verbal and non verbal communication Dr Barba FTC

Disorder with Physical Symptoms and No Organic Cause (Somatoform)

Paralysis, heart palpitations, dizziness; also referred to as hypochondriasis

Patient Education

Patient education may occur at any point during the visit, as well as before and afterward. This education can be presented in several forms and often begins when the patient calls for an appointment. It can include information on office hours, policies, insurance form submissions, and after-hours emergency telephone numbers.

Verbal Communication

Verbal communication is based on words, sounds, and tone of voice

Intellectualization

A mechanism by which an emotional response that normally would accompany an uncomfortable or painful incident is evaded by the use of rational explanations that remove from the incident any personal significance and feelings EXAMPLE The pain over a parent's sudden death is reduced by saying, "He wouldn't have wanted to live disabled." USES /PURPOSE Protects a person from pain and traumatic even

Compensation and reimbursement for work-related activities, such as attending conventions and taking

(CEU/degree), and parking fees • Emergency leave • Grievance (complaint) process • Health benefits • Holidays • Jury duty • Overtime policy • Pension plan • Performance review and evaluation • Probationary period • Sick leave • Termination of employment • Vacation • Work hours, including flex time

Mental retardation

, attention deficit disorders such as hyperactivity or inability to concentrate, and developmental problems

The personnel policy manual, also known as the employee handbook

, contains information for the employee about the employer-employee relationship, the work environment, and the expectations of the particular medical facility. This manual contains general information about office policies relating to dress and behavior codes, punctuality, office safety, and the role of the employee in an emergency, such as a fire.

MASLOW'S HIERARCHY OF NEEDS

Abraham Maslow was a twentieth-century psychologist who developed a hierarchy of human needs. Maslow's hierarchy of needs states that human beings must have their basic physiological and safety needs met before they can move to the next level of development and eventually reach the highest level: self-actualization

STAGES OF PSYCHOSEXUAL DEVELOPMENT

Age Characteristic Oral Birth to 18 months The mouth is the center of pleasure. Anal 18 months to 3 years Toilet-training: the anus is the center of pleasure. Phallic 4 to 6 years The genitals are the center of pleasure. Latency 7 years to puberty Sexual concerns are not important; sexual drives are seen as dormant. Genital Puberty to adulthood Genitals are the center of pleasure; this is expressed as adult sexuality.

Office Policies and Procedures

All offices should have a policy manual and a procedures manual listing the policies of the office and describing how to carry out tasks within a particular medical practice. These manuals are sometimes combined into one manual called the policies and procedures manual. Detailed descriptions of the standard operating procedure (SOPs) and instructions on how to perform both administrative and clinical tasks are included in this manual

MENTALLY AND EMOTIONALLY IMPAIRED PATIENTS

, it is important to first determine the patient's level of communication and understanding. Be sure to speak slowly and clearly. Stay calm, and keep your messages short and to the point. If the patient will be undergoing any type of procedure or will require you to touch the patient, be sure to explain to the patient what you will be doing.

.VISUALLY IMPAIRED PATIENTS

. It is important to ask a visually impaired patient if he or she needs assistance in going to and from the exam room. Don't automatically assume that the patient needs your guidance and assistance. If the patient does request assistance, offer your arm and provide guidance, making sure to alert the patient about any steps, slopes, or ramps

Aggressive Behavior

.""You know you can't expect this medication to work when you're not taking it every day." "That's not my job. "Why did you do that? It was stupid." Rushing into an exam room to say, "Doctor, you've got a telephone call."

Five Cs of better communication

1content2conciseness clarity,4coherent,5chek

Personality disorder

: antisocial reactions, paranoias, and narcissistic behavior

Neuroses

: mild emotional disturbances that impair judgment

Psychoses

: severe mental disorders that interfere with the individual's perception of reality.

Introjection

A form of identification that allows for the acceptance of others' norms and values, even when they are contrary to one's previous assumptions EXAMPLE A seven-year-old boy tells his little sister, "Don't talk to strangers." He has introjected this value from the instructions of parents and teachers. USES/PURPOSE Helps a person avoid social retaliation and punishment; particularly important for the child's development of the superego

Undoing

An action or words designed to cancel disapproved thoughts, impulses, or acts in which the person relieves guilt by making reparation EXAMPLE A father spanks his child and the next evening brings home a present for him; a teacher writes an exam that is far too easy and then constructs a grading curve that makes it difficult to earn a high grade. USES/PURPOSE Allows a person to reduce guilty feelings and atone for mistakes

Denial

An attempt to screen out or ignore unacceptable realities by refusing to acknowledge them EXAMPLE A woman, though told that her father has metastatic cancer, continues to plan a family reunion 18 months in advance. USES/PURPOSE Temporarily isolates a person from the full impact of a traumatic situation

Repression

An unconscious mechanism by which threatening thoughts, feelings, and desires are kept from becoming conscious; the repressed material is denied entry into consciousness EXAMPLE A teenager, seeing his best friend killed in a car accident, becomes amnesic about the circumstances surrounding the accident. USES/PURPOSE Protects a person from a traumatic experience until he or she has the resources to cope

MAJOR DIAGNOSTIC CATEGORIES OF MENTAL DISORDERS

Anxiety Disorder Phobias, panic attacks, compulsive rituals Cognitive Disorder

COMPARISON OF ASSERTIVE AND AGGRESSIVE BEHAVIOR Assertive Behavior

Assertive Behavior "This medication works best when it is taken on a regular daily basis." "You know you can't expect this medication to work when you're not taking it every day." "Let me find someone who can answer that question for you." "That's not my job." "Your behavior is inappropriate." "Why did you do that? It was stupid." Knocking on an exam room door and then coming in to say, "Excuse me, Dr. Thompson. You are needed on the telephone."

Professionalism .

is exhibited by treating everyone, including patients, co-workers, supervisors, and those from outside the office, in a courteous, conscientious, and businesslike manner. All forms of communication should be delivered with a positive attitude, in a respectful manner, and should be appropriate for the intended receiver. Maintaining professionalism is of the utmost importance whether communicating verbally, nonverbally, or in writing.

Communication

is important in all aspects of business, but especially in healthcare, as the exchange of information and interaction between the patient and the healthcare provider will help shape outcomes and actions.

Projection

Blaming other persons or the environment for unacceptable desires, thoughts, shortcomings, and mistakes EXAMPLE A mother is told that her child must repeat a grade in school, and she blames this on the teacher's poor instruction; a husband forgets to pay a bill and blames his wife for not giving it to him earlier. USES/PURPOSE Allows a person to deny the existence of shortcomings and mistakes; protects the self-image

Eating Disorders

Characterized by abnormal eating patterns, distorted body image, fear, guilt, and depression

Schizophrenia and Other Psychotic Disorders

Characterized by delusions, hallucinations, and severe disturbances in thinking and emotion

Factitious Disorders

Characterized by physical and/or psychological symptoms that are consciously created by the patient, which the patient knows are not real; such as pretending to be sick (or to sicken others) to get attention

Infancy

Childbirth to toddler period Motor ability and coordination develop Language and sensory skills develop Basic emotions and feeling expressed Trust develops Attachment to caregivers

Defense Mechanism

Compensation Covering up weaknesses by emphasizing a more desirable trait or by overachievement in a more comfortable area EXAMPLE A high school student too small to play football becomes the star long-distance runner for the track team. USE AND PURPOSE Allows a person to overcome weakness and achieve success

Prenatal Period

Conception to birth Body structures and organs formed Development influenced by the environment

Model on death and dying

Elizabeth Kübler-Ross was a psychiatrist of the late 1960s and 1970s who developed the model on death and dying that now bears her name. She determined that any time loss occurs, an individual may progress through five stages of grief. It is important to understand that not all individuals 122 123 go through all five stages, and they may not go through the stages in the order listed

Assertive Behavior

Expressing your personal preferences and defending your personal rights while respecting the preferences and rights of others

examples of body language

• Facial expressions: may or may not reflect judgment. • Eye contact: depending on whether it is or is not maintained, it may reflect the individual's level of interest, attention, and sensitivity. • Gestures: may be positive or negative. • Posture: may or may not reflect interest and a feeling of self-worth. • Therapeutic touch: may convey empathy and sensitivity, but be aware of the recipient's reaction; not everyone likes to be touched by persons they don't know well.

POLICY AND PROCEDURES MANUALS

• List the tasks to be performed within the office, including equipment needed in order to complete the procedure. • Standardize the procedure for each task. • Describe job responsibilities and titles. The procedures manual, when properly updated, is an excellent reference tool for the new employee since it provides guidelines for performing specific tasks. Temporary or substitute employees also find it valuable.

Some general guidelines to follow when working with hearing-impaired patients are as follow

• Make sure that you are in a quiet, well-lit room. • Face the patient. • Speak slowly and clearly. • Don't have anything in your mouth, such as gum or candy. • Have paper and pen available so that the patient can communicate in writing if desired.

MAJOR DIAGNOSTIC CATEGORIES OF MENTAL DISORDERS

• Neuroses: . • Psychoses: . • Personality disorder:

PATIENT INFORMATION BOOKLET

• Office hours • Payment guidelines 116 117 • Appointment and cancellation policies • Telephone answering service • Information about the physician(s) • After-hours availability • Directions to the facility • Parking information Patient information booklets can help reduce the number of questions by telephone from patients, enhance the office's image, and reduce the number of patients who fail to remember instructions.

Patient Advocacy

At some point during their care, patients may need an advocate. Patient advocates are individuals who help patients make sure that their voices are heard and their wishes are carried out. Typically, a family member will serve as the patient advocate; however, there may be times when a member of the medical office may need to serve in this capacity and ensure that the patient is receiving quality care.

Communicating with Special Needs Patients and Their Families

At times, you will need to communicate with special needs patients and their families. It is important to treat these patients with the same respect, dignity, empathy, and professionalism that you would use with any other patient.

he effects of toxic substances or drugs resulting from brain damage or

Delirium, dementia, amnesia

Sublimation

Displacement of energy associated with more primitive sexual or aggressive drives into socially acceptable activities EXAMPLE A person with excessive, primitive sexual drives invests psychic energy in a well-defined religious value system. USES/PURPOSE Protects a person from behaving in irrational, impulsive ways

Dissociative Disorder Dissociative amnesia,

Dissociative Disorder Dissociative amnesia, in which important events cannot be remembered after a traumatic event, and dissociative identity disorder (multiple personality disorder), in which two or more personalities or identities are present in one person

Adolescence

Early Adolescence Ages 12 to 14 Operational thinking occurs Sexual maturation occurs Desire for independence begins Friendships important Late Adolescence Ages 15 to 19 Positive identity formed Decisions made concerning college, career, and workplace Sexual relationships formed Ability to relate to others increases

Adulthood

Early Adulthood Ages 20 to 30s Career choices made Intimacy develops Middle Adulthood Ages 40 to 50s Vocational success achieved Personal responsibility realized Emotional and physical changes occur Late Adulthood Age 60 to death Physical and mental capacity changes occur Relationships change Satisfaction may be at this stage

Childhood

Early Childhood Ages 3 to 5 Linguistic, physical, and cognitive skills develop Concept of self begins to develop Middle Childhood Ages 6 to 11 Logical thinking develops Advances in reading and writing occur Moral and psychosocial development occurs rapidly Achievement important

Defense Mechanism

Freud believed that coping skills were formed to help reduce anxiety and maintain the self-image. Defense mechanisms, he stated, are the subconscious reactions human beings may use when trying to manage anxiety by denying, misinterpreting, or distorting reality. Overuse of some of these defense mechanisms may lead to self-destructive behavior, as the mechanisms may prevent the individual from addressing the cause of the anxiety.

Identification

I An attempt to manage anxiety by imitating the behavior of someone who is feared or respected EXAMPLE A student nurse imitates the nurturing behavior she observes one of her instructors using with clients. USES /PURPOSE Helps a person avoid self-devaluation

ASSERTIVE VERSUS AGGRESSIVE BEHAVIOR

In order to be an effective medical assistant, most circumstances require the cooperation of peers and/or patients. The use of assertive behavior skills will help you get cooperation. There is a difference between assertive and aggressive behavior. The former behavior is desirable; the latter is not.

Impulse Control Disorder

Inability to resist the impulse to perform some act that is harmful to the individual or others, such as pathological gambling, stealing (kleptomania), setting fires (pyromania), or having violent rages

Personality Disorder

Inflexible behavior patterns that cause distress or the inability to function; these include paranoid, narcissistic, and antisocial disorders

NON-ENGLISH-SPEAKING PATIENTS

It is unlikely that an office will have a multilingual staff available to communicate with patients from all ethnic and cultural backgrounds. In the event that nobody within the practice is familiar with the patient's language, you may need to rely on nonverbal communication initially. However, this can be dangerous, as there are many opportunities for misunderstanding or error when neither of the parties is absolutely sure of what is being communicated by the other. If you are working in a culturally diverse area, it is best to have a list of interpreters available to call when needed. Most acute care facilities can arrange to have multilingual interpreters available if enough advance notice is given

Rationalization

Justification of certain behaviors by faulty logic and ascription of motives that are socially acceptable but did not in fact inspire the behavior EXAMPLE A mother spanks her toddler too hard and says that it was acceptable because he couldn't feel it through the diaper anyway. USES/PURPOSE Helps a person cope with the inability to meet goals or certain standards

Mood Disorder

Major depression, bipolar disorder (manic depression), chronic depressive mood

Nonverbal Communication

Many times the nonverbal message being sent is more accurate than the verbal message. It is important to listen not only with your ears but also with your eyes.

Disorder Diagnosed in Infancy and Childhood

Mental retardation,

Minimization

Minimization Not acknowledging the significance of one's behavior EXAMPLE A person says, "Don't believe everything my wife tells you. I wasn't so drunk that I couldn't drive." USES/PURPOSE Allows a person to decrease responsibility for behavior

acknowledgment

Most offices require the employee to sign an acknowledgment that he or she has received a copy of the personnel manual and understands it. This signed acknowledgment is kept in the employee's personnel file

BODY LANGUAGE

Nonverbal communication is most commonly known as body language. In most instances, body language will tell the real story of how the patient is feeling versus what he or she tells you verbally

DEVELOPMENTAL STAGES OF THE LIFE CYCLE

Prenatal Period Infancy Childhood Adolescence Adulthood

PROOFREADER'S MARKS

Proofreading, or checking for errors in content and typing when preparing written documents, is critical. The professionalism of the office is judged, in part, by the appearance of its correspondence and documents. Therefore, the importance of proofreading cannot be overemphasized. Even small omissions, such as commas, are noticed by readers

Reaction Formation

Reaction Formation Acting exactly opposite to the way one feels EXAMPLE An executive resents his bosses for calling in a consulting firm to make recommendations for change in his department but verbalizes complete support of the idea and is exceedingly polite and cooperative. USES/PURPOSE Aids in reinforcing repression by allowing feelings to be acted out in a more

Substance-Related Disorder

Related to either excessive use of or withdrawal from alcohol, amphetamines, caffeine, cocaine, hallucinogens, nicotine, opiates, and other drugs

Substitution

Replacement of a highly valued, unacceptable, or unavailable object by a less valuable, less acceptable, or available object EXAMPLE A woman wants to marry a man exactly like her dead father and settles for someone who looks a little bit like him. USES/PURPOSE Helps a person achieve goals and minimizes frustration and disappointment

Regression

Resorting to an earlier, more comfortable level of functioning that is characteristically less demanding and responsible EXAMPLE An adult throws a temper tantrum when he does not get his own way; a critically ill client allows the nurse to bathe and feed him. USES/PURPOSE Allows a person to return to a point in development when nurturing and dependency were needed and accepted with comfort

Developmental and Behavioral Theories

Several psychologists and psychiatrists have developed explanations and predictions regarding why people behave the way they do.

FREUD'S STAGES OF PSYCHOSEXUAL DEVELOPMENT

Sigmund Freud was an Austrian neurologist of the late nineteenth to mid-twentieth centuries who developed several theories related to psychology and human development. Many of these theories are no longer accepted, but they provide the foundations of modern psychology. One of Freud's theories concerns the stages of psychosexual development, which focuses on the development of personality in childhood. Freud believed that sexual drive was the result of an instinctual sexual appetite beginning at birth and progressing to adulthood.

ANGRY PATIENTS

Some of the greatest difficulty in communicating occurs when a patient is angry. It is important to remember that the patient is most likely not angry with you, but rather with the situation. The patient's anger may be based on fear and anxiety or loss of control. You should take care not to become defensive and respond to the angry patient in the same manner in which the patient is responding to you. Remain calm and ask, "What can I do to help you?"

Some general guidelines to follow when working with visually impaired patients are as follows:

Speak clearly and pay attention to the speed and volume of your speech. • Face the patient. • Explain in detail any procedures the patient may have performed. • Have large-print patient education materials available.The manner in which you speak will play a significant role in your communication with a visually impaired patient.

COMMUNICATION cycle

The communication cycle includes a source, message, channel, and receive , you have an stimulus, the sender send the stimulus verbal or not verbal one persons receive RECEIVER decoder -----encode---feedback

HEARING-IMPAIRED PATIENTS

The degree of hearing loss can vary greatly. It is important to first understand the level of loss, as this will help determine how best to communicate with the patient. The manner in 112 113 which you communicate will vary, depending on whether or not the patient can lip-read, has a hearing aid, or uses an interpreter. If the patient uses an interpreter, be sure to maintain eye contact and speak directly with the patient

FUNDAMENTAL WRITING SKILLS

The use of correct words when preparing office correspondence includes avoiding the use of the following: • Technical terms • Gender bias (indicating either male or female by the type of language used) • Long sentences and paragraphs • Excessive use of the personal pronoun I • Repetition • Passive voice

Sexual and Gender Identity Disorder

Transsexualism (wanting to be the other gender), impaired sexual performance (lack of orgasm, premature ejaculation, or lack of sexual desire), or unusual or bizarre sexual acts

NEGATIVE COMMUNICATION

Though typically not intentional, negative communication can have the opposite effect of positive communication. Examples of negative communication are mumbling, showing disrespect, and avoiding eye contact.

Displacement

Transferring emotional reactions from one object or person to another object or person EXAMPLE A husband and wife are fighting, and the husband becomes so angry that he hits a door instead of his wife; a student gets a C on a paper she worked hard on and goes home and yells at her family. USES /PURPOSE Allows feelings to be expressed through or to less dangerous objects or people

POSITIVE COMMUNICATION

between the patient and the care-giver will help patients feel more comfortable, increasing their well-being and the likelihood that they will follow the physician's instructions. Examples of positive communication are smiling, showing empathy, listening carefully, and being friendly.

Mental Disorders

can be divided into three major categories: • Neuroses: mild emotional disturbances that impair judgment. • Psychoses: severe mental disorders that interfere with the individual's perception of reality. • Personality disorder: antisocial reactions, paranoias, and narcissistic behavior.

Written Communication

must be professional, courteous, and businesslike, project a positive tone, and protect the confidentiality of the physician and the patient. This requires some diplomacy

degenerative disorders

such as Alzheimer's disease