It is easy to fail to reflect on consultations, to think about what went well and what could have gone better. There's nothing wrong with most consultations, but learning from mistakes can move them from good to great for the patient.

These areas are:

• Under- or over-estimating someone's level of health literacy
• Not asking the right questions
• Using jargon and abbreviations.

Let's examine each of these in turn.

Don't make assumptions

Different patients have different levels of health literacy and knowledge, and so any interaction needs to be pitched at a level that is right for each individual. The simple way to do this is to check their understanding.

This can't be just by asking if the patient has understood. Do this by asking the patient what they have understood. Then, if the patient is unable to repeat any aspects of the information you have given, it's important to retry using different language to explain the information. The conversation will help you to judge how simple or complex the language you are using needs to be for that individual.

The level of education, knowledge or the type of job someone does is not an indicator of their health literacy. Assess someone's understanding throughout a consultation and adapt the information you give accordingly, always framing the explanation in terms they will understand and avoiding jargon. The following scenario demonstrates this.

A couple on holiday both have long-term conditions. The husband has diabetes and the wife has rheumatoid arthritis. They both understand the importance of taking their medicines at particular times. The wife takes one medicine at 10pm in the UK and because they were away, she altered the timing of her medication on holiday to take it at the same time. However, she was waking up during the night and, as they were having a glass or two of wine in the evening while they were away, they were worried that the alcohol was interacting with their medicines.

Patients are unlikely to understand the reasoning behind the timings of medication dosages unless this is explained to them. In this case, the drug releases into the bloodstream fairly quickly and the level declines over the course of the night, so the best advice was to change the time of taking the medication to still be at 10pm in their holiday location rather than working on UK time. Linking advice to a person's lifestyle is also important. In this case, they could be advised that an occasional glass of wine was not a problem. Taking this approach with your communication is far more relevant to most people than talking about bioavailabilty, drug half-life, excretion rates or contraindications.

Ask the right questions

The language you use needs to be easily understood by the patient, and it is your responsibility to check that this is the case. Unfortunately, you may not know if the information you offer has not been understood, as most patients will be polite and say €Yes€ and €Thank you€ even when they haven't understood. We see this problem in the following patient scenario.

A patient is taking three medicines: a betablocker, a diuretic and a statin. Asked if he knew what each of the medicines was for, he told the pharmacist it was because he had high blood pressure and high cholesterol. He knew about changes to his diet, felt the medicines did help and he felt OK taking them. Confident in the patient's knowledge, the pharmacist next asks whether he takes his medicines regularly, and he confirms that he does. The pharmacist is about to move on when the patient adds that he takes his beta-blocker on a Monday, his diuretic on a Tuesday and his statin on a Wednesday. When he had an appointment with the doctor, he took them all the day before.

The patient did not aim to deceive or conceal information, but this is a good example of initially asking the wrong question sort of question that doesn't dig deep enough.

Avoid jargon

We all get so used to the language and terms we use that it is easy to forget that some things will not be familiar or understood. Again, reflect on the following scenario.

An observer in a pharmacy interviewed an elderly patient about a consultation she'd had with a pre-registration pharmacist. The patient said that she had found the pharmacist very helpful and they seemed to know a lot about medicines. She said she felt fairly confident about her tablets, what they were for and when to take them, and added that it was nice to have someone care enough to talk to her about them. However, she didn't quite understand why they'd been talking about NASA, the space agency, but didn't want to ask in case it seemed she'd not been listening properly. She just ignored the bit about NASA, as it had nothing to do with her medicines.

The patient was taking ibuprofen and had either misheard NSAID as NASA or, because she didn't know what the pharmacist was talking about, she had linked it to an abbreviation she had heard before.

This (real) example is a lesson in using the right language. It's always worth asking patients to tell you if you use any confusing abbreviations, as sometimes we do this without thinking. This will help the patient to realise that it isn't just their lack of understanding.