CHAPTER © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 4 Communication with Patients, Families, and Coworkers

© 2011 The McGraw-Hill Companies, Inc. All rights reserved Identify elements of the communication circle. 4.2Understand and define the developmental stages of the life cycle. 4.3Give examples of positive and negative communication. Learning Outcomes

© 2011 The McGraw-Hill Companies, Inc. All rights reserved List ways to improve listening and interpersonal skills. 4.5Explain the difference between assertiveness and aggressiveness. 4.6Give examples of effective communication strategies with patients in special circumstances. Learning Outcomes (cont.)

© 2011 The McGraw-Hill Companies, Inc. All rights reserved Discuss ways to establish positive communication with coworkers and management. 4.8Describe how the office policy and procedures manual is used as a communication tool in the medical office. Learning Outcomes (cont.)

© 2011 The McGraw-Hill Companies, Inc. All rights reserved Describe community resources and how they enhance the services provided by your office Explain how stress relates to communication and identify strategies to reduce stress. Learning Outcomes (cont.)

© 2011 The McGraw-Hill Companies, Inc. All rights reserved. 4-6 Introduction Medical assistants must –Recognize human behaviors –Communicate effectively, with professionalism and diplomacy –Recognize obstacles that affect therapeutic communication

© 2011 The McGraw-Hill Companies, Inc. All rights reserved. 4-7 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.

© 2011 The McGraw-Hill Companies, Inc. All rights reserved. 4-8 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!

© 2011 The McGraw-Hill Companies, Inc. All rights reserved. 4-9 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

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

© 2011 The McGraw-Hill Companies, Inc. All rights reserved The Communication Circle  The communication circle involves an exchange of messages through verbal and nonverbal means.

© 2011 The McGraw-Hill Companies, Inc. All rights reserved Communication Process Patients often believe that health care has become impersonal due to –Technological advances –Managed care organizations Maintain a patient-centered approach

© 2011 The McGraw-Hill Companies, Inc. All rights reserved Apply Your Knowledge What are the three elements of the communication circle? ANSWER: The three elements of the communication circle are the message, source, and receiver. RIGHT!

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

© 2011 The McGraw-Hill Companies, Inc. All rights reserved Maslow’s Hierarchy of Human Needs Self-Actualization Esteem Needs Love/Belonging Needs Physiological Needs Deficiency (Basic) Needs Safety Needs

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

© 2011 The McGraw-Hill Companies, Inc. All rights reserved Types of Communication Positive or negative Verbal or non-verbal Written (Chapter 7)

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

© 2011 The McGraw-Hill Companies, Inc. All rights reserved Negative Verbal Communication  Curb negative communication habits  Mumbling  Speaking brusquely  Avoiding eye contact  Interrupting patients as they speak  Rushing explanations  Forgetting common courtesies  Showing boredom  Treating the patient impersonally

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

© 2011 The McGraw-Hill Companies, Inc. All rights reserved Apply Your Knowledge 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!

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

© 2011 The McGraw-Hill Companies, Inc. All rights reserved Improving Communication Skills (cont.) Interpersonal skills –Warmth and friendliness –Empathy –Respect –Genuineness –Openness –Consideration and sensitivity

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

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

© 2011 The McGraw-Hill Companies, Inc. All rights reserved Ineffective Therapeutic Communication Roadblocks Reassuring Giving approval Disapproving Agreeing/ disagreeing Advising Probing Defending Requesting an explanation Minimizing feelings Making stereotyped comments

© 2011 The McGraw-Hill Companies, Inc. All rights reserved Defense Mechanisms Unconscious, designed to protect self Patients may display –Compensation –Denial –Displacement –Dissociation –Identification –Introjection –Projection

© 2011 The McGraw-Hill Companies, Inc. All rights reserved Assertiveness Skills  Assertive – people who are firm and stand by principles while still showing respect for others  Requires  Openness  Honesty  Directness  Aggressive – people who try to impose their position on others or try to manipulate them

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

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

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

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

© 2011 The McGraw-Hill Companies, Inc. All rights reserved Communication – Other Cultures (cont.) Attitudes about health care Beliefs about causes of illness Symptoms and what they mean Treatment expectations Language barriers

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

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

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

© 2011 The McGraw-Hill Companies, Inc. All rights reserved Communication – Elderly Patients Be respectful Do not talk down to elderly persons Touch – communicates caring

© 2011 The McGraw-Hill Companies, Inc. All rights reserved Communication – Terminally Ill Patients Often under extreme stress, so offer support and empathy Kubler-Ross’s Stages of Dying –Denial –Anger –Bargaining –Depression –Acceptance

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

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

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

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

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

© 2011 The McGraw-Hill Companies, Inc. All rights reserved Communicating with Management Keep supervisor informed Ask questions Minimize interruptions Show initiative

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

© 2011 The McGraw-Hill Companies, Inc. All rights reserved Apply Your Knowledge 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?

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

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

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

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

© 2011 The McGraw-Hill Companies, Inc. All rights reserved Other Resources Reference laboratories Insurance companies Office equipment suppliers Maintenance companies

© 2011 The McGraw-Hill Companies, Inc. All rights reserved Apply Your Knowledge 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!

© 2011 The McGraw-Hill Companies, Inc. All rights reserved Personnel Management Employee –Relations –Benefits –Performance Other administrative tasks Hiring Training Compensation

© 2011 The McGraw-Hill Companies, Inc. All rights reserved Personnel Management (cont.) Employee orientation –Stress competencies Teamwork Policies/procedures Cross-training

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

© 2011 The McGraw-Hill Companies, Inc. All rights reserved Apply Your Knowledge 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!

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

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

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

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

© 2011 The McGraw-Hill Companies, Inc. All rights reserved Burnout (cont.) Stages to burnout –Honeymoon –Awakening –Brownout –Full-scale burnout –Phoenix phenomenon

© 2011 The McGraw-Hill Companies, Inc. All rights reserved Preventing Burnout Take time to rest and relax Be realistic about job expectations, your aspirations, and your goals Create a balance in life

© 2011 The McGraw-Hill Companies, Inc. All rights reserved Apply Your Knowledge What are the phases of burnout? ANSWER: The phases of burnout are Honeymoon Awakening Brownout Full-scale burnout Phoenix phenomenon

© 2011 The McGraw-Hill Companies, Inc. All rights reserved In Summary 4.1The 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.

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

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

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