chapter © 2011 the mcgraw-hill companies, inc. all rights reserved. 4 communication with patients,...

CHAPTER

© 2011 The McGraw-Hill Companies, Inc. All rights reserved.

4Communication with Patients, Families,

and Coworkers


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4.1 Identify elements of the communication circle.

4.2 Understand and define the developmental stages of the life cycle.

4.3 Give examples of positive and negative communication.

Learning Outcomes


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4.4 List ways to improve listening and interpersonal skills.

4.5 Explain the difference between assertiveness and aggressiveness.

4.6 Give examples of effective communication strategies with patients

in special circumstances.

Learning Outcomes (cont.)


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4.7 Discuss ways to establish positive communication with coworkers and management.

4.8 Describe how the office policy and procedures manual is used as a communication tool in the medical office.



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4.9 Describe community resources and how they enhance the services provided by your office.

4.10 Explain how stress relates to communication and identify strategies to reduce stress.



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Introduction

• Medical assistants must– Recognize human

behaviors– Communicate

effectively, with professionalism and diplomacy

– Recognize obstacles that affect therapeutic communication


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Communicating with Patients and Families

• You are the key communicator between the physician and patient

• Your interaction sets the tone for the office visit

• Developing strong communication skills is just as important as mastering administrative and clinical skills

Communication will influence how comfortable the patient feels in your practice.


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Communicating with Patients and Families (cont.)

• Customer service – Most important part of

communication

– Two points fundamental to customer service• The patient comes first• Patient needs are satisfied

Patients are #1!


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Communicating with Patients and Families (cont.)

• Examples of customer service– Telephone techniques

– Writing or responding to telephone messages

– Explaining procedures to patients

– Assisting with billing issues

– Creating a warm and reassuring environment


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Apply Your Knowledge

What are the two key parts of customer service?

ANSWER: The two fundamental parts of customer service are that the patient comes first and you must satisfy patient needs.


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The Communication Circle The communication

circle involves an exchange of messages through verbal and nonverbal means.


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Communication Process

• Patients often believe that health care has become impersonal due to – Technological advances– Managed care organizations

• Maintain a patient-centered approach


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What are the three elements of the communication circle?

ANSWER: The three elements of the communication circle are the message, source, and receiver.

RIGHT!


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Human Behavior: Stages of the Life Cycle

• Understanding growth and development enhances communication skills– Physical development– Psychological and

emotional growth

• Guidelines for communication based on developmental stage– Infant – Toddler– Preschooler– School age– Adolescence– Young, middle, old

adult


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Maslow’s Hierarchy of Human Needs

Self-Actualization

Esteem Needs

Love/Belonging Needs

Physiological Needs

Deficiency (Basic) Needs

Safety Needs


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You can communicate with all people in the same way. Is this statement true or false, and why?

ANSWER: The statement is false. Not all people are at the same place on Maslow’s hierarchy of human needs. To communicate effectively with a person, you need to understand what he or she is deficient in. For example, you would use different communication styles when talking to a homeless person who may have psychological and safety needs than when talking to an elderly person who is lonely and depressed due to the recent loss of his or her spouse.


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Types of Communication

• Positive or negative

• Verbal or non-verbal

• Written (Chapter 7)


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Positive Verbal Communication• Communication

promotes the patient’s comfort and well-being

– Set the stage for positive communication

– Encourage patients to ask questions

– Speak slowly and clearly


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Negative Verbal Communication

Curb negative communication habitsMumblingSpeaking brusquely Avoiding eye contact Interrupting patients as they speakRushing explanations Forgetting common courtesiesShowing boredomTreating the patient impersonally


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Non-Verbal Communication• Facial expression• Eye contact• Posture

– Open– Closed

• Touch• Personal space

In many instances, people’s body language conveys their true feelings, even when their words may say otherwise.


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Mr. Garcia comes to the desk to check in and asks if he will be seen on time. The receptionist continues with her paperwork, points to the sign-in sheet, and tells Mr. Garcia: “Just sign in. The doctor will be with you when he can.” Explain why this is an example of negative communication.

ANSWER: This is an example of negative communication because the clerk

• Did not stop what he or she was doing – was not friendly or attentive

• Did not greet Mr. Garcia or make eye contact with him

• Did not give a satisfactory answer to Mr. Garcia’s question

• Did not make sure Mr. Garcia understood when he would be seen

YEA!


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Improving Communication Skills

• Listening skills– Passive listening

– Active listening

• Improve listening skills

– Prepare to listen

– Relax and listen attentively

– Maintain eye contact

– Maintain personal space

– Think before you

respond

– Provide feedback


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Improving Communication Skills (cont.)

• Interpersonal skills– Warmth and

friendliness– Empathy– Respect– Genuineness– Openness– Consideration and sensitivity


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Therapeutic Communication

• The ability to communicate with patients– In terms they can understand– So they feel at ease and comfortable

• The ability to communicate with other members of the health-care team– Technical terms– Appropriate to the health-care setting


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Therapeutic Communication (cont.)

• Involves Silence

Accepting

Giving recognition

Offering self

Giving a broad opening

Offering general leads

Making observations

Encouraging communication

Mirroring Reflecting Focusing Exploring Clarifying Summarizing


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Ineffective Therapeutic Communication

• Roadblocks Reassuring Giving approval Disapproving Agreeing/

disagreeing Advising

Probing Defending Requesting an

explanation Minimizing feelings Making stereotyped

comments


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Defense Mechanisms

• Unconscious, designed to protect self

• Patients may display– Compensation– Denial– Displacement– Dissociation– Identification– Introjection– Projection


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Assertiveness SkillsAssertive – people who are firm and

stand by principles while still showing respect for othersRequires

OpennessHonestyDirectness

Aggressive – people who try to impose their position on others or try to manipulate them


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What is the difference between being aggressive and being assertive?

ANSWER: Assertiveness means standing by your principles while showing respect for others. You trust your instincts, feelings, and opinions and act on them. An aggressive person tries to impose his or her own position on others or tries to manipulate them. He or she is bossy, may be quarrelsome, and does not consider others’ feelings, needs, thoughts, ideas, or opinions.


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Communication – Anxious Patient

• Can interfere with communication process– May not listen well or pay attention to what

you are saying

• Observe for – Tense appearance– Increased blood pressure and breathing– Sweaty palms– Irritability and agitation


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Communication: – Angry Patient

– Recognize anger and its cause

– Remain calm and demonstrate respect

– Focus on physical and medical needs

– Maintain adequate personal space

– Do not take anger personally

– Ask patient to be specific concerning cause

– Present your point of view

– Avoid breakdown of communication

– Leave if you feel physically threatened

Goal is to help the patient express anger constructively Steps in communicating with an angry patient


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Communication – Patients from Other Cultures

• Each patient has his or her own behaviors, traditions, and values– Strive to understand and be tolerant

• Stereotyping– Negative statement about specific traits of a

group applied to an entire population

• Generalization– Statement about common trends within a

group


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Communication – Other Cultures (cont.)

• Attitudes about health care

• Beliefs about causes of illness

• Symptoms and what they mean

• Treatment expectations

• Language barriers


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Communication – Patients with Visual Impairment

• Use large-print materials

• Use adequate lighting in all areas

• Use a normal speaking voice

• Talk directly and honestly

• Do not talk down to the patient

• Preserve the patient’s dignity


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Communication – Patients with Hearing Impairment

• Find a quiet area to talk

• Minimize background noise

• Position yourself close to and facing the patient

• Speak slowly

• Remember that elderly patients lose the ability to hear high-pitched sounds first

• Verify understanding

• Use written material

• Speak clearly but do not shout


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Communication – Mentally or Emotionally Disturbed

• Determine what level of communication the patient can understand

• Suggestions– Remain calm if the

patient becomes agitated or confused

– Avoid raising your voice

– Avoid appearing impatient


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Communication – Elderly Patients

• Be respectful

• Do not talk down to elderly persons

• Touch – communicates caring


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Communication – Terminally Ill Patients

• Often under extreme stress, so offer support and empathy

• Kubler-Ross’s Stages of Dying– Denial– Anger– Bargaining– Depression– Acceptance


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Communication – Young Patients and Their Parents

• Recognize and accept their fear and anxiety

• Explain all procedures

• Use praise

• Do not tell children that a procedure will not hurt if it will, or you will lose their trust

• Reassuring and keeping parents calm will also help the child relax


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Communication – Patients with AIDS/HIV

• Stigma of disease– Guilt– Anger– Depression

• You must have accurate information about the disease and the risks involved to answer the patient’s questions

• Patients need human contact and to be treated with dignity


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Communication – Patient’s Family and Friends

• Provide emotional support to the patient

• Acknowledge family members and friends

• Keep them informed about patient’s progress

• Remember to protect patient confidentiality– Ask the patient what information can be given

to family or friends


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What can you do to promote communication with someone who is visually impaired?

ANSWER: Use large-print materials, adequate lighting in all areas, and a normal speaking voice. Talk directly and honestly, but do not talk down to the patient; preserve the patient’s dignity.


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Communication with Coworkers

• Develop rapport with coworkers

• Rules for the medical office – Use proper channels

– Have a proper attitude

– Plan an appropriate time for communication


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Communicating with Management

• Keep supervisor informed

• Ask questions

• Minimize interruptions

• Show initiative


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Dealing with Conflict

• Do not gossip

• Do not jump to conclusions

• Set boundaries to limit undesirable behavior

• Do not “feed into” others’ negative attitudes

• Be personable and supportive

• Refrain from passing judgments


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ANSWER: You can use the following strategies to avoid conflict in the workplace:

• Do not “feed into” others’ negative attitudes• Be personable and supportive• Refrain from passing judgments• Do not gossip• Do not jump to conclusions

What strategies can you use to avoid conflict in the workplace?


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Policy and Procedures Manual

• Key written communication tool

• Policies– Dictate the day-to-day

workings of an office– Describe chain of

command

• Procedures– Detailed instructions

for specific procedures


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Policies

• Office purposes• Rules and regulations• Job descriptions• Office hours• Dress code• Insurance • Vacation and sick

leave

• Salary evaluations• Maintenance of

equipment• Mailings• Bookkeeping• Scheduling

appointments• OSHA


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Procedures

• Purpose of test, clinical application, and usefulness

• Specimen required and collection method– Special patient preparations or restrictions

• Reagents, standards, controls, and media used

• Instrumentation– Calibration and schedules

• Step-by-step directions


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Community Resources • Good customer service is

founded on providing or researching services to assist in attaining the goal of patient health and well-being

• Discuss with patient’s physician before referring patient

• Resources – Alcoholics Anonymous

– Shelters

– Hospice

– Mental health services

– Meals on Wheels

– PASSPORT

– Easter Seals

– State agencies

– Support groups


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Other Resources

• Reference laboratories

• Insurance companies

• Office equipment suppliers

• Maintenance companies


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ANSWER: Policies dictate the day-to-day workings of an office and usually describe the chain of command. Procedures are the detailed instructions for specific procedures.

What is the difference between policies and procedures?

Right!


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Personnel Management

• Employee – Relations– Benefits– Performance

• Other administrative tasks

• Hiring

• Training

• Compensation


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Personnel Management (cont.)

• Employee orientation– Stress competencies

• Teamwork• Policies/procedures• Cross-training


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Personnel Management (cont.)

• Successful hiring

– Find the most qualified person for the job

– Scrutinize and check references carefully

– Have a salary range

– Discuss policies and procedures early

– Train properly and re-train


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What is employee orientation essential to?

What should be stressed during employee orientation?

ANSWER: Personnel management

ANSWER: Competencies of teamwork, policies and procedures, and cross-training

Good Answers!


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Managing Stress• Stress can be a barrier to communication

• Stress can occur– Due to a feeling of being

under pressure– As a reaction to anger,

frustration, or change in routine

• Stress is normal – Motivating– More productive


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Managing Stress (cont.)

• Ongoing stress – Overwhelming– Physical effects

• Reducing stress– Consider your strengths

and limitations– Be realistic about

commitments both at work and in your private life

– Techniques to reduce stress


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List three things you can do to relieve stress.

ANSWER: Any of the following can help you reduce stress:

• Exercise regularly

• Eat a balanced diet

• Get enough sleep

• Set realistic goals

• Be organized

Change what you have control over

Keep focused

Identify sources of conflict

Maintain a sense of humor

Try not to overreact


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Burnout

• Burnout is the end result of prolonged periods of stress without relief

• Type A personality– Highly driven, perfectionist-type person– More susceptible to burnout

• Type B personality– More relaxed, calm, “laid back” – Less prone to burnout


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Burnout (cont.)

• Stages to burnout– Honeymoon

– Awakening

– Brownout

– Full-scale burnout

– Phoenix phenomenon


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Preventing Burnout

• Take time to rest and relax

• Be realistic about job expectations, your aspirations, and your goals

• Create a balance in life


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What are the phases of burnout?

ANSWER: The phases of burnout are

• Honeymoon

• Awakening

• Brownout

• Full-scale burnout

• Phoenix phenomenon


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In Summary

4.1 The communication circle involves a message being sent, a source, and a receiver that responds.

4.2 It is important for the medical assistant to understand the development of the life cycle as it will assist in communication skills with patients.

4.3 Communication that promotes comfort and well being is considered positive communication. Medical assistants may not be aware of some of the signs of negative communication they display.


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In Summary (cont.)

4.4 Listening and other interpersonal skills can be improved by becoming more involved in the communication process.

4.5 Assertive medical professionals trust their instincts. Aggressive medical professionals try to impose their positions through manipulation techniques.

4.6 Learning about the special needs of patients and polishing your communication skills will help you become an effective communicator.


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In Summary (cont.)

4.7 The quality of communication you have with your coworkers and your supervisor greatly influences the

development of a positive or negative work climate.

4.8 The policy and procedure manual is a key communication tool.

4.9 Community resources are available in your local area to patients who may need additional outside resources.

4.10Stress can be good or bad. However, it is how we handle stress that makes the difference.


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Often during life-altering experiences, patients and their loved ones need a shoulder to cry on or someone to comfort them. It is important for them to know support is there.

—Lindsey D. Fisher (The Healers Art)

End of Chapter 4

chapter © 2011 the mcgraw-hill companies, inc. all rights reserved. 4 communication with patients,...

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