Ask-Tell-Ask Sample Dialogue

Ask-tell-ask sample dialogue

The foundational health coaching technique

Ask-tell-ask is the basis for all health coaching. Rather than telling patients a lot of information, health coachesask, tell, then ask again:

Ask what they know and what they want to know.
Tell them what they want to know.
Ask them if they understand and what else they want to know.

Ask:

Always ask permission to start the conversation.
Ask the patient to describe their understanding of the visit with their doctor and/or their health. This will help tailor the conversation to the patient’s level of understanding and emotional state.
Asking helps you determine the agenda for the conversation because you understand what the patient hopes to accomplish.

Tell:

Provide simple information that the patient wants to know, using only a few short sentences.
Share information that the physician has authorized the coach to provide.
Use simple language the patient will understand, not medical terminology or jargon.

Ask again:

Confirm understanding by asking the patient to repeat back what was just explained in their own words.
Ask if the patient has any questions or wants to know anything else.

The script below is an example of how ask-tell-ask works in practice. In this dialogue, the coach’s part of the conversation is primarily delivered as questions. The different types of questions and the rationale for each type are described in brackets. Note that the coach does not lecture the patient and the patient is driving the conversation.

Coach / Would it be okay if we talk about your sugars or A1C now?
[Asking permission to have the conversation]
Mr. Newton / Yes, it’s okay.
Coach / What do you know about your A1C?
[Determining Mr. Newton’s level of understanding]
Mr. Newton / Not much.
Coach / That’s fine. Let’s go over it together. A1C tells you how well you are controlling your diabetes. A1C tells you what your average blood sugar has been for the last three months. Just to make sure I was clear, can you tell me what your A1C measures?
[Tells the information Mr. Newton doesn’t know, then asks to check understanding, also called “closing the loop”]
Mr. Newton / I think A1C is an average of my blood sugar over 3 months. Is that right?
Coach / Yes, that’s correct! Why do you think we care about your A1C number?
[Finding out what Mr. Newton knows or doesn’t know]
Mr. Newton / I’m not sure. I think you said it shows something about my diabetes.
Coach / Yes! Your A1C number is another way to measure how your diabetes is doing. Can you tell me what your A1C number is? And do you know your goal?
[Tells information and then asks to find out what Mr. Newton knows or doesn’t know]
Mr. Newton / I’m not sure.
Coach / Your A1C is 10 and your goal is seven. What do you think about that?
[Asking about Mr. Newton’s motivation]
Mr. Newton / My A1C is too high. I don’t like that. It needs to be seven.
Coach / Yes, would you like to talk about how to bring it down to seven?
[Asking permission]
Mr. Newton / Yes.
Coach / Do you know how to bring your A1C to seven?
[Asking to assess Mr. Newton’s knowledge]
Mr. Newton / No, I don’t.
Coach / The three main options are healthy eating, physical activity and taking your medicines. Is there one of those you would like to work on?
[Tells options then asks for Mr. Newton’spreference]
Mr. Newton / I think eating better.
Coach / Could we talk about that when we meet next week?
[Asks permission for a future coaching meeting]

Source: AMA. Practice transformation series: health coaching. 2016.

References

University of California San Francisco Center for Excellence in Primary Care. Health coaching curriculum.

Updated 2012.

Accessed December 7, 2015.

California Healthcare Foundation. Coaching patients for successful self-management [video].

selfmanagement/terms-of-use/watch-video-on-coaching-patients. August 2008. Accessed December 8,

2015.

Vitaltalk.org. Fundamental communication skills.

Updated 2002. Accessed

December 8, 2015.

The Oncology Nurse Community. Interview with Dr. James Tulsky on the ‘Ask-tell-ask’ Model [video].

October 26, 2012. Accessed

December 8, 2015.