Chapter 4: Interacting with Patients

Identify and describe three examples of inside interference with communication.

-Emotions such as fear, anger, or anxiety can interfere with communication by preventing concentration. -Preoccupation with something else can prevent a person from focusing on what is being communicated. -Fatigue can impair a person's ability to listen effectively and thus interfere with communication.

Differentiate between a patient who is totally blind and one who is legally blind.

A patient who is totally blind has no useful sight and usually cannot even clearly differentiate between light and dark. The vision of a patient who is legally blind cannot be corrected to better than 20/200 in the better eye. The individual still may be able to see well enough to walk without assistance and to distinguish objects, but he or she cannot see well enough to drive or perform other activities that require sharp vision.

Differentiate between a patient who is deaf and a patient who is hearing impaired.

A person who is deaf has no useful hearing. A patient who is hearing impaired may have difficulty hearing or interpreting sounds in a certain tone range. Some deaf individuals wear hearing aids even though they do not hear well enough to understand human speech.

Describe active listening.

Active listening means placing one's total concentration on the conversation with another person and paying close attention to what is being said without thinking of anything else.

What measures should be implemented to communicate with a deaf patient?

American Sign Language is often used to communicate with the deaf. The office may need to provide a sign language interpreter. Some deaf individuals are able to read lips if they have a clear view of the speaker.

Why is it important for medical assistants to identify the unmet needs of patients?

An illness may interfere with a patient's usual means of meeting his or her needs, resulting in attention-seeking behavior or inappropriate behavior. The medical assistant can respond to a perceived threat to self-esteem by helping to teach a patient to manage his or her condition. The medical assistant can also respond with acceptance instead of irritation if a patient exhibits negative emotions. Helping a patient to express and accept uncomfortable feelings is an important task for the medical assistant.

Give four examples of nonverbal communication.

Body posture, tone of voice, facial expression, and gestures are examples of nonverbal communication.

When is it appropriate to use closed questions during an interview?

Closed questions are appropriate when a one- or two-word answer is expected (e.g., when filling out a form).

Differentiate between empathy and sympathy.

Empathy is the capacity to make an emotional connection with another person's feelings without allowing the emotional connection to become overpowering. Empathy is often contrasted with sympathy. Sympathy is defined as experiencing the same emotions as another. Sympathy is often accompanied by a feeling of pity.

How can the medical assistant use eye contact and body posture to facilitate communication?

Good eye contact communicates interest and involvement in the conversation. Maintaining a comfortable distance, keeping the arms at the side instead of folded across the body, and using touch as reassurance can facilitate communication.

What measures will improve communication with a patient who is hearing impaired?

If a patient is hearing impaired, the medical assistant should get his or her attention before speaking and face the person. A clear tone of voice should be used, but the medical assistant should not shout. It is helpful to speak a little slower than normally. The medical assistant should repeat as needed without becoming impatient.

How can the medical assistant improve communication with a patient whose understanding is impaired?

If a patient's understanding is impaired, the medical assistant should offer simple explanations using short sentences. It is helpful to repeat or restate the most important ideas using gestures and/or demonstration. Strong eye contact helps the patient focus on what is being communicated.

What is a general rule about accepting traditional medical practices that patients may use?

In general, traditional medical practices that do not have a potential for harm and that do not interfere with medical treatment are accepted. It is important for physicians to know what traditional treatments patients are using, because some of them, such as certain herbal remedies, may interact with prescribed treatments or medications.

Give two examples of how nonverbal communication is different in different cultures.

In some cultures, avoiding eye contact is a sign of respect for individuals who are older or have higher status. In some cultures the comfortable distance between two speakers is either larger or smaller than the 3 to 4 feet that is felt to be comfortable in the United States.

Identify and discuss two different cultural practices related to behavioral requirements for women and men.

In some cultures, women must be accompanied by a male relative when seeking health care. The male may wish to be present for any examination or treatment and may wish to speak for the female. Medical assistants should accept this behavior if it is the tradition of a patient.

What do individuals from other cultures sometimes believe is a cause of illness other than physiologic factors?

Individuals from other cultures may believe that illness is caused by bad spirits or by supernatural effects invoked by other people, such as the "evil eye."

What are four listening techniques that facilitate good communication between medical assistants and patients?

Listening techniques that facilitate good communication include checking to make sure that the listener understands completely, listening for feelings, observing body language and other nonverbal cues, and being patient to allow the other person to express herself or himself completely.

How do unmet needs affect a patient during illness?

Lower-level needs always take precedence over higher-level needs. When patients are struggling to meet physiologic needs, such as a need for oxygen, other needs seem much less important. Patients may neglect social behaviors because their focus on their immediate needs is so intense.

Identify and describe three examples of outside interference with effective communication.

Noise in a room, lack of privacy, and a distracting environment are examples of outside interference with effective communication.

When are open-ended questions more useful than closed questions?

Open questions encourage a patient to open up and talk. They are more useful than closed questions when it is important to allow the patient to tell his or her own story in a personal way.

What are three things that patients often expect when they seek health care?

Patients expect relief from the health problem that has brought them to the medical office. In addition, they do not want to be nagged to change their habits or improve their lifestyle. They also hope to be seen and be on their way in a reasonable amount of time. The patient's definition of a "reasonable" time may be shorter than that of the medical office.

How do patients who are totally blind usually prefer to be assisted in an unknown setting?

Patients who are totally blind usually prefer to take the arm of another individual when walking in an unfamiliar setting. The location of objects must be described to them.

What are three types of responses that inhibit communication or make the patient defensive?

Responses that show disapproval or blame, responses that are challenging, or responses that are not genuine may inhibit communication or make a patient defensive.

What are self-boundaries?

Self-boundaries include physical, mental, and spiritual guidelines or limits that a person uses to define how close other people can come without posing a threat to personal integrity.

Give four examples of different types of verbal communication.

Speaking to someone who is present, talking to someone on the telephone, writing a letter, and sending an e-mail are examples of verbal communication.

How can a medical assistant communicate caring to a patient?

The medical assistant can communicate caring to a patient by listening carefully and allowing the patient to express himself or herself completely. Caring can also be expressed nonverbally by sitting or standing at the same level, at a comfortable distance, and by maintaining eye contact. Touching the patient lightly if it seems appropriate can also communicate caring.

Describe three ways to support a terminally ill patient in the grieving process.

The medical assistant should listen to the terminally ill patient carefully. If the patient is in denial, the medical assistant should not confront unrealistic statements. If the patient expresses anger, the medical assistant should not take it personally. If the patient is depressed, the medical assistant should still try to maintain supportive communication.

Give examples of appropriate ways for a medical assistant to maintain self-boundaries when a patient or other staff member appears to assume that a closer relationship exists than the medical assistant is comfortable with.

To maintain self-boundaries in interactions with others, the medical assistant should calmly refuse to provide a telephone number and refuse unwanted invitations. If personal space is entered, the medical assistant should move away and, if necessary, ask the other person not to stand so close and/or not to touch.

What are three ways to provide translation services for a patient who is not comfortable communicating in English?

Translation service can be provided by an interpreter in the office, through a telephone translation service, or through a video translation service.

Identify the needs on each level of Maslow's hierarchy of needs.

a. Level 1 (lowest level): Physiologic needs such as food, water, oxygen, need to excrete wastes, etc. b. Level 2: Needs for safety and security. c. Level 3: Needs for love and belonging. d. Level 4: Needs for esteem and recognition. e. Level 5 (highest level): Need for self-actualization.

Identify and describe six communication techniques that draw patients out and encourage them to keep talking.

a. Paraphrasing involves putting the patient's meaning into one's own words. The entire message is included. b. Translating a nonverbal message into words is an attempt to describe what the patient's body language is communicating. c. Reflecting means turning a question or statement around and asking the patient to give his or her own opinion. d. Summarizing is an attempt to state the main point of a conversation. It includes only the most important point or points. e. Repeating or restating means to repeat the last part of what the patient has just said. It demonstrates that the medical assistant is listening without introducing a new thought. f. Silence causes most people to become uncomfortable. Patients will usually talk rather than allow a silence to continue.