Any professional in a medical setting needs to be able to deal with people in a productive manner. Often, the clients you encounter will be under a great deal of stress regarding their health. Many people also have a high level of anxiety produced by just being in a doctor’s office or a clinic setting. Even medical professionals operate under a certain level of stress, induced just by the nature of the job, and this can affect the style of communication.
You will, therefore, want to know all you can about the best ways to handle all sorts of situations. This knowledge involves understanding the human situation, as well as learning effective communication techniques.
The definition of Psychology is the scientific study of the human mind and its functions, especially those affecting behavior in a given context. It seeks to examine how thoughts, attitudes, and emotions impact the decisions and actions of groups and individuals.
The study of psychology in the 1920’s through the 1950’s began to turn more toward examining how one’s behavior was affected by his or her external circumstances, rather than by the unconscious or his or her own internal drives (Sigmund Freud’s Psychoanalytic Theory of the early 1900’s). Known also as Behaviorists, theorists in this area of psychology believed that nature, or one’s own innate personality, had little to do with behavior. Instead, they believed that one’s behavior was determined almost solely by learned experiences. By conditioning with external stimuli, they believed a person with any genetic background, internal thoughts, or personality traits could learn to behave in a certain manner.
Abraham Maslow (1908-1970) sought to balance and marry key concepts of both Psychoanalytic and Behavioral theories by founding what is known as Humanistic Psychology. Maslow believed that behavior and development of a person were a more global phenomenon, dependant on both the individual’s circumstance and innate personality. He developed what is known as the hierarchy of human needs to explain an individual’s behavior. According to his theory, every person must have his or her most basic, physiologic needs met (such as food and shelter) prior to being able to advance to higher levels of development. This theory can be graphically displayed as a pyramid, with physiologic needs at the base and self-actualization (which is living at one’s best) at the pinnacle.
In his theory, an individual may move up or down the pyramid based on his or her external circumstances. This theory is important to you as a medical assistant as you may deal with patients across many different socio-economic backgrounds that can affect their ability to move up and down the pyramid.
Citation: Huitt, W. (2007). Maslow’s hierarchy of needs. Educational Psychology Interactive. Valdosta, GA: Valdosta State University. Retrieved 2016 from, http://www.edpsycinteractive.org/topics/regsys/maslow.html
Eric Erikson (1902-1994) is considered to be the father of what is known today as Developmental Psychology. His theories are based on social interactions that occur along one’s entire lifespan. According to Erikson, there are eight stages of human development, each with its own unique, age-specific, psychosocial task that must be accomplished prior to advancing to the next stage. Erickson believed these developmental tasks presented as “crises” that one must resolve in order to grow and develop one’s identity as a person.
Citation: Huitt, W. (2008). Socioemotional development. Educational Psychology Interactive. Valdosta, GA: Valdosta State University. Retrieved 2016, from http://www.edpsycinteractive.org/topics/affect/erikson.html
As a medical assistant, you may deal with patients that are in any one of these developmental stages. This will undoubtedly affect how your patient reacts to and deals with his or her medical situation.
Defense mechanisms are conscious or subconscious ways that people cope with difficult or stressful news or situations. A medical assistant will need to be aware of these as they may prevent effective communication with a patient. If a patient continues to exhibit a defense mechanism for an extended period of time, this should raise the question of a more serious mental health issue.
While this list is not exhaustive, it provides many of the common defense mechanisms that a person may use: denial, undoing, regression, rationalization, intellectualization, sublimation, projection, suppression, and compensation. There are numerous real-world examples for each of these, and you should make sure you understand each and how it would manifest itself in a medical situation. For example, someone who exhibits projection will try to avoid their own accountability by assigning blame or projecting their own thoughts and/or feelings onto someone else. In this instance, an angry patient may accuse you of speaking harshly or being upset with him or her.
As frustrating and difficult as it may be to deal with people using defense mechanisms, it is your utmost responsibility to recognize them, remain calm, and do your best to empathize and understand your patient’s perspective. Speak in a slow, soft voice and avoid sounding annoyed or condescending. These types of responses will inflame a tense situation even more and may further provoke a person who is upset.
In every act you perform in your daily work as a medical assistant, you will need to be cognizant of the needs and capabilities of the patients you are taking care of. Each patient will present a unique opportunity for you to have an impact (positive or negative) in the outcome of their care and ultimately, in their life. You must always carefully consider an individual’s specific background and take that into account when dealing with their emotional and behavioral responses in the medical setting.
Physical disability is defined as a limitation of one’s physical function, mobility, dexterity, or stamina. It can also be an impairment or illness that limits other facets of daily living, such as blindness or epilepsy. Physical disabilities can span a very broad range of impairments and affect patients of all ages. A physical disability can be congenital (a patient is born with it) or acquired during one’s lifetime. This can be an important aspect to consider as a patient with a new disability will face many new challenges that have become routine for a patient who was born disabled and has always lived life that way.
A developmental delay refers to any major or minor lag in a child reaching his or her normal developmental milestones. Developmental delays can be physical (gross and/or fine motor skills), speech or language related, behavioral and/or emotional, or cognitive. They are usually temporary, but can be ongoing. They can be resolved with intervention and treatment, but might develop into long term disabilities if not identified early and treated. These children and their parents will need special consideration as they may already face obstacles in coping with everyday life.
Medically fragile patients are those who are affected by a chronic medical condition that necessitates a prolonged dependency on daily, skilled medical care. These patients may be any age; their conditions and disease states are so severe that without this care, they would likely die. Often, families and medical professionals will work closely together so that patients may spend most of their time at home and not in the hospital. For example, their care may involve the use of continuous oxygen, ventilators, dialysis, or parenteral nutrition. The lives of these patients and their families revolve almost exclusively around this medical care.
Every infant and child has an age-dependant “checklist” of tasks that he or she should be doing, or be capable of doing, as they grow and develop. These tasks involve all of the following categories: gross and fine motor skills, language skills, thinking skills, and social interaction. While each individual is on his or her own unique timeline for all of these tasks, if a developmental milestone is not met by a certain age, it could signal a developmental delay requiring intervention. As a medical assistant, it is helpful to have a broad understanding of these milestones. You will often be on the front line of contact with patients and their families. You may be the first to notice that an infant or child is not at the appropriate level for his or her age as you conduct a medical interview.
Another subset of patients with special needs are those that have a terminal illness. As a medical assistant, you will need to be familiar with the unique psychological perspective of someone who is at the end of life. Perhaps the most well known work in this area was done by a Swiss psychologist by the name of Elisabeth Kübler-Ross. In her work with dying patients, she found they typically go through five specific stages when faced with the prospect of their life ending. These five phases are denial, anger, bargaining, depression, and acceptance. They may also be called the stages of grief (see next item), as they can also apply to anyone who suffers a major loss of a loved one or who undergoes a debilitating change in health that transforms their life.
The stages of grief begin with denial. In this phase, the patient refuses to accept the reality and finality of their diagnosis and/or situation. They may refuse care and be non-compliant. Next, they enter the anger phase. Here, patients often exhibit misdirected hostility towards anyone around them or involved in their care. In the bargaining phase, the patient may attempt or ask for extreme treatment in order to counter a fatal or devastating diagnosis. Once they realize the futility of this, they enter the depression phase and will exhibit classic symptoms such as crying and withdrawal. Lastly, patients will enter the acceptance phase, where they finally come to terms with their own mortality, making preparations for the end of their life or finally accepting their new reality. A patient may not move through all five stages or may become “stuck” in any one of them along the way.
As a medical assistant dealing with patients of various backgrounds facing any and all kinds of medical diagnoses and situations, a very basic understanding of normal psychological development, defense mechanisms, and coping strategies is essential. It allows you to be vigilant for those patients who exhibit signs and symptoms of mental illness. While no patient ever completely fits a textbook description, you will be well equipped to trust what you know, along with your intuition, in evaluating and identifying a patient who may desperately need a mental health intervention.