Chapter 3; Communication Skills

Personal space is considered to be a radius of a. 2 ft. b. 1 ft. c. 4 ft. d. 3 ft.

3 ft.

Define active listening.

Active listening is important to ensure that messages are correctly received and interpreted. Failure to do so can result in poor patient care. To listen actively, you must give your full attention to the patient with whom you are speaking. Interruptions should be kept to a minimum. Active listening is a skill that develops with practice.

"The doctor must have read the test wrong" is an example of which of the following? a. depression b. denial c. acceptance d. bargaining

denial

Dysphasia

difficulty speaking

Non-Language

not expressed in spoken language; e.g., laughing, sobbing, grunting, sighing

Which of the following actions undermines professional distance? a. keeping conversations light and impersonal b. picking up prescriptions for a patient c. keeping personal problems to yourself d. engaging in small talk about general topics

picking up prescriptions for a patient

Paralanguage includes all of the following except a. tone b. volume c. quality d. quantity

quantity

Which of the following would NOT improve communication with a vision-impaired person? a. orienting the patient to the room b. explaining the sounds of the machines c. offering your arm d. raising your voice

raising your voice

"Mrs. Robinson, you were saying that when your foot hurts you" is an example of a. validating b. reflecting c. clarification d. summarizing

reflecting

Which of the following is NOT appropriate when making a patient referral? a. providing only the facts b. confirming that the message was received c. maintaining patient confidentiality d. relaying suspicions or assumptions

relaying suspicions or assumptions

Reflecting

repeating what one heard using open-ended questions

Paraphrasing

restating what you heard using your own words

Demeanor

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

Mourning

to demonstrate signs of grief; grieving

What is the main goal of the patient interview? a. to answer all the patient's questions b. to provide patient teaching and instruction c. to clarify any patient concerns d. to obtain accurate information

to obtain accurate information

Stereotyping

to place in affixed mold; without consideration of differences

Messages

words sent from one person to another; information sent through spoken, written, or body language

An example of a closed-ended question is a. "Do you have any questions for the doctor?" b. "Are you taking all your medications?" c. "Why are you not taking your Digoxin pills?" d. "What medications do you take?"

"Are you taking all your medications?"

Debbie Jones, CMA, has just met 80-year-old Doris Keller for the first time. Which of the following is the proper form of address? a. "Good morning, sweetie." b. "Good morning, Doris." c. "Good morning, Mrs. Keller." d. "Good morning, granny."

"Good morning, Mrs. Keller."

A 13-year-old patient has just revealed to the Medical Assistant that she may be pregnant. Which of the following is an inappropriate reaction? a. "You should not be sexually active at age 13." b. "It's okay to cry." c. "It is normal to be scared." d. "Take all the time you need."

"You should not be sexually active at age 13."

Chapter Review

- Communication is a complex and dynamic process involving the sending and receiving of messages. It includes verbal and nonverbal forms of expression and is influenced by personal and societal values, individual beliefs, and cultural orientation. - In the medical practice, important aspects of patient communication are interviewing and active listening. - You will need to overcome many communication challenges to communicate with all patients. These challenges include patients with hearing, sight, and speech impairments. - Children, angry or distressed patients, and patients with mental illnesses can also present a challenge to communication. - To communicate effectively, you must understand the various factors that can affect the exchange of messages and to use communication techniques that are most appropriate for each individual situation.

Which statement regarding the Medical Assistant's communication responsibilities is correct? a. Always validate or clarify patient perceptions. b. Only clarify confusing messages. c. Offer as much reassurance as possible. d. Do not adapt communication to the patient's level of understanding.

Always validate or clarify patient perceptions.

List and describe interviewing techniques.

As a Medical Assistant, you are typically responsible for gathering initial patient information and updating existing information about the patients. This task is accomplished by interviewing the patient. The main goal is to obtain accurate and pertinent information. To conduct an interview, you must use effective techniques: - Listen actively - Ask the appropriate questions - Record the answers The six interviewing techniques are: - Reflecting - Paraphrasing - Clarification - Asking Open-Ended Questions - Summarizing - Allowing Silence Reflecting is repeating what you have heard the patient say, using open-ended questions. Paraphrasing or restatement means repeating what you have heard, using your own words or phrases. Clarification - if you are confused about some of the information you have received, ask the patient to give an example of the situation being described. 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. open-ended questions usually begin with "what," "when," or "how". Briefly reviewing the information you have obtained, or summarizing, gives the patient another chance to clarify statements or correct misinformation. Periods of silence sometimes occur during the interview. These can be beneficial. Silences are natural parts of conversation and can give patients time to formulate their thoughts, reconstruct events, evaluate their feelings, or assess what has already been said.

Explain what communication is and list two major forms of communication.

Communication is sending and receiving messages, verbally or otherwise. The ability to communicate effectively is a crucial skill for Medical Assistants. In your role, you must accurately and appropriately share information with physicians, other professional staff members, and patients. During the act of communicating, two or more people will alternate roles as sender and receiver as they seek feedback (responses) and clarification (understanding) regarding the message. Your responsibilities for ensuring good communication include the following: - Clarifying confusing messages - Validating (confirming) the patient's perceptions - Adapting messages to the patient's level of understanding - Asking for feedback to ensure that the messages you sent were received by the patient or other persons as intended Verbal communication involves and exchange of messages using words or language; it is the most commonly used form and is usually the initial form of communication. You need good verbal communication skills when performing such tasks as making appointments, providing patient education, making referrals, and sharing information with the physician. Nonverbal communication - exchanging messages without using words - is sometimes called body language. Body language includes several types of behavior, such as kinesics, proxemics, and the use of touch. Nonverbal communication may more accurately reflect a person's true feelings and attitude than verbal communication.

List the five stages of grief as outlined by Elisabeth Kubler-Ross.

Dr. Elisabeth Kubler-Ross identified five distinct stages in the human grieving process. In her book 'On Death and Dying', she lists these stages that follow the realization that a person has a terminal illness: denial, anger, bargaining, depression, and acceptance. Dr. Elisabeth Kubler-Ross believed that these stages are also found in those experiencing change. These stages may spread over months or years. It is possible to go through stages more than once.

What is the difference between dysphasia and dysphonia?

Dysphasia is defined as difficulty with speech. Dysphonia is defined as a voice impairment.

Discuss how to handle communication problems caused by language barriers.

Effective communication depends on the use of language, but some patients cannot speak or understand English well enough for good communication. Because it is crucial for you to give and receive accurate information, you may need to use an interpreter to help bridge any language barriers. Use the following suggestions for communicating with non-English speaking patients: - Do not shout. Raising your voice will not increase their understanding. - Demonstrate or pantomime as needed. Gestures are usually relatively universal. - If you are using an interpreter, speak directly to the patient, with the interpreter in your line of vision, so that the patient can read your facial expressions. - Speak slowly with simple sentences and phrases that require simple answers. The patient may comprehend some simple English. - Avoid slang; it may not translate well. - Avoid distractions and provide a relaxed, quiet interview space. - Learn some basic phrases of the most common non-English languages used in your area. Patients appreciate your efforts.

What three elements must be present for communication to occur?

For communication to occur, these three elements must be present: 1. A message to be sent 2. A person to send the message 3. A person to receive the message

A patient is hearing-impaired, and you cannot communicate with him or her to explain the procedure you are about to perform. What should you do?

If the patient does not understand the procedure, he or she is not informed. Legally, you have not met your responsibilities to obtain informed consent if the patient does not understand the information you are trying to convey. If the patient cannot provide his or her own assistance, it is the legal responsibility of the physician and his agents to provide the means for effective communication. Most community colleges offer courses in sign language. The Internet offers sites for the deaf community that can direst you resources in your area. The American Sign Language alphabet chart is available online. It can be printed out for use with hearing-impaired patients. Handspeak is another website that provides a visual language dictionary.

Nonverbal Communication

Kinesics refers to body movements, including facial expressions, gestures, and eye movements. A patient's face can sometimes reveal inner feelings, such as sadness, happiness, fear, or anger, that may not be mentioned explicitly during a conversation. Proxemics refers to spacial relationships or physical proximity tolerated by humans. Generally, the area within a three foot radius around a person is considered personal space and is not to be invaded by strangers, although this area varies among individuals and people of various cultures. Related to proxemics is the use of touch, which can be therapeutic (beneficial) for some patients.

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

Levels of comprehension vary greatly during childhood, and therefore, communication needs must be tailored to the specific child's needs. The following suggestions will help facilitate communication with a child: - Children are responsive to eye-level contact. Either raise them to your height or lower yourself to theirs. - Keep your voice low-pitched and gentle. - Make your movements slow and keep them visible. Tell children when you need to touch them. - Rephrase your questions until you are sure the child understands. - Be prepared for the child to return to a lower developmental level for comfort during an illness. For example, a child may revert to thumb sucking during a stressful event. - You play to phrase your questions and to gain the child's cooperation. For example, if the child appears shy and does not want to talk, start by asking the child how a stuffed animal feels today. "How does Teddy feel today?" Follow up on the child's answer with "and how do you feel?" Offering to take the Teddy's temperature first may lessen any fears the child might have. - Allow the child to express fear, to cry, and so on. - Many adolescence resent authority. During the interview, some teenagers may not want a parent in the room. Assess the situation before including the parent. - Never show shock or judgment when dealing with adolescence; this will immediately close communication.

Mrs. Brown is in the office for a blood pressure check, when you notice that she is limping. She says, "Everything is fine, I just want my blood pressure checked." Which statement is correct? a. Limping is a nonverbal clue that should be investigated further. b. There is no need for further questioning. c. You should pretend that you did not see her limping and take her blood pressure. d. You should take her blood pressure and encourage her to call the office for an appointment if her limping gets worse.

Limping is a nonverbal clue that should be investigated further.

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

Many situations present special communication challenges. Patients must feel that they are part of the process even if their condition requires involvement by family members or other caregivers. There are many forms of hearing impairment. Impairments can vary from a partial loss to anacusis, complete hearing loss. Two types of hearing impairment are conductive and sensorineural. Conductive hearing loss is caused by interference with sound in the external canal or the middle or inner ear. Sensorineural hearing loss is caused by lesions or problems caused by either nerves or the cochlea. Most patients with anacusis are adept with communicating through sign language, interpreters, or other tools. However, patients with presbyacusis, a common hearing impairment in older patients, often have a more difficult time communicating and tend to be in denial about their hearing abilities. Patients with presbyacusis benefit from hearing aids and other amplification devices. To communicate with patients who have trouble hearing what you are saying, you need tact, diplomacy, and patience. These suggestions may help: - Touch the patient gently to gain his or her attention. - Talk directly face-to-face with the patient, not at an angle and certainly not with your back turned. - Turn to the most prominent light so that your face is illuminated. - Lower the pitch of your voice. - Use note pads and demonstration as needed. - Pictograms are very helpful and should be readily available. A pictogram is a flash card that shows basic medical terms. - Use short sentences with short words. Enunciate clearly, but do not exaggerate your facial movements. - Eliminate all distractions. Extraneous noise may confuse the patient. Sight impairments range from complete blindness to blurred vision. Patients who cannot see lose valuable information from nonverbal communication. To improve communication with a sight-impaired patient, try these suggestions: - Identify yourself by name each time the patient comes into the office. - Do not raise your voice; the patient is not hearing-impaired. - Let the patient know exactly what you are or will be doing at all times, and alert him or her before touching them. - Orient the patient spatially by having him or her touch the table, the chair, the counter, and so forth. - Assist the patient by offering your arm and escorting him or her to the exam room. - Tell the patient when you are leaving the room and knock before entering. - Explain the sounds of any machines to be used in the examination and what each machine will do. Speech impairments can come from a variety of medical conditions. Here are some suggestions to help you communicate with a patient who has a speech impairment: - Allow such patients time to gather their thoughts. - Allow plenty of time for them to communicate. - Do not rush conversation. - Offer a note pad to write questions. - Discuss with the physician the potential benefits for getting a speech therapist referral for the patient.

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

Occasionally you will need to support patients who are in grief or great sadness caused by a loss. In medical settings, expect to see grief displayed in many ways. Know, too, that several factors can influence how a patient demonstrates grief and that different cultures and individuals demonstrate their grief in a variety of ways, ranging from stoic, impassive responses to loud, prolonged wailing and fainting. Grieving patients may want to talk about their feelings and review events. Terminally ill patients may want to discuss their fears of dying and concerns for surviving loved ones. It is normal for you to feel sad when a patient dies. It is important that your communication focuses on empathy, not sympathy. Empathy can help you recognize a patient's fear and discomfort so you can do everything possible to provide support and reassurance.

Verbal Communication

Oral communication is sending or receiving messages using spoken language. Gear your conversation to the patient's educational level. Be aware, too, that the meaning of spoken messages may be affected by other components of oral communication, including paralanguage and nonlanguage sounds. Paralanguage includes voice tone, quality, volume, pitch, and range. Nonlanguage sounds include laughing, sobbing, sighing, grunting, whining, and so on. Written communication uses written language to exchange messages. The ability to write clearly, concisely, and accurately is important in the health care profession. If the instructions, oral or written, are not clear, the patient may misinterpret them. As a Medical Assistant, you are responsible for asking questions to verify that the patient has correctly understood the information.

Give examples questions during an initial patient interview.

Past Medical History: - Any previous hospitalizations? If so, when? - Any previous surgeries? If so, when? - Any chronic health problems (e.g., asthma, diabetes, hypertension)? - Any miscarriages, stillbirths, or abortions? Family History: - Age and health of parents? - If deceased, what was the cause of death and at what age did they die? - Age and health of siblings? - Are there any genetic disorders? Body System Review: - General questions regarding all body systems: cardiovascular, pulmonary, integumentary, musculoskeletal, neurologic, sensory, respiratory, gastrointestinal, endocrine, immune, urologic, and reproductive. Social History: - Alcohol use? - Smoking? - Drug use? - Hobbies? - Education level? - Employment? Medications: - What do you take? When? How often? - Any vitamins or herbal supplements?

Discuss how to handle an angry or distressed patient.

Patients' emotions can run the spectrum from polite and cordial to angry and upset. There are numerous reasons for the latter. The key to communicating with upset patients is to prevent an escalation of the problem. Here are some suggestions that will help you communicate with an angry or distressed patient: - Be supportive. - Be open and honest in all communications. - Do not provide false reassurance. - Do not belittle the problem or concern. - Ensure your own safety if the angry patient becomes aggressive or threatening.

Give reasons for miscommunication.

Sometimes, despite our best efforts, others may not receive your message accurately. A common occurrence that causes messages to be misinterpreted is the use of a cliche. Here are some other reasons for miscommunication: - The message may have been unclear or inappropriate for the situation. - The person receiving the message may have been detached, anxious, or confused. - Environmental elements, such as noise or interruptions, may also distort messages. - 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.

How does the TDD system work?

The caller types their message, and the patient reads the message and types a response. If you need to call a hearing-impaired patient, keep in mind that patients can make and receive calls using a special telephone with a service called converse communication center, which uses a system called telecommunication device for the deaf (TDD) or a text telephone (TTY).

What are the five stages of grieving?

The five stages of grieving are: 1. Denial 2. Anger 3. Bargaining 4. Depression 5. Acceptance

List five examples of paralanguage.

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

What are the six interviewing techniques?

When interviewing patients, you can use six different techniques. These include: 1. Reflecting 2. Paraphrasing or restatement 3. Asking for examples or clarification 4. Asking open-ended questions 5. Summarizing 6. Allowing silences

Discuss how to you can avoid communication problems.

You should never let your personal values, or biases (opinions) affect your communication or treatment of a patient. To treat them in any other fashion is discrimination. Stereotyping is holding an opinion of all members of a particular culture, race, religion, age group, or other group based on oversimplified or negative characterizations. 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.

Discuss the key elements of interdisciplinary communication.

Your approach to patients conveys a message about who you are and how you feel about yourself and your profession. The way you address patients provides clues about your attitude and how you will likely provide care. Always address a patient by their last name unless and until they instruct you otherwise. How people interact with each other is influenced by the level of emotional involvement between them. You should not become too personally involved with patients because doing so may jeopardize your ability to be objective. One of the fundamental communication skills you will need is the ability to teach patients about their medical condition. Follow these suggestions to provide effective patient education: - 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. - 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. Communication among your peers must remain professional and appropriate throughout the workday. Discussions of non-work related topics should be kept to a minimum and occur only during designated break times. An excellent way to promote communication among your peers is to become active in your local professional organization. Your involvement at the local level can spread to national exposure. Involvement in local community organizations and support groups is also beneficial to promoting you and your profession. Physicians and other health care professionals will rely on you to communicate pertinent information to patients in a timely manner to provide quality care. Your communication must always be professional. The physician should always be addressed unless he or she specifies otherwise. Do not feel intimidates when speaking with a physician. Speak slowly and confidently and you will develop a professional rapport. The medical administrative staff often makes referrals to other facilities or physicians. No matter who you are contacting, follow these key points: - Maintain patient confidentiality. Make sure you have appropriate patient consent. - Observe all legal requirements for dispensing patient data. - Use caution with fax machines, e-mail, and other electronic devices. make sure the intended receiver is the one who gets the communication. - Provide only the facts. Do not relay suspicions or assumptions. - Always be nonjudgmental. - Confirm that the message was received and that the referral will be handled.

Nonlanguage sounds include a. sobbing b. sighing c. laughing d. all of the above

all of the above

Complete hearing loss is properly termed a. deafness b. anacusis c. presbyacusis d. dysphasia

anacusis

The Medical Assistant should communicate with a child: a. like an adult b. at eye level c. standing above the child d. through the parent

at eye level

A TDD phone system is used for patients with a. both partial and total hearing loss b. total hearing loss c. language barriers d. partial hearing loss

both partial and total hearing loss

Summarizing

briefly reviewing the information discussed to determine the patient's comprehension

A question such as, "Can you tell me about your headaches?" is an example of a. summarizing b. clarification c. open-ended questioning d. in-depth questioning

clarification

Anacusis

complete hearing loss

Which of the following would NOT improve communication with a patient who has a hearing impairment? a. using note pads or demonstration b. enunciating clearly and exaggerating your facial movements c. eliminating all distractions d. touching the patient gently to gain his or her attention

enunciating clearly and exaggerating your facial movements

Clarification

explanation; removal of confusion or uncertainty

Paralanguage

factors connected with, but not essentially part of, language; e.g., tone of voice, volume, pitch

Bias

formation of an opinion without foundation or reason; prejudice

Grief

great sadness caused by loss

Therapeutic

having to do with treating or curing diseases; curative

Dysphonia

impairment of voice; hoarseness

Feedback

in communication, the response to input from another

A question such as, "Why did you do that?" is a. a form of summarizing patient actions b. negative and should not be said c. a type of paraphrasing d. helpful for obtaining additional clarification

negative and should not be said

Presbyacusis

loss of hearing associated with aging

Discrimination

making a difference in favor of or against someone