1. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Interpersonal Skills and Human Behavior Chapter 5

2. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 2 Introduction The medical assistant’s interpersonal skills help to set the tone of the office. Interpersonal skills and human relations intersect, and the successful medical assistant will work to improve both sets of skills throughout his or her career.

3. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 3 This chapter will examine: The importance of first impressions The differences between verbal and nonverbal communications Spatial separation The value of touch while communicating Elements of the transactional communication model Barriers to effective communication Defense mechanisms, listening, and dealing with conflict

4. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 4 The Patient’s Perception The patient’s perception of the physician’s office and the staff members is critically important. Perception may not be accurate at all times, but what the patient perceives is just as important as what is actually happening.

5. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 5 First Impressions First impressions are still lasting ones!

6. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 6 First Impressions First impressions are more than physical appearance or dress. Opinions formed in the first few moments of meeting last much longer in our thoughts than the actual time we spend with a person we have just met. The first impression includes attitude, compassion, and the smile!

7. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 7 Introductions Always introduce yourself to patients Smile Wear a name badge Show the patient around the office Introduce other staff members to the patient Put the patient at ease

8. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 8 Communication Paths Verbal Communication Depends on words and sounds Do not interrupt a person who is speaking

9. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 9 Verbal Communication Speak clearly and enunciate properly. Vary the pitch of the voice. Use appropriate volume. Speak at an audible level. Make eye contact. Speak in an animated fashion. Show concern.

10. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 10 Verbal Communication Tone of voice is very important in communication. Never be sarcastic. Never be rude. Never make an inappropriate remark and follow it by saying “I was just kidding.” Take care not to hurt anyone’s feelings with words or phrases.

11. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 11 Patients Need Tender Care Remember that patients are in the office to be cared for. They may have great concerns. They may be very apprehensive. They may be fearful.

12. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 12 Listen to Patients Allow patients to do most of the talking. Do not offer personal information about your own life and problems. Share only positive experiences, and then, only briefly. Do not burden the patient with your problems at any time!

13. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 13 Nonverbal Communication Nonverbal communications are messages that are conveyed without the use of words. Transmitted by: Body language Gestures Mannerisms Eye movement

14. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 14 Body Language Partly instinctive Partly taught Partly imitative

15. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 15 Body Language Involves: Eye contact Facial expression Hand gestures Grooming Dress Space Tone of voice Posture Touch

16. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 16 Appearance Appearance is a vital part of nonverbal communication. Appearance can present conflicting nonverbal information.

17. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 17 Appearance The successful medical assistant expresses: self-esteem confidence pleasant facial expressions caring attitudes

18. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 18 Conservative Appearance In the medical profession, patients expect professionalism, and conservative appearance is preferred to avoid blocks in communications.

19. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 19 Proxemics Proxemics is the study of the nature, degree, and effect of the spatial separation individuals naturally maintain and how this separation relates to cultural and environmental factors.

20. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 20 What Can Touch Mean? Touch, in the medical profession, can be comforting or can promote a sexual harassment lawsuit.

21. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 21 Avoid Claims of Battery Be very careful when touching a patient. Non-consensual touching can be considered battery in today’s litigious society.

22. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 22 The medical assistant should not be afraid to touch patients in an appropriate manner.

23. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 23 Posture and Positioning Can signal: Depression Anger Excitement Fear An appeal for help

24. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 24 The Process of Communication To communicate well, we must have a general understanding of the process of communication. Usually when two people interact, they both function as senders and receivers.

25. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 25 Channels Channels can be: Spoken words Written messages Body language

26. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 26 Encoding Senders encode a message, which means that they choose a specific method of expression using words and/or other channels.

27. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 27 Decoding The receiver decodes the message according to his or her understanding of what is being communicated.

28. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 28 Noise Noise contributes to the misunderstanding of messages. Noise is anything that interferes with the message being sent.

29. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 29 Feedback Verbal expression Body language Nod of understanding

30. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 30 Transactional Communication Model

31. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 31 Listening Listening is paying attention to sound or hearing something with thoughtful attention. Listening is an important skill that the medical assistant can develop.

32. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 32 What Prevents Us from Listening? Our own thoughts distract us. Situations in our lives make it hard to listen. Conversation seems meaningless and unimportant. Too many messages are coming in at once. Emotions, such as anger, render us unable to listen. Exhaustion makes listening difficult. We have prejudged the speaker and feel there is no need to listen.

33. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 33 Listening to Patients Patients must know that we are listening—not only hearing the words that are being spoken, but attempting to interpret what the patient is trying to communicate.

34. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 34 Paraphrasing Paraphrasing: Listening to what the sender is communicating Analyzing the words Restating them to confirm that the receiver has understood the message as the sender intended it Clarifies speaker’s thoughts Helps to indicate that there is common understanding

35. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 35 Ask Open-Ended Questions Can you explain what the pain feels like? When did you first notice these symptoms? What are you usually doing when you have symptoms? What do you think is causing the symptoms?

36. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 36 Observing Carefully Watch for signals from patients, such as tears, sad expressions, or volatile temper.

37. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 37 Defense Mechanisms Verbal Aggression—A person attacks another without addressing the original complaint or disregards it inappropriately. Sarcasm—A biting edge added to words that a person states with the intent to cause pain or anger. Rationalization—Attributing actions to rational and credible motives without analyzing underlying methods.

38. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 38 Defense Mechanisms Compensation—Making up for one behavior by stressing another. Regression—The reversion to an earlier mental or behavioral level. Repression—Process whereby unwanted desires or impulses are excluded from the consciousness and left to operate in the unconscious.

39. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 39 Defense Mechanisms Apathy—A lack of feeling, emotion, interest, or concern. Displacement—The redirection of an emotion or impulse from its original object, such as an idea or person, to another object.

40. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 40 Defense Mechanisms Denial—A state in which confrontation with a personal problem or with reality is avoided by denying the existence of the problem or reality. Physical avoidance—Avoidance of any representation of a painful event. Projection—The attribution of one’s own ideas, feelings, or attitudes to other people or to objects.

41. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 41 Dealing with Conflict Conflict is the struggle resulting from incompatible or opposing needs, drives, wishes, or external or internal demands.

42. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 42 Conflict can… Be beneficial to relationships Be constructive Allow people to learn about each other Promote stronger understanding Promote deeper levels of intimacy

43. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 43 Assertion—Stating or declaring positively, often forcefully or aggressively Nonassertion—The inability to express needs and thoughts or the refusal to express them

44. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 44 Crazymakers The Avoider: Refuses to fight; keeps from facing the problem at hand. The Pseudoaccommodator: Refuses to face up to a conflict by either giving in or pretending nothing is wrong.

45. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 45 Crazymakers The Guiltmaker: Tries to make his or her partner feel responsible for causing pain. The Subject Changer: Escapes facing up to aggression by shifting the conversation when it approaches an area of conflict.

46. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 46 Crazymakers The Distracter: Attacks other parts of his or her partner’s life rather than expressing feelings of dissatisfaction. The Mind Reader: Refuses to allow his or her partner to express feelings honestly and goes into an analysis of what the partner “really means.”

47. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 47 Crazymakers The Trapper: Sets up desired behavior, then attacks that behavior once it manifests. The Crisis Tickler: Brings what is bothering him or her almost to the surface but never quite expresses true feelings.

48. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 48 Crazymakers The Gunnysacker: Does not immediately respond to anger. Directs pent-up frustrations and aggression on the unsuspecting partner. The Trivial Tyrannizer: Does things that will bother the partner instead of honestly sharing his or her own resentments. The Beltliner: Hits the partner below the psychologic belt.

49. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 49 Crazymakers The Joker: Kids around when the partner wants to be serious, instead of expressing true feelings. The Blamer: More interested in finding fault than in resolving a conflict. The Contract Tyrannizer: Will not allow relationships to change from the way they once were.

50. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 50 Crazymakers The Kitchen Sink Fighter: Brings up things that are totally off the subject instead of dealing with the issues at hand. The Withholder: Punishes the partner by holding something back, building up greater resentment. The Benedict Arnold: Gets back at partners by sabotage, failing to defend them and encouraging ridicule toward them.

51. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 51 Barriers to Communication Physical impairment Language Prejudice Stereotyping Perception

52. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 52 Communication during Difficult Times During Anger One of the most difficult times to communicate Expression of anger is usually healthy Unexpressed anger causes or contributes to all types of health problems

53. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 53 Communication during Difficult Times Anger Anger is usually not directed toward the medical assistant. Be a good listener. Use logic. Do not use absolutes such as “never” and “always.” Remain calm.

54. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 54 Communication during Difficult Times Shock Many types of shock can occur. Usually happens after some catastrophe. Patient often cannot think or move. Some scream in agony, others seem almost normal. We never know how we might react in a deeply stressful situation. Our reactions may differ from time to time.

55. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 55 Communication during Difficult Times Shock Never leave a person in shock alone. Do not allow the person to speed off in a car. Listen! Watch the person carefully. Make sure the person is with a trusted relative or friend before he or she leaves the office.

56. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 56 Death and Dying Elisabeth Kübler-Ross Dr. Kübler-Ross studied thanatology, the study of the phenomena of death and of psychologic methods of coping with death.

57. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 57 Five Stages of Grief Denial Anger Bargaining Depression Acceptance

58. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 58 Multicultural Issues We sometimes think that people all over the world think and behave as we do. We often stereotype those from other cultures and think that we understand them. Those from other geographic areas, even within the United States, may experience culture shock in new surroundings. Patience is an important trait when dealing with those from other cultures.

59. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 59 Communicating with Those from Other Cultures Treat them as you would wish to be treated. Overcome language barriers. Be patient when communicating. Encourage patients to bring a translator, if necessary. Understand the nonverbal communications of other cultures.

60. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 60 Maslow’s Hierarchy of Needs Physical needs: food, rest, sleep, water, air, sex Safety needs Social needs: sense of belonging, interaction with others Self-esteem needs: feeling good about ourselves Self-actualization: maximized potential

61. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 61 Maslow’s Hierarchy of Needs

62. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 62 Human Needs Approval Acceptance Achievement

63. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 63 Stages of Sleep Two Main Phases of Sleep NREM (non–rapid eye movement) - Four stages, during which the body slows down and relaxes REM (rapid eye movement) - Deep sleep when dreaming occurs - Brain is highly active - Eyes move rapidly - Occurs in the last hours of sleep