Page 2 Psychology and Communication Study Guide for the Medical Assistant test

Communication

There are all sorts of communication formats involved in medical settings, from a formal letter to a patient to the everyday banter in the waiting room. As a medical assistant, you will be responsible for handling all of it in a professional manner. Here are some things to consider about the methods in which you communicate.

Communication Basics

As a medical assistant you will not only be communicating with patients, but also their families, your co-workers, and other medical professionals, as part of the healthcare team. Your goal should always be to perform as a professional, effective, and empathetic communicator.

Grammar, Spelling, and Punctuation

When composing written communication, it is absolutely essential that you use correct spelling, grammar, and punctuation. This not only makes your message easier to understand, but it makes you appear professional, knowledgeable, thoughtful, and careful in your work. While most word processing programs now provide tools to help you, always be sure to proofread your communication and make sure your message is complete, concise, and well composed.

Email Etiquette

Email has become a widely used, fast and easy way for all members of the medical team to communicate with each other and with patients. When communicating via email, it is tempting to send quick, one or two sentence message rather than composing one with a more formal structure. Resist that temptation. Use a proper greeting, followed by complete sentences to concisely convey your message and end with a closing along with your full name and title.

These components will ensure your communication is professional and will not leave the reader confused about the intent or any underlying meaning of the message. Remember that any and all communication with patients is usually a permanent part of the medical record. Always know the rules of your facility regarding what kind of patient communication is allowed via email and make sure that all patient privacy laws are obeyed.

Telephone Etiquette

Telephone skills are some of the most important communication skills you will need as a medical assistant. Whether it’s scheduling patient appointments, delivering test results and answering patient questions, or speaking to referring offices and outside salespeople, you are a direct representative of your practice. Your level of professionalism and competency will be judged by your skills in this area. Your goal should always be to speak and treat the caller in the same manner that you would if you were having a face to face conversation with them. Speak slowly and clearly and use a tone of voice that is warm and sincere. Telephone calls are not interruptions. They are essential to the lifeblood of your practice, and your employment may very well depend on the strength of your skills to be effective in this form of communication.

Business Letter Formats

As a medical assistant, you may be asked to compose formal letters of communication for patients, insurance providers, and other medical practices. It is helpful to familiarize yourself with the various formats and components of these forms of communication.

Every business letter that you compose must contain each of the following components. full date (write out the month, day and year), full name, address and title of the person you are corresponding with, greeting, subject line, body of the letter, closing, and signature line. If you are typing the letter for the sender, include your initials in the left lower corner, followed by a notation that denotes any enclosures (labs, records, reports, etc) that are being sent with it, and copy notations with another recipient’s name if a copy of the letter is being sent to them for their records.

Business letters may be in any of the following forms:

  • Full-block: All lines of the letter are aligned with the left hand margin. This form is the most commonly used, as it appears professional and clean and is easy to remember.

  • Modified-block: All lines of the letter are aligned with the left hand margin except the date, closing and signature lines. These are centered on the page.

  • Indented modified-block: This follows all of the same directions for modified-block, but the first line of each paragraph needs to be indented five spaces.

  • Simplified: The simplified format follows the full-block format, but omits the greeting and closing.

Again, it is important to remember that these forms of communication will likely become a permanent part of a medical record. They may be used in legal proceedings as proof of communication. Attention to detail, completeness, and clarity are, therefore, essential.

Responding Therapeutically to Diverse Populations

Obviously, every person is different, but there are some overall communication differences among special populations. You will need to consider these when formulating your messages to them.

Visually Impaired

Patients who are blind or have limited vision will need extra time and attention from a medical assistant to assure their communication needs are met respectfully and effectively. Some patients may be highly functional while others may need more assistance. Always ask before assisting a visually impaired patient. They will need extra verbal cues before and during procedures as well as additional assistance in navigating the facility, changing into a gown, and positioning for exams or procedures. They will require special materials or more detailed explanations for informed consent and patient education.

Hearing Impaired

Patients who are hearing impaired will also require special consideration. Not all hearing impaired patients communicate in the same way. Some may read lips, while other use American sign language. Ask before communication begins which method the patient is most comfortable using. Always speak directly to the patient, even if a sign language interpreter is used. Directly face a lip-reading patient and speak slowly and clearly. While written and visually-oriented materials are of great value to those who are hearing impaired, avoid the temptation to type or write during these encounters.

Geriatric

The elderly are a very special group of patients. They often will require most, if not all of your advanced communication skills. They may have both hearing and visual impairments in addition to cognitive and/or memory deficiencies. Effective communication with these patients will depend on your ability to recognize if outside help from a caregiver or family member is needed. Keep communication with these patients simple, concise, and brief. Ascertain if your message was correctly received and interpreted by asking the patient to verbalize it back to you rather than asking if they understand. Properly formatted written materials, especially those with visual cues (pictures, etc.) are helpful to use with geriatric patients.

Pediatric

Children require special consideration of age and developmental level when formulating a communication strategy. While some may not be fearful of the doctor’s office, many will be. Be empathetic and respectful of this. Communicate on an age-appropriate level directly with the child, and assess the level of help you may need from the parent or guardian. Try to use language that the child understands and physically position yourself at their level when speaking to them. Allow them the opportunity to ask questions and gauge their level of understanding before proceeding further. Never lie to a child about a procedure or the pain they may experience. Express respectful understanding of his or her discomfort and provide positive feedback when the procedure is completed.

Adolescent

Communication with an adolescent may at first seem straight-forward, but do not approach these patients as “small adults.” While adolescents may possess adult physical stature, their cognitive abilities to receive, process, and understand information is not the same as an adult. Try to assess the true level of understanding of an adolescent patient by asking them to verbalize information back to you. Make sure the proper stage is set for effective communication by minimizing and/or eliminating all sources of distraction during your encounter.

Seriously/Terminally Ill

Patients (and their loved ones and families) who are dealing with a serious, life-threatening illness or condition are under an enormous amount of stress. Keep this in mind when communicating with these patients and those who care for them. Be direct, concise, and empathetic when communicating information. It may be difficult, but remain objective and in control of your own emotional responses when dealing with those of the patient and family. Advocating for these patients and families can include your assessment of the need for advanced counseling and mental health care.

Intellectually Challenged

When communicating with intellectually challenged patients, remember to pay special attention to their non-verbal cues such as body language and facial expressions. While many of these patients will be accompanied by a family member or care-giver, it is essential to speak directly to them using short phrases of simple words that they can understand. Effectively communicating with these patients may require you to patiently repeat information and/or instructions to ensure they are taking an active part in their own healthcare.

Non-English-Speaking

As the cultural diversity of our population continues to grow, you will often take care of patients who do not speak your native language. English may be a second language for these patients and they may prefer to communicate in their native language to ensure complete understanding. It is your responsibility to facilitate a translator for the patient, if that is their preference. Many facilities provide medical translation services to their patients, but sometimes it may be a family member. It is helpful to have written medical materials in another language if your geographical location has a large population of a certain, non-English speaking ethnicity.

Emotionally Challenged

Medical patients can demonstrate a gamut of emotions. Anxiety, fear, anger, and sadness are just a few that can be encountered by a medical assistant. While some patients may have more chronic emotional reactions, such as those dealing with a severe illness or injury, some patients may have very temporary or situational emotional reactions, such as the angry patient who has missed an appointment due to a scheduling error. Remember the context of the patient’s emotional reaction when communicating with him or her. If an apology is indicated, offer a simple and sincere one. Do all you can to de-escalate a tense situation, including removing yourself and asking for help if needed. Never jeopardize the safety of yourself and your co-workers when dealing with an emotionally challenged patient.

Socially/Culturally/Ethnically Diverse

As stated previously, you will most likely encounter patients with many different social and cultural values and norms that are different from your own in your work as a medical assistant. Always be respectful to others and do your best to understand the differences in both verbal and nonverbal communication with different groups of patients. If you sense by your patient’s reaction that you are offending them, you should ask about this and then offer a sincere apology. Being proactive is key in gaining a patient’s trust and building a relationship with them.

Environmentally/Socio-Economically Stressed

Depending on where you work and what kind of work you do as a medical assistant, you may encounter indigent groups of people or patients who have very little financial or educational resources available to them. These patients are extremely vulnerable and need extra time and attention to make sure that they are not neglected or improperly taken care of. Assess the patient’s level of understanding and do not assume that they have all of the resources they need to be compliant with care. Advocate and communicate on their behalf if they need outside assistance with basic necessities or intervention from harmful or dangerous circumstances.

Body Language

Body language refers to physical or nonverbal cues that we often give as we communicate. Sometimes, they can be intentional, such as a nod to reinforce our verbal agreement or a handshake to reinforce a welcome given to a patient. Many times, however, our body language can be a subconscious reaction to information and the emotions it evokes. Often, non-verbal language is more indicative of our true feelings and emotions than our spoken words.

Your nonverbal communication with a patient as a medical assistant will begin with your appearance to your patients. How you appear upon first meeting can set the tone for the entire medical encounter. Your nonverbal communication can either be an asset in effective communication or a barrier to doing your job as a medical assistant.

Posture

We often don’t think of our posture as relaying information to an observer or patient, but it absolutely does. Standing straight and tall helps reinforce your professionalism and imparts that you are alert, ready, and capable of taking care of someone. On the other hand, if you are sitting or slouching it can make you appear disinterested or like you are not taking an active part in the conversation or situation around you.

Position

When you are communicating with a patient, consider your position in relation to them. If you are standing and they are lying or sitting, this may make the patient feel vulnerable or lead them to feel that you are “talking down” to them. It is always a good rule of thumb to get down to or be on the same level as the patient to demonstrate you are speaking to them and not “over” or “at” them.

Facial Expression

Be mindful of your facial expressions when communicating with patients. A smile is a warm, inviting, and welcoming nonverbal way to put an anxious patient at ease, but it may also offend or agitate an angry or upset patient. Maintain a thoughtful or impartial face when a patient shows you an unexpected or shocking physical finding, such as an advanced wound infection or severe traumatic wound. The facial expressions of your patient can also help you assess if they understand what they are being told.

Territoriality/Physical Boundaries

Remember distance, as well, when taking a history or giving education to patients. If you are all the way across the room, a patient may not be as engaged and open in communication with you. If you are too close to them, they may feel threatened or uncomfortable. Gauge your distance appropriately and assess your patient’s response to you. Make adjustments to find the correct distance that is comfortable for both of you.

Gestures

Gestures, such as nodding in agreement, can help affirm that you are engaged and involved in the communication process. Be aware of nonverbal head and hand gestures. Shaking your head “no” as your patient is telling you something can indicate disapproval and make a patient feel embarrassed or ashamed. Putting your hand up to a patient while they are speaking to catch up or finish documenting is not only rude, but it interrupts- and can shut down- a patient who is relaying information to you.

Touch

Patients can have varying reactions to touch. Touch is often considered a very intimate and important part of a medical encounter. Medical providers who do not touch their patients can be seen as cold and uncaring. However, there are patients who may be uncomfortable with touch from a stranger. Always try to “read” your patient’s nonverbal reactions to touch before continuing. For an anxious or upset patient, or one in pain, a physical touch can provide powerful nonverbal communication of support and empathy.

Mannerisms

Mannerisms are habitual ways of speaking or using gestures when communicating. Be aware of your own and how they may impact your ability to effectively communicate. For instance, if you use the words “um” or “like” over and over as you speak, it may distort the meaning of your message or distract the patient as he or she is trying to listen.

Eye Contact

It is always a good rule of thumb to try to maintain direct eye contact with whomever you are speaking to. However, in some cultures, prolonged eye contact is a sign of disrespect. Take this into consideration when communicating with a patient who is of a different cultural background.

Communication Cycle

Every message of communication consists of four distinct parts. When all of these parts have been completed, communication has successfully occurred. The four parts of successful communication are:

Sender: someone who forms a piece of information to be communicated and then transforms that information into words, actions, or writing

Message: the piece of information that is being sent to another person

Receiver: someone who receives the information and then decodes the information to give it meaning

Feedback: a response from the receiver that indicates that the information was sent and how it was decoded

If the feedback demonstrates the receiver didn’t receive or process the information correctly, the cycle can begin again. Often, the sender will adjust the message using tone of voice, different actions or words, to try to convey the information again to the receiver.

Listening Skills

While the importance of good verbal and nonverbal communication skills cannot be overstated in regards to how effectively a medical assistant functions, the importance of developing good listening skills ranks highly as well. While it seems silly to say that listening is a skill, it truly is, and it is one that will take practice to ensure success.

In medicine, there are two important types of listening skills, and they are often used at the same time. These skills complement each other and are both necessary for effective, respectful, and sincere communication with patients. The first is active listening, in which the medical assistant pays attention to exact words the patient uses and the tone of voice in which they are delivered. The second is therapeutic listening, which occurs when the medical assistant uses active listening skills, but also pays attention to nonverbal communication, such as a patient’s facial expressions, gestures, and posture.

The goal of both active and therapeutic listening is to become empathetic to the patient and further understand his or her view of the information or situation.

Assessing Level of Understanding

As a therapeutic listener, a medical assistant will need to be familiar with various ways to confirm to the patient that you understand all of the information and the context in which it is being conveyed. Four different ways to do this are listed here, followed by a brief explanation of each.

Reflection happens when the listener paraphrases the message back to the patient, using words that describe the patient’s emotional response to the content. This ensures that both the correct information and emotional context were successfully conveyed.

Restatement is a technique where the listener will repeat the words used in the message, verbatim, back to the patient. This confirms that the exact words the patient spoke were the words he or she intended to use.

Clarification occurs when the listener asks further questions of the patient, so that the exact meaning of the message can be interpreted. Questions should use different, but similar words to those used by the patient.

Feedback is given by the listener using appropriate verbal and nonverbal communication. Facial expressions, touch, and gestures can all communicate to the patient that you understand and empathize with the information and emotion contained in the message. Simple expressions like, “Oh, I understand” and “Yes, that is right” are helpful, as well.

Communication Barriers

Both external and internal factors can interfere with effective communication between a patient and the medical assistant. When appropriate, and if able, the medical assistant should be proactive about removing all external barriers. Choose quiet, private areas to have conversations—ones that are free of telephones and televisions. Ensure the patient’s comfort with a chair, bed, or blanket if necessary.

A patient may be experiencing internal barriers that you may notice by way of nonverbal communication. Fear, pain, hunger and anger can all cause interference to good communication. Address any of these internal barriers if you can. Offer the patient food and drink prior to discussion. If their facial expressions are consistent with pain, see if you can assist them in relieving discomfort before giving instructions or patient education.

Defense Mechanisms

The ability to empathize, or see a situation from the patient’s point of view, will help you greatly in establishing effective communication. If you feel you’ve accounted for all external barriers and are practicing good, therapeutic communication skills, but do not feel you can communicate with a patient, assess for answers that indicate the patient is using a defense mechanism as a coping strategy for the information he or she is receiving. These are another barrier to effective communication.

Working with Different Audiences

Remember that, as a medical assistant, effective communication is not only necessary with patients, but also with co-workers, supervisors, medical providers (internal and external), other ancillary staff, and patients’ families and caregivers.

Modifying Communication for Each

The content of your communication will often have to be tailored to your specific audience. While medical jargon may be fine for co-workers, you may need to use common terms to describe a disease process for a patient, caregiver, or family member. When communicating with providers (MDs, NPs, PAs), be concise and direct, as their time is often short and they may need to receive the information quickly.

Relaying and Clarifying Messages Between Audiences

A medical assistant will often have to switch gears between these different groups very quickly throughout the course of a typical workday. Providers will want information and education conveyed to patients, and patients and their family members or caregivers will have questions for the providers. The medical assistant will be the go-between, skillfully crafting the messages of each so that the other can understand them clearly. It can make for a busy, hectic, and, sometimes, long day, but you can take pride in the fact that at the end of it, you performed as an integral part of the healthcare team.

Facilitating Teamwork and Team Engagement

Communication between staff and co-workers is an essential part of the workplace. Good communication between staff and co-workers can be the difference between a workplace to which you dread going everyday and one you hate to leave at the end of the day. Good communication is a powerful weapon to boost morale, that is easily damaged in a busy, chaotic, and physically and emotionally demanding medical office or hospital. Be respectful in the words you use and the way you deliver them to your co-workers. A good, respectful communicator is not only a team leader, but often someone who will advance or be given selective opportunities to participate in decision-making roles or continuing education. In short, it can be your vehicle for advancement throughout your career.

Patient Relationships

As you work as a medical assistant taking care of people every day, you will naturally find that you develop relationships with them. In medicine, this is known as rapport. At the base of developing rapport with patients is your communication with them. The more effective you are as a communicator, the more trust you will garner from patients, their caregivers, and their families. This is essential if you want to give your patients good care.

Impartial Conduct

As we have discussed numerous times within this section, you will encounter people from all walks of life in your work as a medical assistant. With each one of them, your goal should be to treat each with the same respect, empathy, and care without regard to their particular race, religion, age, gender, sexual orientation, socioeconomic status, physical challenges, special needs, or lifestyle choices. This is the heart of the code of ethics that you work by as a medical assistant.

Stereotypes and Biases

A stereotype is a preconceived notion about the intellect, capabilities, and behaviors of a certain group of people, based on race, gender, ethnicity, or some other defining characteristic. A bias is an inclination to be for or against one person or a group, especially in a way that is considered to be unfair. We all tend to have inherent biases toward, and subconsciously stereotype, certain people. Favorable or unfavorable, this can unknowingly affect the way we interact, communicate with, and take care of certain groups of people. Work very hard to identify these and refrain from allowing stereotypes and biases to affect how you communicate with your patients. Remain respectful and accepting of all patients, at all times, during communication.

Establishing Rapport

Establishing rapport with your patients will depend on your ability to establish and maintain open, honest, and direct communication. This imparts your sincere desire to help and take care of them and, in turn, opens them up to trust you. As members of the healthcare profession, we all share the innate drive to help and serve others. We all possess the traits of empathy (the ability to consider another person’s perspective), sympathy (the ability to share another person’s emotional reaction) and compassion, which is the ability to feel concern for another person’s pain and suffering. While all are important, empathy ranks highest with regard to establishing good, therapeutic communication.

Scope of Permitted Questions

When interviewing a patient to gain information about their medical history or symptoms, you will need to ask questions. Patients may be more comfortable answering certain types of questions and you may find that by asking for information in a certain way, you are better able to direct and control the flow of information from the patient. Using exploratory or open-ended questions usually elicits more complete answers. In contrast, closed or direct questions prompt much more limited discourse, yielding more simple “yes” and “no” answers. Both types of questioning can be of value and are helpful in gathering useful information.

Professional Presence

When communicating with patients, their families, and your co-workers, how you look and how you speak may be just as important as the words you actually say. Maintaining a professional appearance sets the stage for effective communication. This includes proper and regular grooming, clean and neat clothes, the avoidance of excessive or eccentric accessories and styles that can cause distraction during conversation. Your demeanor should be always be professional and appropriate in the workplace and during all conversations. When speaking, be mindful of your tone of voice, as it may convey a message that is contradictory to the words in your message. All forms of nonverbal communication are powerful ways to either reinforce or undermine the content of your message.

Patient Satisfaction Surveys

Patient satisfaction surveys are frequently and regularly conducted in medical practices today as medicine is very much a business. The success of any business rests on the satisfaction of the consumers of it’s services. While these surveys may initially seem intimidating, they can be a very useful tool when used correctly. Positive patient feedback is good for morale and reinforces good employee practices that are already in place. Negative feedback communicates information about areas in which the medical team has opportunities to improve. When viewed as constructive criticism, patients’ negative experiences and views can be invaluable in identifying systematic weaknesses or lapses in care that need to be addressed.

Problem Situations and Safety

Inevitably, when dealing with people, you will encounter problematic situations that can potentially compromise your safety or that of your co-workers and patients. These situations can include angry patients (for various reasons), parental arguments over the care of a minor, and privacy issues regarding sharing of medical information without legal consent. For example, a wife may call the office demanding her husband’s test results. If the husband has not given consent for his medical information to be shared with her, then you are legally bound to keep it private. This may often be an unintentional oversight on the part of the patient, but in some cases, it may be intentional. Regardless of the intent, it will be your job to deal with any emotional reaction to standards and decisions.

Deal with these problematic situations in a calm, objective, and respectful way. Be extra cautious of your nonverbal communication in these types of discussions and avoid letting your own emotional responses play a part in the conversation. If you feel the situation is escalating, or you are not able to be an effective communicator, involve someone else. This person could be a supervisor, provider, or security officer. You are never wrong to politely and calmly excuse yourself from a conversation if you feel that person is threatening your safety or if you feel you have lost the ability to effectively communicate.

Documentation of Unusual Events

While situations like this are rare, they do occur. Be sure to completely and accurately document the occurrence in the patient’s medical record. Be objective when you record the events and details of the conversation. Do not interject or record any of your own emotional observations or reactions of the events that unfolded. You may use the patient’s own words in quotations in the account. For example, it is not advisable to write, “Mrs. Smith complained and shouted that we lied to her.” Rather, write, “Mrs. Smith stated in a loud voice that we did not give her the correct information by saying ‘you all lied to me.’ ” Remember that anything you write in the medical record may be called into question and used in a legal proceeding. As a medical assistant, your documentation should be honest, accurate, and objective.

Cause and Effect Analysis

A cause and effect analysis is a structured, group activity where members of the healthcare team brainstorm together to identify root causes and contributing factors involved with an adverse event. This process can be used for general events that occur in a facility or particular setting, such as “patient falls” in a nursing home.

During the exercise, the group constructs a visual diagram called a “fishbone diagram” where the adverse outcome is at the “head” of the fish and the root/contributory causes are located on the “body”. The group will usually define the root causes that contribute to the problem first, and then by asking why the root causes occur, they will “connect” these as contributing factors to the underlying problem. Filling these in on the diagram is similar to drawing the “bones” of the fish.

The overall goal of the exercise is to identify unrecognized contributing factors that can be corrected to prevent future adverse outcomes. It is a very useful tool to correct systemic problems that put patients at risk of suffering unnecessary injuries or pain and helps keep medical employees from taking unnecessary medicolegal risks.

This is an example of a fishbone diagram:

fishbone-diagram.jpg

https://upload.wikimedia.org/wikipedia/commons/5/52/Ishikawa_Fishbone_Diagram.svg http://creativecommons.org/licenses/by-sa/3.0/