Always look to "The Simpsons" for tips on how not to interact with others. The savagely satiric show recently featured a smug physician who exemplified lousy patient communications. As Marge Simpson lies on the operating table, awaiting general anesthesia prior to surgery, she says she still has a few questions about the procedure. The doctor's response: "Time is money. Ask the mask."

If that's not the bedside manner you want to emulate, check out this list of tips from your flesh-and-blood colleagues instead:

1. Keep it very simple.
"I believe all providers should assume patients cannot understand medical jargon and have a difficult time with communication issues," emphasizes Gloria Mayer, RN, EdD, president and CEO at the La Habra, Calif.-based Institute for Healthcare Advancement.

Doctors should speak in very plain language, Mayer says, and should discuss only the most important issues the patient needs to address-no more than three per visit. "Ask the patient to come back again or have someone call if he or she needs to know more," she advises.

2. Focus on language access.
Most providers in Southern California face language barriers with their patients on a daily basis, notes Michelle Scott, RN, MA, president and CEO at Voices for Health Inc., Grand Rapids, Mich. Finding an interpreting agency with qualified interpreters for multiple languages is one of the best ways to ensure effective communications with patients of diverse backgrounds, she adds.

Indeed, if you receive federal funding, Title VI of the Civil Rights Act of 1964 requires you to offer an interpreter to a limited-English-proficient patient-without cost. "If a provider cannot communicate with a patient, the provider misses out on 50 percent of the assessment process-the subjective assessment, such as the clinical history," Scott notes. "He or she must rely instead on more objective information, including blood tests and X-rays. Furthermore, a patient will not understand the consent for treatment, his or her rights and responsibilities as a patient, and the diagnosis and instructions for follow-up care."

Mayer agrees. She tells the story of a patient required to take medication "once a day." But the patient was Latino, and "once" is Spanish for 11-so the patient took the pill 11 times a day. A Spanish-speaking nurse in the ER figured out what happened.

3. Check proficiency with English.
There's a difference between understanding conversational English and understanding detailed medical jargon. "Sometimes we make the mistake of thinking that someone who seems to speak English well can understand every aspect of a medical encounter," Scott says. "A person may speak English proficiently enough to survive a general conversation, but medical jargon can get complicated."

And that's even more likely if the patient is under stress from illness. Also, remember that a patient may understand what the provider is saying, but may not speak English well enough to communicate his or her issues back to the doctor.

4. Remember the basics.
"Look the patient in the eyes. It always establishes a closer bond with the patient and seems to help the patient feel that the doctor spent more time with him or her than if there is no eye contact," urges Kenneth T. Hertz, CMPE, an Alexandria, La.-based senior consultant with MGMA Health Care Consulting Group. "And make sure that your staff understands the importance of 'please' and 'thank you' in communications."

5. Be inclusive with communications.
Recognize that patients don't live alone in plastic bubbles. With the patient's permission, include others in the conversation. Danielle Onstot, MD, an Oxnard pediatrician, reminds doctors to "acknowledge everyone in the room."

6. Use the teach-back method.
The experts can't emphasize enough the importance of simply asking patients if they understand. "Always ask the patient if he or she has any questions," Hertz says. "Too often, a patient will leave a practice with unanswered questions." It's also helpful to have your checkout staffer ask patients if all their questions were answered.

Mayer recommends the "teach-back method," calling it critical to knowing whether the patient understands. "To know if communication is working, a doctor simply needs to ask the patient to repeat back what he or she said," Scott explains. "Say something like, 'Mr. Smith, I want to be sure that I am explaining everything to you well. Can you please tell me the name of your diagnosis?' or 'I want to be sure that you understand how to take your medication. Can you please tell me how you will take these pills when you get home?'" That, she says, will tell you immediately if your communication has been effective.

7. Strive to continually improve.
Urologist Tim Pietro, MD, says it best: "I'm still learning and still trying to do better," he comments. "Our medical school curriculum is a bit lacking in the area of patient communications. I try to be very flexible, modifying my approach to fit an individual patient's needs. It's difficult to plan ahead when it comes to patient communications."