What is Ask-Tell-Ask?

Ask-Tell-Ask helps physicians assess what the patient already knows, provide targeted information, and confirm understanding. The physician first asks what the patient understands or wants to know, then tells the patient the most relevant information in clear language and finally asks again to confirm comprehension and identify remaining concerns.

Step One: Ask Before You Tell

Begin with an open-ended question before explaining a diagnosis, test result, medication change, referral, or treatment option. For example: “What is your understanding of what we are evaluating today?” or “What concerns you most about this plan?” These questions reveal baseline knowledge, priorities, and misconceptions.

Step Two: Tell Clearly, Briefly, and Specifically

The “tell” portion should be brief, organized, and tailored to what the patient shared. Avoid jargon. Prioritize what the patient needs to know now: the working diagnosis, reason for the plan, key risks and benefits, warning signs, and next steps.

For example: “Your blood pressure has been higher than our goal on several visits. Over time, this can increase the risk of stroke, heart disease, and kidney problems. I recommend adding a medication to help lower that risk.”

Step Three: Ask Again to Confirm Understanding

The final “ask” closes the loop. Instead of asking, “Do you understand?” use teach-back: “Just so I know I explained this clearly, can you tell me how you will take this medication?” This makes understanding the physician’s communication responsibility, not the patient’s failure.

The second “ask” can also surface barriers such as cost, transportation, fear of side effects, disagreement with the plan, or limited support at home, allowing the care team to adjust before nonadherence or harm occurs.

Why It Matters for Management of Clinical Risk

Communication failures often contribute to dissatisfaction and escalation. Ask-Tell-Ask reduces risk by creating a defensible process: the physician elicited the patient’s understanding, provided relevant information, and confirmed comprehension.

The method is useful for informed consent, test results, medication changes, chronic disease management, discharge instructions, referrals, unexpected outcomes, and refusal-of-care conversations.

Practical Phrases for Daily Use

Ask: "What is your understanding of what we found?"

Ask: "What concerns you most about this recommendation?"

Tell: "The most important thing to know is..."

Tell: "There are three options, and each has benefits and risks."

Ask again: "Can you tell me in your own words what the plan is?"

Ask again: “What questions do you still have?”

Putting it into Practice