.
  • Third, inform the patient within the context of the patient’s perspectives and preferences. Speak slowly and provide small chunks of information at a time. Use understandable language and visual aids. (This will increase recall by 60%.)
  • Finally, assess the patient’s understanding and emotional reaction to information provided.
  • Repeat the cycle to introduce other chunks of information.

Dr. Velez is director of faculty development in the Center for Excellence in Healthcare Communication at the Cleveland Clinic.


  1. Windover A, Boissy A, Rice T, Gilligan T, Velez V, Merlino J. The REDE model of healthcare communication: optimizing relationship as a therapeutic agent. J Patient Exp. 2014;1(1):8-13.

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