Post 14: Framework: Ask-Tell-Ask
SPIKES and Ask-Tell-Ask
In post 12, we discussed using the SPIKES framework to help us with shared decision-making (SDM). In the closing of that post, I emphasized that there are several models out there for learning and teaching communication skills. There is no one right or wrong way to communicate as long as we keep the foundational principles in mind:
Active Listening
Active Reflection
Empathy
When I learned communication skills in medical school, I learned a model called “Ask-Tell-Ask,” as the name implies, we should always ask the patient (so listen for their responses) before telling them what we want to say to them. After we have told them, we need to check back in with them to ensure they have heard what we meant to say by asking again.
This model relied on “building rapport” first.
If we think that building rapport is part of the Setup, then the first Ask is “asessing perceptions.” This is accomplished by using open ended questions. I think active listening is implied in this model.
The “tell” refers to “obtaining invitation followed by giving knowledge with empathy.”
The last Ask is for summarizing the conversation by asking patients to sumarize what they have heard or asking for what questions or concerns they still have.
What framework do you use? What are some key skills you rely on for having meaningful conversations with those around you?
Biren Saraiya MD