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Chapter XX:

Chapter Title

Chapter 3:

Communication Skills

Learning Outcomes

Cognitive Domain

Note: AAMA/CAAHEP 2015 Standards are italicized.

1. Spell and define the key terms

2. List two major forms of communication

3. Identify styles and types of verbal communication

4. Identify types of nonverbal communication

5. Recognize barriers to communication

6. Identify techniques for overcoming communication barriers

7. Recognize the elements of oral communication using a sender-receiver process

8. Identify resources and adaptations that are required based on individual needs, that is, culture and environment, developmental life stage, language, and physical threats to communication

Learning Outcomes (cont’d)

9. Discuss examples of diversity:

Cultural

Social

Ethnic

10. Discuss the role of cultural, social, and ethnic diversity in ethical performance of medical assisting practice

11. Discuss the role of assertiveness in effective professional communication, and relate the following behaviors to professional communication:

Assertive

Aggressive

Passive

Learning Outcomes (cont’d)

12. Discuss the theories of:

A. Erik Erikson

B. Kübler-Ross

13. Explain how various components of communication can affect the meeting of verbal messages

14. Define active listening

15. List and describe the six interviewing techniques

16. Give an example of how cultural differences may affect communication

17. Discuss how to handle communication problems caused by language barriers

18. List two methods that you can use to promote communication among hearing-, sight-, and speech-impaired patients

Learning Outcomes (cont’d.)

19. Discuss how to handle an angry or distressed patient

20. List five actions that you can take to improve communication with a child

21. Discuss your role in communicating with a grieving patient or family member

22. Discuss the key elements of interdisciplinary communication

23. Explore issue of confidentiality as it applies to the medical assistant

Learning Outcomes (cont’d)

Psychomotor Domain

Note: AAMA/CAAHEP 2015 Standards are italicized.

1. Respond to nonverbal communication (Procedure 3-1)

2. Use feedback techniques to obtain patient information including the following:

A. Reflection (Procedure 3-1)

B. Restatement (Procedure 3-1)

C. Clarification (Procedure 3-1)

3. Coach patients appropriately considering the following:

A. Cultural diversity (Procedure 3-2)

B. Development life stage (Procedure 3-2)

C. Communication barriers (Procedure 3-2)

Learning Outcomes (cont’d)

Affective Domain

Note: AAMA/CAAHEP 2015 Standards are italicized.

1. Demonstrate

A. empathy

B. active listening

C. nonverbal communication

2. Demonstrate respect for individual diversity including:

Gender

Race

Religion

Age

Economic status

Appearance

Learning Outcomes (cont’d)

3. Use appropriate body language and other nonverbal skills in communicating with patients, family, and staff

4. Demonstrate awareness of the territorial boundaries of the person with whom one is communicating

5. Demonstrate sensitivity appropriate to the message being delivered

6. Demonstrate awareness of how an individual’s personal appearance affects anticipated responses

7. Demonstrate recognition of the patient’s level of understanding in communication

8. Analyze communication in providing appropriate responses/feedback

9. Demonstrate the principles of self-boundaries

10. Respond to issues of confidentiality

Learning Outcomes (cont’d)

ABHES Competencies

1. Identify and respond appropriately when working/caring for patients with special needs

2. Use empathy when treating terminally ill patients

3. Identify common stages that terminally ill patients go through and list organizations/support groups that can assist patients and family members of patients struggling with terminal illness

4. Advocate on behalf of family/patients, having ability to deal and communicate with family

Learning Outcomes (cont’d)

5. Analyze the effect of hereditary, cultural, and environmental influences

6. Locate resources and information for patients and employers

7. Be attentive, listen, and learn

8. Be impartial and show empathy when dealing with patients

9. Communicate on the recipient’s level of comprehension

10. Serve as liaison between physician and others

11. Recognize and respond to verbal and nonverbal communication

Communication is sending and receiving messages, verbally or otherwise. Until the message is received accurately, communication has not taken place.

The ability to communicate effectively is a crucial skill for medical assistants. The medical assistant is usually the first person the patient meets in the medical office. Thus, your positive attitude, pleasant presentation, and use of good communication skills will set the tone for future interactions.

message: words sent from one person to another; information

sent through spoken, written, or body language

Back to Learning Outcomes

Introduction

In your role, you must accurately and appropriately share information with physicians, other professional staff members, and patients.

Basic Communication Flow

Communication requires three things

Message

Sender

Receiver

Two or more people act as sender and receiver as they seek feedback and clarification

Back to Learning Outcomes

feedback: in communication, the response to input from

another

clarification: explanation; removal of confusion or uncertainty

Basic Communication Flow (cont’d.)

Good communication entails:

Clarifying confusing messages

Validating patient’s perceptions

Adapting messages to patient’s understanding level

Asking for feedback to ensure that the messages you sent were received by the patient or other persons as intended

Back to Learning Outcomes

Figure 3-1 Flow of communication.

Checkpoint Question

What three elements must be present for communication to occur?

Back to Learning Outcomes

Checkpoint Answer

For communication to occur, these three elements must be present:

A message to be sent

A person to send the message

A person to receive the message

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Forms of Communication

Verbal Communication

Verbal

Uses words or language

Most common form, so important to use clearly

Types

Oral

Written

Gear speech to patient’s educational level

Example—heart attack vs. myocardial infarction

Back to Learning Outcomes

You need good verbal communication skills when performing such tasks as making appointments, providing patient education, making referrals, and sharing information with the physician.

Forms of Communication (cont’d.)

Research indicates that primary message transmitted more by the way it is said than by the words that are used:

Paralanguage

Voice tone

Quality

Volume

Pitch

Range

Back to Learning Outcomes

paralanguage: factors connected with, but not essentially

part of, language, e.g., tone of voice, volume, pitch

Forms of Communication (cont’d.)

Nonlanguage

Laughing

Sobbing

Signing

Written

Should be clear and concise

Reinforces oral

Back to Learning Outcomes

The ability to write clearly, concisely, and accurately is important in the health care profession.

nonlanguage: not expressed in spoken language, e.g.,

laughing, sobbing, grunting, sighing

Forms of Communication (cont’d.)

Back to Learning Outcomes

Checkpoint Question

List five examples of paralanguage.

Back to Learning Outcomes

Checkpoint Answer

Examples of paralanguage are:

Voice tone

Quality

Volume

Pitch

Range

Back to Learning Outcomes

Forms of Communication (cont’d.)

Nonverbal Communication

Also called body language

Kinesics

Facial expressions

Body and eye movement

Gestures

Back to Learning Outcomes

Forms of Communication (cont’d.)

Proxemics

Physical proximity

Personal space — usually about 3 foot diameter

Varies among individuals and cultures

Medical care involves entering personal space

Some patients tolerate it better than others

Back to Learning Outcomes

culture: the way of life, including commonly held beliefs, of a group

of people

Forms of Communication (cont’d.)

Touch

Therapeutic — convey support and caring

Some patients find it uncomfortable

Seek cues from patient’s demeanor

Back to Learning Outcomes

therapeutic: having to do with treating or curing disease;

curative

Figure 3-2 Therapeutic touch conveys caring and concern.

demeanor: the way a person looks, behaves, and conducts himself or herself

Forms of Communication (cont’d.)

Defense Mechanisms

Can imped communication

The process in the brain that makes you forget or ignore painful or disturbing thoughts, situations, etc.

Be unaware exhibiting

Must be aware of various barriers and respond appropriately

Back to Learning Outcomes

Active Listening

Importance of active listening

Ensures that listener understands patient message

Ensures that patient understands information

Components of active listening

Give patient full attention

Minimize interruptions

Watch for nonverbal cues — especially where they conflict with verbal message

Back to Learning Outcomes

To listen actively, you must give your full attention to the patient with whom you

are speaking.

Interview Techniques

Main requirements for effective interview:

Listen actively

Ask appropriate questions — prepare ahead of time

Record answers

Conduct interview in private place — introduce yourself

Be organized

Back to Learning Outcomes

To conduct either type of interview, you must use effective techniques: listen actively, ask the appropriate questions, and record the answers.

Figure 3-3 Begin the interview by introducing yourself.

Interview Techniques (cont’d.)

Do not answer phone calls or attend to other distractions

Let patients know what will happen next and approximate time

Six interviewing techniques:

Reflecting

Paraphrasing

Clarification

Asking open-ended questions

Summarizing

Allowing silences

Back to Learning Outcomes

Interview Techniques (cont’d.)

Reflecting

Repeat what you heard patient say

Leave sentence unfinished

Do not overuse

Paraphrasing or Restatement

Repeat what you heard in your own words

Allows patients to clarify and correct

Asking for Examples or Clarification

Clarifies and reinforces patient’s statements

Back to Learning Outcomes

reflecting: repeating what one heard using open-ended questions

paraphrasing: restating what you heard using your own words

Interview Techniques (cont’d.)

Asking Open-Ended Questions

What, when, or how questions

Patient can’t answer only yes or no

Avoid why questions

Avoid closed-end questions that allow only a “yes” or “no” answer

Back to Learning Outcomes

The best way to obtain specific information is to ask open-ended questions that require the patient to formulate an answer and elaborate on the response.

Interview Techniques (cont’d.)

Summarizing

Reiterate what has been discussed

Allowing Silences

Allows patient to add information or ask questions

Allows patient to formulate thoughts

Allows listener to organize thoughts and form questions

Back to Learning Outcomes

Briefly reviewing the information you have obtained, or summarizing, gives the patient another chance to clarify statements or correct misinformation.

summarizing: briefly reviewing the information discussed to determine the patient’s comprehension

Checkpoint Question

What are the six interviewing techniques?

Back to Learning Outcomes

Checkpoint Answer

When interviewing patients, you can use six different techniques:

Reflecting

Paraphrasing or restatement

Asking for examples or clarification

Asking open-ended questions

Summarizing

Allowing silences.

Back to Learning Outcomes

Factors Affecting Communication

Many factors can influence communication effectiveness

Use of cliché

Message unclear or inappropriate to the situation

Personal distractions (pain or anxiety)

Environmental distractions (noise)

Cultural differences

Stereotyping or biases

Language barriers

Hearing or sight impairment

Back to Learning Outcomes

Factors Affecting Communication (cont’d.)

Cultural differences

Perception is guided by cultural, social, religious beliefs

Avoid preconceived ideas about people from different cultures

Individuals vary within cultures

Back to Learning Outcomes

The way a person perceives situations and other people is greatly influenced by cultural, social, and religious beliefs or firmly held convictions.

To help avoid miscommunication and offending patients, you must be sensitive to these differences in all of your patient interactions.

Factors Affecting Communication (cont’d.)

Back to Learning Outcomes

Factors Affecting Communication (cont’d.)

Back to Learning Outcomes

Factors Affecting Communication (cont’d.)

Stereotyping and Biased Opinions

Should not let personal values or bias affect communications

Stereotyping and prejudice are deterrents to establishing therapeutic relationship

Example—patient who lives in homeless shelter

Back to Learning Outcomes

bias: formation of an opinion without foundation or reason;

prejudice

stereotyping: to place in a fixed mold, without consideration

of differences

As a health care professional, you are expected to treat all patients impartially, to guard against discriminatory practices, remain nonjudgmental, avoid stereotypes, and have a professional demeanor.

discrimination: making a difference in favor of or against someone

Factors Affecting Communication (cont’d.)

Language Barriers

Some patients don’t speak English well or at all — problem to convey and obtain accurate information

Use of interpreters

Staff or family member

Lacking interpreter, written references contain common medical questions and answers

If office serves speakers of particular language, obtain phrase book for that language

Back to Learning Outcomes

Factors Affecting Communication (cont’d.)

Try to use someone same sex as patient

Guidelines:

Do not shout

Demonstrate or pantomime as needed

Speak to patient, not interpreter

Speak slowly; use simple sentences that require simple answers

Avoid slang

Avoid distractions; find a relaxed, quiet environment

Learn basic phrases in appropriate language(s)

Back to Learning Outcomes

Special Communication Challenges

Sensory impairments

Motor (speech) impairments

Patients with limited understanding

Very ill or sedated patients

Very frightened or traumatized patients

Young children

Back to Learning Outcomes

Patients must feel that they are part of the process even if their condition

requires involvement by family members or other caregivers.

Special Communication Challenges (cont’d.)

Hearing-Impaired Patients

Impairments:

Conductive — interference with sound conduction

Sensorineural — lesions or problems with nerves or the cochlea

Anacusis

Sign language, interpreters or other tools

Presbycusis

Often in denial, hearing aids or other amplification devices

Back to Learning Outcomes

presbycusis: (also: presbyacusis) loss of hearing associated

with aging

anacusis: complete hearing loss

Special Communication Challenges (cont’d.)

Methods for communicating with hearing-impaired patients (use tact, diplomacy, and patience):

Touch patient gently to get his or her attention

Talk face to face

Ensure good lighting makes your face visible

Lower vocal pitch; speak distinctly and with force but do not shout

Use note pad and demonstrations

Use pictograms

Use short sentences, short words; enunciate clearly but do not exaggerate facial expressions

Eliminate distractions

Back to Learning Outcomes

Special Communication Challenges (cont’d.)

Back to Learning Outcomes

Figure 3-4 Pictogram for instructing a patient on medication routine.

Checkpoint Question

How does the TDD system work?

Back to Learning Outcomes

Checkpoint Answer

The caller types a message, and the patient reads the message and types a response.

TDD: Telecommunication device for the deaf

Back to Learning Outcomes

Special Communication Challenges (cont’d.)

Sight-Impaired Patients

Range from blurred vision to total blindness

Different conditions can result in impairment

Cataracts

Glaucoma

Macular degeneration

Retinal detachment

Hyperopia

Myopia

Nyctalgsia

Retinopathy

Strabismus

Presbyopia

Back to Learning Outcomes

Patients who cannot see lose valuable information from nonverbal communication.

Special Communication Challenges (cont’d.)

Methods for communicating with sight-impaired patients:

Identify yourself by name at each visit

Do not raise your voice

Explain fully exactly what you’re about to do; alert patient when you will touch him or her

Orient patient spatially by having him or her touch furniture or walls

Offer to escort patient while he or she holds your arm

Tell patient when you leave room; knock when entering room

Explain sounds of equipment used and what each machine will do

Back to Learning Outcomes

Special Communication Challenges (cont’d.)

Speech Impairments

Dysphasia

Dysphonia

Stuttering

Methods for communicating with speech-impaired patients:

Allow patient time to gather thoughts

Allow ample time for patient to communicate

Do not rush conversation

Do not appear impatient

Offer note pad for writing questions

Discuss with physician the possibility of speech therapist

Back to Learning Outcomes

dysphasia: difficulty speaking

dysphonia: impairment of voice; hoarseness

Checkpoint Question

What is the difference between dysphasia and dysphonia?

Back to Learning Outcomes

Checkpoint Answer

Dysphasia is difficulty with speech, usually the result of nerve problem.

Dysphonia is a voice impairment, usually caused by a physical condition.

Back to Learning Outcomes

Special Communication Challenges (cont’d.)

Mental Health Illnesses

Create broad range of communication challenges:

Uncontrollable outburst

Mute conditions

Hear voices

See objects that do not exist

Communicating with patients with moderate to severe disorders required indepth training

Back to Learning Outcomes

Special Communication Challenges (cont’d.)

Methods for communicating with patients with mild mental illnesses:

Tell patient what to expect

Keep conversations focused and professional

Do not force or demand answers

If you feel unsafe, speak to your supervisor or the physician

Do not confirm hearing voices or seeing nonexistent objects

Orient the patient to reality as appropriate

Back to Learning Outcomes

Your communication should be professional, nonjudgmental, and encouraging when appropriate.

Special Communication Challenges (cont’d.)

Angry or Distressed Patients

Contributing factors:

Frustration

Long wait times—keep patients informed of long wait times

Illness

Financial strain

Billing or insurance problems

Bad health news

Back to Learning Outcomes

Special Communication Challenges (cont’d.)

To improve communication:

Be supportive

Take to private area

Stay calm

Be open and honest

Do not provide false reassurance

Do not belittle problem or concern

Ensure own safety if angry patient becomes aggressive or threatening

Back to Learning Outcomes

The key to communicating with upset patients is to prevent an escalation of the problem.

Special Communication Challenges (cont’d.)

Developmental

Need to understand stages of development

Erik Erikson, developed theory of 8 stages of development

Each stage has different accommodations to be made when interacting with patients

Back to Learning Outcomes

Special Communication Challenges (cont’d.)

Children

To facilitate communication:

Place child at your eye level or lower yourself to child’s eye level

Keep voice gentle and low-pitched

Make movements slow and visible

Rephrase question until sure child understands

Tell child when you will touch him or her

Expect that a child will return to an earlier developmental phase when ill

Use play and toys to phrase questions

Allow child to express feelings

Back to Learning Outcomes

Special Communication Challenges (cont’d.)

Adolescents:

May wish to be seen without parent

Do not show shock or disapproval — will stop communicating

Back to Learning Outcomes

Special Communication Challenges (cont’d.)

Back to Learning Outcomes

Figure 3-5 The medical assistant communicates at the child’s eye level.

Checkpoint Question

What is the stage of development in which trust versus mistrust is developed?

Back to Learning Outcomes

Checkpoint Answer

The developmental stage where trust versus mistrust is developed is the infant stage, ages 0 to 1 years.

Back to Learning Outcomes

Communicating with a Grieving Patient or Family Member

Loss of loved one

Death

Loss of relationship

Loss of body part

Loss of health

Dr. Elisabeth Kübler-Ross’ five distinct stages of grief in On Death and Dying— mourning can occur over months or years:

Denial: Patient does not believe diagnosis

Anger: Toward doctor or facility

Bargaining: Attempt to trade diagnosis

Depression: Quiet, withdrawn, uncaring

Acceptance: Acknowledgment of situation

Back to Learning Outcomes

grief: great sadness caused by loss

mourning: to demonstrate signs of grief: grieving

Communicating with a Grieving Patient or Family Member (cont’d.)

Back to Learning Outcomes

Communicating with a Grieving Patient or Family Member (cont’d.)

Grief when a patient dies:

Normal to feel sad

Focus on empathy, not sympathy

Empathy = feeling with

Sympathy = feeling for

Back to Learning Outcomes

Empathy can help you recognize a patient’s fear and discomfort so you can do everything possible to provide support and reassurance.

Checkpoint Question

What are the five stages of grieving?

Back to Learning Outcomes

Checkpoint Answer

The five stages of grieving are:

Denial

Anger

Bargaining

Depression

Acceptance

Back to Learning Outcomes

Establishing Positive Patient Relationships

Proper Form of Address

Use proper form of address to show respect and set a professional tone

Use last name unless otherwise instructed by patient

Calling patients by pet names, such as sweetie, granny, gramps, or honey, can offend the person

Avoid referring to patient by his or her medical condition

Back to Learning Outcomes

Pet names denigrate the individual’s dignity and put the interaction on a personal, not professional, level.

Establishing Positive Patient Relationships

Professional Distance

Avoid revealing intimate information about yourself

Choose general topics and keep the conversation light

Back to Learning Outcomes

You should not become too personally involved with patients because doing so may jeopardize your ability to be objective.

Establishing Positive Patient Relationships (cont’d.)

Teaching Patients

Be knowledgeable about current medical issues, discoveries, and trends.

Be aware of special services available in your area.

Have pertinent handouts or information sheets available.

Allow enough teaching time so that you are not interrupted or rushed.

Find a quiet room away from the main office flow if at all possible.

Back to Learning Outcomes

Establishing Positive Patient Relationships (cont’d.)

Give information in a clear, concise, sequential manner; provide written instructions as a follow-up.

Allow the patient time to process this new information.

Encourage the patient to ask questions.

Ask open-ended questions in a way that will allow you to know whether the patient understands the material.

Invite the patient to call the office with additional questions that may arise.

Back to Learning Outcomes

Professional Communication

Assertiveness in Professional Communication

An assertive person:

Sets clear boundaries for himself or herself and others

Knows how to set limits

Clearly and politely communicates his or her wants and needs

Can say “no” without offending another person

Understands the appropriate time for assertiveness versus passive compliance

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Professional Communication (cont’d.)

Refuses to be inappropriately dominated or “handled”

Considers the feelings and roles of others

Voices differences of opinion without being rude or overbearing

Stands up for what he or she believes when appropriate

Holds himself or herself with confidence and maintains eye contact

Looks for compromise, not conflict

Speaks firmly but pleasantly

Respects others

Understands when he or she is about to “step over a line” and pulls back

Is honest and fair

Back to Learning Outcomes

Professional Communication (cont’d.)

An aggressive person, conversely, is:

Hostile

Threatening

Demanding

Loud

Annoying

Sarcastic

Angry

Mean

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Professional Communication (cont’d.)

Communicating with Peers

Must remain professional

Minimize discussion of non-work-related topics

Minimize loud talking, laughter, whispering

Remain honest

Become active in local professional organization

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Involvement in local community organizations and support groups is also beneficial to promoting you and your profession.

Professional Communication (cont’d.)

Communicating with Physicians

Address with professional title

Use correct medical terminology

Do not use slang

Display confidence

Communicate clearly

Be honest if you do not know something

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Professional Communication (cont’d.)

Communicating with Other Facilities

Maintain patient confidentiality

Observe legal requirements for dispensing patient data

Use caution with fax machines, e-mail, and other electronic devices

Provide only facts

Always be nonjudgmental

Confirm receipt of message

Back to Learning Outcomes