Fundamental Communication Skills

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Chapter 3

• Fundamental Communication Skills

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Fundamental Communication Skills

• Communication sending and receiving messages
• Verbal or otherwise

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Fundamental Communication Skills (continued)

• Medical assistants role
• Accurate and appropriate information sharing
• First point of contact for patients
• Be positive, pleasant
• Use good communication skills at all times

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Basic Communication Flow

• Three elements
• Message to be sent
• Person to send message
• Person to receive message
• Two or more people alternate as sender and
  receiver

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Basic Communication Flow (continued)

• Medical assistant communicates in therapeutic
  manner
• Office procedures
• Policies
• Patient care

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Basic Communication Flow (continued)

• Other communication responsibilities
• Clarifying messages
• Validating patient perceptions
• Adapting messages to patients understanding
• Verifying message as received

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Checkpoint Question 1

• What three elements must be present for
  communication to occur?

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Answer

• For communication to occur, these three elements
  must be present a message to be sent, a person
  to send the message, and a person to receive the
  message.

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Forms of Communication

• Verbal communication
• Nonverbal communication

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Verbal Communication

• Verbal communication involves an exchange of
  messages using words or language it is the most
  commonly used form and is usually the initial
  form of communication.
• Oral communication sending and receiving
  messages using spoken language
• Be pleasant, polite
• Use proper English and grammar

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Verbal Communication (continued)

• Gear your conversation to the patients
  educational level.
• Consider
• Heart attack vs. myocardial infarction
• Do not talk down to patients

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Verbal Communication (continued)

• Paralanguage voice tone, quality, pitch,
  volume, range
• Nonlanguage laughing, sighing, grammatical
  structure, pronunciation
• Its not what you say, its how you say it.

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Verbal Communication (continued)

• Written communication using written language to
  exchange messages
• Must be clear, concise, and accurate
• Unclear messages may hinder treatment
• Example
• Return to the office if you dont feel better.
• OR
• If your temperature is not back to normal in 24
  hours, call to schedule a revisit.

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Checkpoint Question 2

• List five examples of paralanguage.

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Answer

• Voice tone, quality, volume, pitch, and range are
  five examples of paralanguage.

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Nonverbal Communication

• Nonverbal communicationexchanging messages
  without using wordsis sometimes called body
  language.
• Kinesics
• Proxemics
• Touch

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Nonverbal Communication (continued)

• Kinesics body movements
• Facial expressions
• Gestures
• Eye movements
• Can reveal patients true feelings more
  accurately than verbal communication
• Learn to read patients actions and nonverbal
  clues for information

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Nonverbal Communication (continued)

• Proxemics physical proximity
• 3-foot area around patient considered personal
  space
• Must enter personal space to deliver care
• Because some individuals become uncomfortable
  when their space is invaded, it is essential to
  approach the patient in a professional manner and
  explain what you plan to do.

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Nonverbal Communication (continued)

• Touch
• Can be therapeutic
• Indicates support, concern
• Some patients threatened by touch
• Assess patients demeanor for clues before
  applying touch

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Active Listening

• Ensures messages are correctly received
• Give full attention
• Minimize interruptions
• Focus on verbal and nonverbal indicators
• Develop active listening skills with practice

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Interview Techniques

• Medical assistants responsibility to gather
  patient information
• Patient interviewing
• Ask questions
• Interpret responses
• Goal is to gather accurate and pertinent
  information

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Interview Techniques (continued)

• New patients
• Medical and family history
• Review of body systems
• Social history
• Established patients
• Review chart
• Make a list of questions
• Reconfirm medications and treatments

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Interview Techniques (continued)

• Conducting an interview
• Listen actively
• Ask appropriate questions
• Record answers
• Introduce yourself
• Know what questions to ask and in which order
• Eliminate distractions

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Interview Techniques (continued)

• Six interviewing techniques
• Reflecting
• Paraphrasing
• Clarification
• Open-ended questions
• Summarizing
• Allowing silences

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Reflecting

• Repeating what you hear the patient say with
  open-ended statements
• Allow patients to complete sentences
• Reflection encourages the patient to make further
  comments.
• Example
• Mrs. Rivera, you were saying that your back
  hurts you.
• Do not overuse

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Paraphrasing or Restatement

• Repeat statements using your own words
• Paraphrasing can help verify that you have
  accurately understood what was said.
• Allows patients to clarify
• Example
• You are saying that.

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Asking for Examples or Clarification

• Asking patients to provide examples
• Such as
• Can you describe one of those dizzy spells?

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Asking Open-Ended Questions

• Requires patient to form answers and elaborate
• Be careful about asking why questions, because
  they can often sound judgmental or accusing.
• Example
• How did you get that large bruise on your arm?

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Asking Open-Ended Questions (continued)

• Avoid closed-ended questions
• Example
• Are you taking your medications?

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Summarizing

• Reviewing information obtained
• Gives patient chance to clarify or correct
  misinformation
• Also helps you organize your information
• Example
• You told me that you have been feeling dizzy for
  the past 3 days and that you frequently stumble
  when walking.

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Allowing Silences

• Silences can be beneficial
• Silences are natural parts of conversations and
  can give patients time to formulate their
  thoughts, reconstruct events, evaluate their
  feelings, or assess what has already been said.

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Checkpoint Question 3

• What are six interviewing techniques?

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Answer

• When interviewing patients, you can use six
  techniques. These include reflecting,
  paraphrasing or restatement, asking for examples
  or clarification, asking open-ended questions,
  summarizing, and allowing silences.

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Factors Affecting Communication

• Messages may not be received despite best efforts
• Common causes
• Clichés
• Unclear message
• Anxious patient
• Environmental distractions

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Factors Affecting Communication (continued)

• Clichés
• Example
• Dont worry. Rome wasnt built in a day.
• Patient may interpret message to mean she is slow
  or old
• Better statement
• I can see youre making progress.

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Factors Affecting Communication (continued)

• Unclear or inappropriate message
• Example
• I have scheduled you for a PET scan in radiology
  tomorrow at 800 a.m.
• Patients may not understand technical language
• Better statement
• The doctor wants you to have a test called a PET
  scan here is a brochure that explains it.

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Factors Affecting Communication (continued)

• Patients may be anxious or distracted
• Pain
• Positive or negative news

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Factors Affecting Communication (continued)

• Environmental distractions
• Noises
• Interruptions

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Cultural Differences

• Patients perceptions and values are influenced
  by cultural, social, and religious beliefs
• Patients have a variety of ethnic and cultural
  backgrounds
• Medical assistants must understand differences
  for effective communication

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Cultural Differences (continued)

• Consider
• Personal questions during a medical history
• Eye contact
• Shyness

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Stereotyping and Biased Opinions

• All patients must be treated fairly,
  respectfully, and with dignity, regardless of
  their cultural, social, or personal values
• Stereotyping judging all members of an ethnic
  or cultural group based on oversimplified
  negative characterizations
• Stereotyping and bias prohibit therapeutic
  relationships

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Stereotyping and Biased Opinions (continued)

• Treat patients impartially
• Guard against discrimination
• Remain nonjudgmental
• Avoid stereotypes
• Maintain professional demeanor

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Language Barriers

• Because it is crucial for you to give and receive
  accurate information, you will need to use an
  interpreter to help bridge any language barriers.
• Staff member
• Family member
• Phrase book

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Language Barriers (continued)

• Additional suggestions
• Do not shout
• Demonstrate or pantomime
• Speak to patient, with interpreter in line of
  vision
• Speak slowly, simply
• Avoid slang
• Avoid distractions
• Learn basic phrases of other languages in your
  area

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Special Communication Challenges

• Assess situation and patients ability to
  comprehend
• Include patients in exchange
• Examples
• Hearing- or sight-impaired patients
• Speech impairments
• Mental health illness
• Distressed patients
• Children
• Grieving patients

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Hearing-Impaired Patients

• Many forms of impairment
• Anacusis complete hearing loss
• Presbycusis partial hearing loss, common in
  older patients
• Tact, diplomacy, and patience are needed for
  effective communication

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Hearing-Impaired Patients (continued)

• Other suggestions for effective communication
• Touch gently to gain attention
• Talk directly, face-to-face
• Illuminate face
• Lower voice pitch
• Notepads, demonstrations, pictograms
• Short sentences
• Eliminate distractions

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Checkpoint Question 4

• What is the term for complete
• hearing loss?

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Answer

• The medical term for complete hearing loss is
  anacusis.

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What If?

• You need to call a hearing-impaired patient. What
  should you do?

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Sight-Impaired Patients

• Range from complete blindness to blurred vision
• Lose valuable nonverbal communication

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Sight-Impaired Patients (continued)

• Suggestions for improving communication
• Identify yourself by name
• Maintain normal speaking voice
• Keep patient informed notify before touching
• Allow patient to touch table, chair, counter,
  etc.
• Offer to escort patient in office
• Tell patient when entering or leaving room
• Explain machine sounds

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Speech Impairments

• Variety of types
• Dysphasia difficulty with speech usually a
  neurological problem
• Dysphonia voice impairment usually a physical
  condition
• Stuttering

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Speech Impairments (continued)

• Suggestions for communicating effectively
• Allow patient time to gather thoughts
• Allow time for communicating
• Do not rush conversation
• Offer a notepad
• Consider speech therapist

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Checkpoint Question 5

• What is the medical term for
• difficulty with speech? What does
• dysphonia mean?

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Answer

• The medical term for difficulty with speech is
  dysphasia. Dysphonia is voice impairment.

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Mental Illness

• Mental illness can affect communication
• Outbursts
• Muteness
• Patients may hear voices
• In-depth training required with moderate to
  severe mentally ill patients
• Keep communication professional, nonjudgmental,
  and encouraging

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Mental Illness (continued)

• Suggestions for improving communication
• Tell patient what to expect and when
• Focused and professional conversation
• Do not force patient to answer
• Alert supervisor if you feel unsafe
• Do not confirm hearing voices
• If necessary, orient patient to reality

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Angry or Distressed Patients

• With upset patients, prevent escalation of
  problem
• Keep patients informed
• Wait times
• Billing or insurance charges
• Office policies

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Angry or Distressed Patients (continued)

• Most patients take sad news calmly
• Offer assistance
• Provide written information
• Be supportive
• Be honest
• Avoid false reassurances
• Do not belittle patients problem
• Ensure safety with angry patients

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Children

• Tailor communication to childs comprehension
  level
• Other suggestions
• Maintain eye contact
• Use low-pitched, gentle voice
• Slow, visible movements
• Rephrase questions as needed

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Children (continued)

• Child may return to lower development level for
  comfort
• Use play to gain cooperation
• Allow expression (fear, crying)
• With adolescents
• Assess situation before including parent
• Remain objective

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Communicating With a Grieving Patient or Family
Member

• Grief great sadness caused by a loss
• Also called mourning
• Five stages
• Denial
• Anger
• Bargaining
• Depression
• Acceptance

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Communicating With a Grieving Patient or Family
Member (continued)

• Patients may want to discuss
• Feelings
• Fears
• Concerns for loved ones
• Allow time for expression
• Listen actively
• Offer appropriate education

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Communicating With a Grieving Patient or Family
Member (continued)

• Focus on empathy, not sympathy
• Empathy can help you recognize a patients fear
  and discomfort so you can do everything possible
  to provide support and reassurance.
• Sympathy can compromise professional relationship
  with patient.

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Checkpoint Question 6

• What are the five stages of grieving?

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Answer

• The five stages of grieving are denial, anger,
  bargaining, depression, and acceptance.

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Establishing Positive Patient Relationships

• To establish and maintain positive relationships
  with patients, speak respectfully and exhibit an
  appropriate demeanor during all interactions.

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Proper Form of Address

• Use proper form of address when greeting patients
• Example
• Good morning, Mr. Jones.
• Shows respect
• Sets professional tone
• Avoid pet names

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Proper Form of Address (continued)

• Referring to the patient as a medical condition
  sends the message that the staff values the
  patient as nothing more than an illness, which
  can lead to increased anxiety.

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Professional Distance

• Establish level of communication to deliver
  patient care
• Personal involvement may jeopardize ability to
  make objective decisions
• Maintain professional distance
• Avoid revealing intimate personal details

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Teaching Patients

• One of fundamental communication skills necessary
  for medical assistants
• May be simple or complex

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Teaching Patients (continued)

• Guidelines for effective patient education
• Be knowledgeable
• Know special services in area
• Have printed information available
• Allow enough teaching time
• Minimize disruptions
• Be clear, concise, organized
• Give patient time to assimilate
• Ask questions to determine patient understanding
• Invite follow-up call

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Professional Communication

• Communicating with peers
• Communicating with physicians
• Communicating with other facilities

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Communicating With Peers

• Professional and appropriate at all times
• Avoid nonwork-related topics
• Be honest, accurate
• Become involved in local and national
  professional organizations

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Communicating With Physicians

• Be professional
• Address physician as doctor unless otherwise
  specified
• Use correct medical terminology
• Be honest
• If unsure, explain condition rather than guessing
  at a term

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Communicating With Other Facilities

• Maintain patient confidentiality
• Observe legal requirements
• Use caution with fax, e-mail
• Provide only the facts
• Be objective
• Confirm receipt