1

Interpersonal Skills and Human BehaviorChapter 5

2

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.

Introduction

3

How can the medical assistant treat patients as individuals during a busy workday?How does the medical assistant communicate effectively with the patient’s family members?How will developing good listening skills make the medical assistant more effective?How do friends and family members play a role in the health of the patient?

Questions to consider…

4

The importance of first impressionsThe differences between verbal and nonverbal communicationsSpatial separationThe value of touch while communicatingElements of the transactional communication modelBarriers to effective communicationDefense mechanisms, listening, and dealing with conflict

This chapter will examine:

5

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.

The Patient’s Perception

6

First impressions are still lasting ones!

First Impressions

First impressions are important and some individuals will have a difficult time moving past a negative first impression. 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

Medical assistants may have to make introductions to patients several times, especially if there are multiple staff members. Always be pleasant with the patients. Offer them the type of customer service that one would receive in a high-end retail store. Treat them in a way that lets them know they are appreciated. The patients are not a hindrance to the practice – they ARE the practice.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

First Impressions

8

Medical Records as CommunicationWritten communication and its perception are also important and will be covered later in the course (Chapter 13).

Must be legible Spelling and grammar must be well-used If it is not in the medical record, legally, it did not happen Anything that influences the patient’s mental, physical, or

even spiritual health can be added to the medical record, because all affect the whole person

First Impressions

9

Verbal Communication depends on words and sounds. Speak clearly and enunciate properly. Vary the pitch of the voice. Tone of voice is very important in communication. Use appropriate volume. Speak at an audible level. Make eye contact. Speak in an animated fashion. Show concern. Do not interrupt a person who is speaking.

Verbal Communication

10

Medical assistants should not say anything to the patient that they feel a supervisor or the physician would regard as inappropriate. Patients will not cooperate with a physician that they do not trust or respect. They will not trust or respect a medical assistant who is rude or sarcastic. Remember that the medical assistant is employed to serve the patient.

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.

Verbal Communication

11

Listening is one of the medical assistants most valuable skills. Ask clarifying questions and restatement to ensure that you understand what the patient has said and that it is charted accurately.

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!

Remember that patients are in the office to be cared for. Treat patients as you would a treasured member of your own family.

They may have great concerns. They may be very apprehensive. They may be fearful

Verbal Communication

12

Nonverbal communication is said to be more accurate than verbal communication. Medical assistants must learn to observe patients, and sometimes the people that accompany the patient to the office, very carefully. Look for body language that verifies or negates what the patient says verbally. Nonverbal communications are messages that are conveyed without the use of words. They are transmitted by:

Body language• Partly instinctive• Partly taught• Partly imitative

Gestures Mannerisms Eye movement

Nonverbal Communication

13

Remember that the medical assistant’s body language is seen by the patient the same way that the patient is seen by the medical assistant. Project a positive image with body language.Involves:

Eye contact Facial expression Hand gestures Grooming Dress Space Tone of voice Posture Touch

Nonverbal Communication

14

Appearance often influences the patient’s opinion of office staff members. What does your appearance communicate about you?

Appearance is a vital part of nonverbal communication. Appearance can present conflicting nonverbal information. The successful medical assistant expresses:

• self-esteem• confidence• pleasant facial expressions• caring attitude

Nonverbal Communication

15

Conservative AppearanceIn the medical profession, patients expect professionalism, and conservative appearance is preferred to avoid blocks in communications.If in doubt about an article of clothing or accessory, do not wear it to the office. Patients respond more positively to medical professionals who look professional and are conservative in dress.

Nonverbal Communication

16

Facial expressions often convey our true feelings and are not masked by the words we use.

Our eyes often tell the truth when our words are misleading or false.

Use open body stance when dealing with patients. Nonverbal and verbal communication are interdependent;

they must be in harmony to convey an accurate message that the receiver can easily interpret.

If the two are not congruent, the nonverbal presentation usually is dominant and expresses the true message.

Nonverbal Communication

17

ProxemicsThe study of the nature, degree, and effect of the spatial separation individuals naturally maintain and how this separation relates to cultural and environmental factors.Be aware of proxemics in the office to avoid repetitive motion injuries, back injuries, or strains and sprains. Learn the spatial separation measurements and do not invade the patient’s (or co-workers) personal space.Spatial Boundaries

Public Space: 12–25 feet Social Space: 4–12 feet Personal Space: 1½–4 feet Intimate Space: touching to 1½ feet

Nonverbal Communication

18

What Can Touch Mean?Touch, in the medical profession, can be comforting or can promote a sexual harassment lawsuit.

Avoid Claims of BatteryBe very careful when touching a patient. Nonconsensual touching can be considered battery in today’s litigious society.

Nonverbal Communication

19

Posture and PositioningThese nonverbal communications should be questioned verbally. If the medical assistant suspects any of the above situations, talk to the patient. Remember to tell the patient that the physician can refer the patient to various resources to help with most situations.Can signal:

Depression Anger Excitement Fear An appeal for help

Nonverbal Communication

20

To communicate well, we must have a general understanding of the process of communication. Once a message is sent, it cannot be retrieved and restated. One exception is an email program that allows a message to be recalled. That message can be deleted prior to being read. Usually when two people interact, they both function as senders and receivers.During everyday communication in talking, the sender speaks, then listens as the other person speaks. Both are senders and receivers.The sender sends a message through a channel.Channels can be:

Spoken words Written messages Body language

The Process of Communication

21

EncodingSenders encode a message, which means that they choose a specific method of expression using words and/or other channels.DecodingThe receiver decodes the message according to his or her understanding of what is being communicated.Remember that perception is important. The sender must make certain that the receiver perceives the correct message.

The Process of Communication

22

NoiseAnything that interferes with the message being sent. Noise contributes to the misunderstanding of messages.

External – literal noise (radio, other people talking, overhead projector) Internal – the receiver’s own thoughts, prejudices, or opinions. Physiologic – any biologic factor such as not feeling well or being tired.

FeedbackAsk for feedback. It helps the sender to determine if the message was received and whether it was accurately received.

Verbal expression Body language Nod of understanding

The Process of Communication

23

Transactional Communication Model

24

Listening is paying attention to sound or hearing something with thoughtful attention.It is one of the most important skills that the medical assistant must develop and hone.Remember to pay attention to the patients’ body language while listening to their verbal communications.

Listening

25

Hearing is the process, function, or power to perceive sound.Listening is paying attention to sound or hearing something with thoughtful attention.Comprehension is listening with understanding.

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.

Listening

26

Listening to PatientsPatients 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.Using the phrase “I hear you” can reassure the patient that their concerns are important. Remember to use restatement and clarifying statements to make certain that the patient is understood and that the medical assistant charts accurately.

Listening

27

Paraphrasing is… 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

Listening

28

Open-ended questions allow an answer other than “yes” or “no.” Closed questions can be answered with only “yes” or “no.” Medical assistants should ask open-ended questions with patients.

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?

Listening

29

Many patients open up more quickly and completely to the medical assistant than to the physician. This is important in developing a rapport with the patient.The medical assistant should never agree to withhold information from the physician under any circumstances. But specific details don’t always have to be shared.The medical assistant must never agree to lie to the physician!The best solution is to always tell the physician what the patient has shared.Never display a judgemental attitude or express negativity about the patient’s activities, thoughts, or behavior.

Listening

30

Medical assistants are not qualified to give any type of advice to a patient.

Medical assistants cannot encourage the patient to choose one option over another. You can offer a listening ear.

Patients must make their own decisions about treatment options.

All communication with the patient must be professional and accurate.

Always attempt to get the patient to discuss all concerns with the physician.

When giving written instructions to the patient, keep a copy in the patient’s medical chart.

Treat all patients with respect and compassion. An open and trusting relationship prevents legal issues in the future.

Warnings Against Advising the Patient

31

Watch for signals from patients, such as tears, sad expressions, or volatile temper. Remember that nonverbal communication is usually more accurate than verbal communication. What is the woman in the photo communicating?

Observing Carefully

32

A mental disorder is a psychological or behavior pattern that occurs in an individual and is thought to cause distress or disability that is not expected as a part of normal development and culture.Some behavior patterns are better studied and understood. Some can be contained or controlled with medication.

Phobias Obsessive-Compulsive Disorder Antisocial Behavior Panic Disorder General Anxiety Disorder Major Depressive Disorder

Abnormal Behavior Pattern

33

Defense mechanisms are psychological methods of dealing with stressful situations or stressors, that are encountered in day-to-day living. They are often subconscious reactions designed for emotional protection.

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.

Compensation—Making up for one behavior by stressing another.

Regression—The reversion to an earlier mental or behavioral level.

Defense Mechanisms

34

Repression—Process whereby unwanted desires or impulses are excluded from the consciousness and left to operate in the unconscious.

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.

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.

Defense Mechanisms

35

Conflict is the struggle resulting from incompatible or opposing needs, drives, wishes, or external or internal demands.Conflict is not always negative and can lead to needed change and good decisions.Conflict can…

Be beneficial to relationships Be constructive Allow people to learn about each other Promote stronger understanding Promote deeper levels of intimacy

Conflict

36

Assertion — Stating or declaring positively, often forcefully or aggressively.Nonassertion — The inability to express needs and thoughts or the refusal to express them.Aggression – hostile, injurious, or destructive behavior or outlook, especially when caused by frustration. Can make a person seem pushy.

Direct – occurs when one directly attacks another, causing the victim to feel embarrassment, shame, anger, or a range of other emotions.

Passive – when one expresses themselves in an obscure ambiguous way. They may have feelings of rage, inadequacy, or resentment that they cannot articulate in a direct manner.

Conflict

37

Every relationship experiences conflict Put aside thoughts of personal attack First impulse is often the “fight-or-flight” syndrome

In the fight-or-flight syndrome, some individuals will “fight,” which means to stay and face conflict aggressively. In “flight,” individuals run from and avoid conflict. Most people tend to do one or the other consistently even in different situations.

Think logically

Resolving Conflict

38

Expect conflict – do not fear or dread it Realize that conflict can be healthy Accept that others have legitimate, viable opinions Listen and consider the opinions of others Never attack those with differing opinions Do not insist on being right all of the time Avoid judgment or assigning blame Deal with conflict quickly when it arises

Tips for Resolving Conflict

39

Boundaries indicate a limit or fixed extent. Setting boundaries at work helps to avoid awkward situations and misunderstandings.Examples of Workplace Boundaries

Calling a person by a first name or Mrs./Ms./Mr. Refusing to listen to offensive jokes. Refraining from forwarding emails that are not business-

related. Leaving the office door open when speaking with someone

of the opposite sex. Dating people who work for the same facility or patients

from the practice.

Boundaries

40

Being called by the first name, a nickname, or by the surname. Refusing to be responsible for driving others to or from work on a

regular basis. Insist on a 5-minute time limit or breaks for visiting with co-

workers. Be respectful of all co-workers. Refrain from any public display of affection at the office, even

with a spouse. Make politics and religion off-limits subjects. Using inappropriate language, including curse words. Making coffee or getting coffee for a supervisor or co-worker. Taking on a co-worker’s responsibilities. Being berated for taking vacation or sick time when earned.

Boundaries

41

Five Steps to Setting Boundaries in the Workplace1. Know how you expect to be treated and communicate that

to others.2. Do not feel that you have to explain your boundaries to

others.3. Be respectful, thoughtful, and responsible when setting

boundaries.4. Respect other people’s boundaries if you want yours to be

respected.5. Be proactive when dealing with other people’s boundaries.

Boundaries

42

Self-boundaries are your own rules about how you will behave in the workplace and what you will and will not accept or condone.

What to Say to Stop Inappropriateness“Stop! I am not interested in hearing this topic!”“Stop! I am not interested in seeing this behavior!”

Self-Boundaries

43

George Bach describes dirty fighting passive-aggressive behavior as “crazy-making”, which is a detrimental behavior for all involved.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.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.

Crazymakers

44

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.”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.

Crazymakers

45

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 psychological belt.The Joker:Kids around when the partner wants to be serious, instead of expressing true feelings.

Crazymakers

46

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.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.

Crazymakers

47

Physical impairment – patients may have physical conditions that impair their ability to communicate effectively, such as a vision or hearing condition.

Language – may need to use gestures or body language to convey messages. A family member or bilingual employee can also assist.

Prejudice – personal and social bias that brings about discrimination. Subtle and blatant discrimination can be equally painful.

Stereotyping – viewing someone on preconceived and often incorrect assumptions.

Perception – comprehension of what is being communicated based on the receiver’s point of reference.

Barriers to Communication

48

Medical assistants must develop communication skills that can be used in times of trouble.

They must be able to understand why a patient or co-worker is unable to communicate.

Always remain calm when dealing with someone who is experiencing a traumatic event.

Listening is the key! Pay attention to non-verbal cues.

Communication during Difficult Times

49

Anger Anger is a normal emotion but can be dangerous if not

expressed in a healthy manner. The medical assistant may feel anger from time to time at the workplace.

When angry, your blood pressure and heart rate increases.

Speak calmly Anger is usually not directed toward the medical

assistant Be a good listener Do not use absolutes such as “never” and “always.” Address the problem and use logic

Communication during Difficult Times

50

Shock When an event or a circumstance occurs that is

especially painful, an individual may experience emotional shock.

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. May have insomnia.

Communication during Difficult Times

51

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.

Communication during Difficult Times

52

Elisabeth Kübler-Ross

Dr. Kübler-Ross studied thanatology, the study of the phenomena of death and of psychological methods of coping with death.

Death and DyingFive Stages of Grief Denial Anger Bargaining Depression Acceptance

53

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.

Multicultural Issues

54

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.

Communicating with Those from Other Cultures

55

Communicating with Those from Other Cultures

Non-English-Speaking Patients Patients who do not speak English should bring an

interpreter to help with communication to each office visit.

If they do not bring an interpreter, attempt to find a person who can communicate, but this is not the office’s responsibility.

Offices that serve a large population of non-English speakers should have a bilingual person on staff.

56

Communicating During the Patient Encounter

Sensitivity to All Patients Any patient can feel anxiety when seeing the

physician Be very sensitive to the patients’ feelings Explain steps of the procedures to put them at ease Always display a caring attitude

57

Believed our human needs fit into five categories.The needs on each level must be satisfied before we can move to the next level.

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

Maslow’s Hierarchy of Needs

58

We seek the approval of specific people. We have a healthier self-esteem if we feel accepted by

others. We have an inner need for achievement. We all enjoy praise for a job well done. Everyone benefits when legitimate praise is shared

freely and appreciated.

Approval, Acceptance, and Achievement

59

Approval, Acceptance, and Achievement

60

Two Main Phases of SleepNREM (non-rapid eye movement)

- Four stages, during which the body slows down and relaxesREM (rapid eye movement)

- Deep sleep when dreaming occurs- Brain is highly active- Eyes move rapidly- Occurs in the last hours of sleep

Stages of Sleep

61

A balanced diet is essential to ensure that the organs and systems within us function at optimal levels.Vitamin and mineral deficiencies can lead to health conditions or diseases.

Healthy Nutrition

62

The effects of a problem relationship is reflected in our attitude, which greatly influences our performance at work.

Carefully and wisely choose to be involved in healthy relationships.

We must learn coping techniques for dealing with our difficult relationships.

Open, honest communication is paramount.

Positive Relationships

63

Self-esteem is confidence and satisfaction in oneself. You must honestly recognize your strengths and

weaknesses to be self-aware. No one can make you feel a certain way; it is a choice

YOU make. We control two things in life – our attitude and actions. Think before speaking Take a timeout Choose y0ur battles wisely

Healthy Self-Esteem

64

Healthy Self-Esteem

65

Fear and doubt can sabotage efforts to improve your self-image, confidence, and potential.

Almost every failure or mistake can be traced to fear or doubt.

Blaming the circumstances around us is no excuse for poor performance.

Self-esteem improves with adapting. Failure teaches us more than success. Procrastination is a symptom of the

fear of failure and success.

Improving Yourself

66

Facing new ideas or experiences places you outside the comfort zone.

A comfort zone is a place in the mind where we feel safe and comfortable.

Blaming the circumstances around us is no excuse for poor performance.

Comfort Zones

67

Interpersonal skills are critical to the medical assistantCommunication is a part of most events during every dayEnhance interpersonal skills and human relations skills at every opportunity through classes and continuing educationAll communications must be effective to be of benefit

Closing Comments

68

People who are facing death or other catastrophes want to be treated like everyone elseGreet them warmly and make sure they know that you care about themBe sure the patients understand their medications and treatmentsDirect them to community resourcesListening is one of the most important skills to develop

Summary of Scenario