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New Medical Assistant
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Advance to Chapter 10next lesson Reporting and Charting

Communication

Communication is a highly complicated interpersonal process of people relating to each other through conversation, writing, gestures, appearance, behavior, and at times even silence.

Medical assistants must recognize, know, and practice proper communication techniques with people: patients, family members, colleagues, and other professionals in a health care setting.

   

Chapter 9
Communication Process in Medical Office

When two people communicate with eachother one-on-one, it is called interpersonal communication. Such communications not only occur among medical assistants and patients, but also among medical assistants and support personnel. Support personnel may include housekeeping, maintenance, security, supply, and food service staff. Another critical communication interaction occurs among medical assistants and co-workers, patient family members, and other visitors to the medical office.  It is only through effective communication that medical assistants are able to identify the goals of individual people and the healthcare system.

Because of the critical nature of communication in health care delivery, it is important that medical assistants understand the communication process and the techniques used to promote open, honest, and effective interactions.

THE COMMUNICATION PROCESS 
The human communication process consists of four basic parts: the sender of the message, the message, the receiver of the message, and feedback. The sender of the message starts the process. The message is the body of information the sender wishes to transmit to the receiver. The receiver is the individual intended to receive the message. Feedback is the response given by the receiver to the message. Feedback, at times, is used to validate whether effective communication has taken place.

Verbal and Nonverbal Communication
The two basic modes of communication are verbal and nonverbal. Verbal communication is either spoken or written. Verbal communication involves the use of words. Nonverbal communication, on the other hand, does not involve the use of words. Dress, gestures, touching, body language, face and eye behavior, and even silence are forms of nonverbal communication. Remember that even though there are two forms of communication, both the verbal and the nonverbal are inseparable in the total communication process. Conscious awareness of this fact is extremely important because their professional effectiveness is highly dependent upon successful communication. 


Barriers to Effective Communication 
Ineffective communication occurs when obstacles or barriers are present. These barriers are classified as physiological, physical, or psychosocial. 

Physiological barriers result from some kind of sensory dysfunction on the part of either the sender or the receiver. Such things as hearing impairments, speech defects, and even vision problems influence the effectiveness of communication. 

Physical barriers consist of elements in the environment (such as noise) that contribute to the development of physiological barriers (such as the inability to hear). 

Psychosocial barriers are usually the result of one's inaccurate perception of self or others; the presence of some defense mechanism employed to cope with some form of threatening anxiety; or the existence of factors such as age, education, culture, language, nationality, or a multitude of other socioeconomic factors. Psychological barriers are the most difficult to identify and the most common cause of communication failure or breakdown. Medical assistants might or might not be aware of it, but a person's true feelings are often communicated more accurately through nonverbal communication than through verbal communication. 

Listening 
Listening, a critical element of the communication process, becomes the primary activity for the medical assistant, who must use communication as a tool for collecting or giving information. When one is engaged in listening, it is important to direct attention to both the verbal and nonverbal cues provided by the other person. Like many other skills necessary for providing a health care service, listening requires conscious effort and constant practice. Their listening skills can be improved and enhanced by developing the following attitudes and skills: 
Hear the speaker out 
Focus on ideas 
Remove or adjust distractions 
Maintain objectivity 
Concentrate on the immediate interaction 

Medical assistants will be using the communication process to service a patient's needs, both short and long-term. To simplify this discussion, short-term needs will be discussed under the heading of "patient contact point." Long-term needs will be discussed under the heading of "therapeutic communications." 


PATIENT CONTACT POINT 
To give medical assistants a frame of reference for the following discussion, the following definitions will clarify and standardize some critical terms: 

1. Initial contact point - The physical location where patients experience their first communication encounter with a person representing, in some role, the health care facility. 

2. Contact point - The place or event where the contact point person and the patient meet. The contact point meeting can occur anywhere in a medical office or clinic, and also includes telephone events. 

3. Contact point person - The medical assistant in any health care experience whose role and responsibility is to provide a service to the patient. The contact point person has certain criteria to meet in establishing a good relationship with the patient. Helping the patient through trying experiences is partially the responsibility of all contact point personnel. Such medical assistants must not only have skills related to their professional duty, but they must also have the ability to interact in a positive, meaningful way to communicate concern and the desire to provide a service. 

Consumers of health care services expect to be treated promptly, courteously, and correctly. They expect their care to be personalized and communicated to them in terms they understand. 

Some of the most frequent complaints received in a medical office or clinic are those pertaining to the lack of courtesy, tact, and sympathetic regard for patients and their families exhibited by medical office staff. These points of initial patient contact, which include central appointment desks , telephones, patient affairs offices, emergency rooms, pharmacies, laboratories, record offices, information desks, walk-in and specialty clinics, and hospitals are critical in conveying to the entering patient the sense that their personnel is there to help them. The personnel who man these critical areas are responsible for ensuring that the assistance that they provide is truly reflective of the spirit of "caring" for which a medical office or clinic must stand. 

No matter how excellent and expert the care in any of the above listed facilities may be, an early impression of nonchalance, disregard, rudeness, or neglect of the needs of patients reflects poorly on its efforts and achievements. Medical assistants must be constantly on their guard to refrain from off-hand remarks or jokes in the presence of patients or their families. We must insist that our personnel in all patient areas are professional in their attitudes. What may be commonplace to us may be to a patient frightening or subject to misinterpretation. 

By example and precept, we must insist that, in dealing with our beneficiaries, no complaint is ever too trivial not to deserve the best response of which we are capable. . . . 

THERAPEUTIC COMMUNICATION 
A distinguishing aspect of therapeutic communication is its application to long-term communication interactions. Therapeutic communication is defined as the face-to-face process of interacting that focuses on advancing the physical and emotional well-being of a patient. This kind of communication has three general purposes: 
Collecting information to determine illness 
Assessing and modifying behavior 
and providing health education. 

By using therapeutic communication, we attempt to learn as much as we can about the patient in relation to his illness. To accomplish this learning, both the sender and the receiver must be consciously aware of the confidentiality of the information disclosed and received during the communication process. Medical assistants must always have a therapeutic reason for invading a patient's privacy. 

When used to collect information, therapeutic communication requires a great deal of sensitivity as well as expertise in using interviewing skills. To ensure the identification and clarification of the patient's thoughts and feelings, medical assistants, as the interviewer, must observe his behavior. Listen to the patient and watch how he listens to medical assistants. Observe how he gives and receives both verbal and nonverbal responses. Lastly, interpret and record the data medical assistants have observed. 

As mentioned earlier, listening is one of the most difficult skills to master. It requires medical assistants to maintain an open mind, eliminate both internal and external noise and distractions, and channel attention to all verbal and nonverbal messages. Listening involves the ability to recognize pitch and tone of voice, evaluate vocabulary and choice of words, and recognize hesitancy or intensity of speech as part of the total communication attempt. The patient crying aloud for help after a fall is communicating a need for assistance. This cry for help sounds very different from the call for assistance medical assistants might make when requesting help in transcribing a physician's order. 

The ability to recognize and interpret nonverbal responses depends upon consistent development of observation skills. As medical assistants continue to mature in their role and responsibilities as a member of the health care team, both their clinical knowledge and understanding of human behavior will also grow. Their growth in both knowledge and understanding will contribute to their ability to recognize and interpret many kinds of nonverbal communication. Their sensitivity in listening with their eyes will become as refined as-if not better than-listening with their ears. 

The effectiveness of an interview is influenced by both the amount of information and the degree of motivation possessed by the patient (the person being interviewed). Factors that enhance the quality of an interview consist of the participant's knowledge of the subject under consideration; his patience, temperament, and listening skills; and their attention to both verbal and nonverbal cues. Courtesy, understanding, and nonjudgmental attitudes must be mutual goals of both the interviewee and the interviewer. 

Finally, to function effectively in the communication process, medical assistants must be informed and skilled participants in all areas of the medical office. The development of required knowledge and skills is dependent upon their commitment to seeking out and participating in continuing education learning experiences across the entire spectrum of medical office and health care services. 



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