Therapeutic

CHAPTER 4 Communication

Learning Objectives:

After the completion of the chapter, students should be able to:

1. discuss first impression and patient centered care.

2. identify and respond to types of verbal and non-verbal communication.
3. recognize communication barriers and ways to overcome it.

First Impressions

Because a first impression is so important, a medical assistant must help ensure that each patient’s first impression
of the medical office is a positive one. Good communication is one of the most essential skills for ensuring a
positive first impression. Communication is a complex, continuous, multidimensional process. The message, or
content, of communication includes not only what a person says but also the nonverbal and symbolic language of
facial expressions, body language, and vocal inflections. Thus, a medical assistant must be sure the message she
sends with her body language is congruent, or consistent, with the message she sends with her words.

Patient-centered Care

Strategies for Dealing with Difficult People

For most medical assistants, working with and helping people is the most rewarding part of the job. However,
working with people can also be the most challenging part of the job. Because of pain or illness, patients do not
always behave at their best. They may be upset with their lowered quality of life or feeling frustrated and angry over
their lack of improvement. They sometimes seem to have unrealistic expectations of what the physician and medical
science are able to offer. They may be feeling frightened, vulnerable, angry, or confused. As a result, patient
behavior can sometimes be unpredictable and unpleasant. During such times, a medical assistant can become a
convenient target and can find it challenging to maintain her professional demeanor. However, it is especially during
such times that her degree of professionalism becomes apparent.

Focusing on the Patient

It is not easy to avoid taking personal offense at criticism or other negative comments from a patient. However, the
medical assistant must remind herself to keep her focus on the patient’s needs, rather than on herself. By doing so,
she is less likely to feel personally upset or offended by the patient’s words or behaviors. In addition, the medical
assistant who tries to treat others as she would want to be treated maintains the ability to empathize with her
patients. This empathy makes her less likely to react in anger and more likely to respond with compassion.

Acknowledging the Patient

All people like to feel acknowledged, and no one likes to be treated as if they were a number or an object. If patients
believe they are being treated as an object rather than a person, they will be offended, angry, and frustrated. A
medical assistant may be extremely busy dealing with multiple patients, ringing telephones, physicians, coworkers,
and numerous other demands. However, she must never fall into the habit of viewing patients as an inconvenience.
Patient care is at the heart of the profession of medical assisting. Regardless of how busy a medical assistant is, it
takes no more time to look a patient in the eyes, speak in a kind voice, and smile than it does to deal with that patient
in a harried, distracted manner.

Validating the Patient’s Feelings

When a patient feels upset, they do not want someone to argue with them or trivialize her feelings. Such treatment
will simply further upset the patient. On the other hand, if the medical assistant responds with a calm voice and
validates the patient’s feelings in a kind, empathetic manner, her response will most likely have a soothing effect
that deescalates the situation. However, it can be difficult for a medical assistant to validate a patient’s feelings
without implying agreement with the patient’s statement. For example, a patient complains to the medical assistant,
saying, “I can’t believe that I wasted $65 on a worthless medication. You people are incompetent!” The medical
assistant can simply validate the patient’s feelings by saying, “You are feeling concerned that the medication was
ineffective.” Then, she can offer a temporary solution by saying, “Since you are not feeling better, you should
probably speak with the physician.”

Using “I” Language

Communication with others is vital in reaching
agreements, resolving conflicts, and creating a positive
work environment. However, when people’s emotions
rise and tempers flare, their efforts at communication
may quickly deteriorate into accusations and arguments.
In order to avoid such a situation, people should try to
plan such conversations for a time when the persons
involved are not feeling angry or upset. They should
also remind themselves that the goal is to achieve a
positive resolution for everyone. When attempting to
address a conflict or disagreement, the medical assistant
who uses “I” language, rather than “you” language, can
help ensure a successful conversation that does not
make the other persons involved feel as though they
must defend themselves. For example, the medical
assistant who is feeling annoyed with her coworker for
always returning from lunch late might yell at her as she
comes in the door, “You are always late and messing up
our schedule, and I’ve had it!” Doing so will probably
put her coworker on the defense and start an argument.
A better approach would be to wait until feelings of
anger subside and then find an opportunity to have a private conversation where patients cannot overhear. She then
might state something like “I’ve noticed that you’ve been taking 45 minutes for lunch lately. Because we are each
supposed to take 30-minute lunches, this is affecting patient scheduling. I am feeling frustrated but do not want this
to hinder our working relationship. I would like to find a solution that meets both of our needs.” Of course, there is
no guarantee that the coworker will respond as desired, but he or she is much more likely to do so when he or she
realizes the impact his or her behavior is having on others and when he or she does not feel that his or her personal
character is being attacked.
Communication
Communication Cycle
Communication, or the process of sending and receiving information between two or more individuals, occurs in a
cycle. The main features of the communication cycle include the referent, sender, receiver, message, channels,
feedback, interpersonal variables, and environment.

Referent
The referent is what stimulates or motivates the communication. It might be an object, a sight, a sound, an idea, a
sensation, or anything that prompts a person to communicate.

Message
The message is the content of the communication. It includes verbal communication through words, nonverbal
communication through gestures such as head nodding, and communication through symbolism, as with such
commonly understood symbols as . for male and . for female. When a person receives a message, the message also
becomes a referent for that person, who in turn may respond with another message.

Sender and Receiver

The person who delivers the message is the sender. This person is responsible for the emotional tone and accuracy
of the message. The sender can increase the effectiveness of the communication experience by using clear speech,
simple language, and adequate volume as well as facial expressions and body language that are congruent with the
spoken message. The sender should observe the person to whom he is sending the message for signs of
understanding or confusion. A receiver is the person who receives the message and decodes it, or extracts the
meaning of the message. The accuracy with which the receiver understands the message depends, in part, on how
well the receiver pays attention to the sender. Paying close attention involves focusing, listening, and noting verbal
and nonverbal cues. The roles of sender and receiver are fluid, meaning they change back and forth as the
communication cycle continues. Compatibility, familiarity, and commonality between sender and receiver enhance
their communication and understanding.

Channels
Channels are the means of conveying messages, such as vision, hearing, and touch. Such channels may incorporate
facial expressions, voice volume, vocal inflection, touching a person’s shoulder, and so on. The more channels a
sender uses, the more clearly he conveys the message—as long as all of the channels are consistent with the message
he or she is sending.

Feedback
Feedback is the message returned by the receiver, which reflects his or her level of understanding. It also may
include the receiver’s response to the original message.
Interpersonal Variables
Communication is greatly impacted by interpersonal variables, or factors that influence the receiver’s interpretation.
Such factors include personal biases, education, developmental level, sociocultural background, values, beliefs,
emotions, gender, health issues, roles, relationships, and prior experiences.

Environment
The communication environment is the setting in which the communication experience occurs. A number of
environmental factors can interfere with the accuracy of communication, including pain, medication effects, room
noise, temperature, humidity, lack of privacy, and inadequate space. In the medical office, a medical assistant is
responsible for ensuring accurate communication with patients and coworkers. Therefore, she must address
environmental and patient comfort issues in order to minimize distractions and maximize the patient’s ability to
focus, listen, and understand.

Verbal Communication
Spoken language is a key means of communication. However, the meaning of words can change, depending on
vocal pitch and inflection, word emphasis, and pauses. Therefore, the medical assistant must consistently speak
clearly, enunciate carefully, use a pleasant tone of voice, and keep her mind on the messages she is conveying. She
must also remember that many patients, especially the elderly, may have some degree of hearing loss. When
speaking to such individuals, she should face toward them so that they can see her lips and use adequate volume
without shouting.

Nonverbal Communications
When a discrepancy exists between verbal and nonverbal messages, a listener will tend to believe the nonverbal
message. Therefore, the medical assistant must pay careful attention to her body language. Body language
encompasses many components, including hand gestures, mannerisms, facial expressions, posture, touch, and the
use of personal space. A medical assistant in a closed stance with her arms crossed, who is looking away from the
person and wearing a solemn expression, conveys disinterest or displeasure. To help patients feel welcome and at
ease and to project the message of concern, caring, and openness, the medical assistant should use an open body
stance, make frequent eye contact, and maintain a pleasant expression, punctuated by an occasional, genuine smile.
An important feature of body language is personal space. The study of how much personal space people prefer and
how it relates to cultural and environmental factors is known as proxemics.

Active Listening
One of the most important parts of effective communication is active listening. Active listening involves 90%
listening and 10% speaking. Most people overestimate their skills as a listener. When a person should be attending
to what a speaker is saying, most are thinking about what they want to say next. Additionally, people sometimes
become distracted and let their minds wander to other matters. Some, in an effort to be active listeners, jump in and
finish the speaker’s sentences. Others interrupt the speaker to get in their own thoughts and opinions. In these
examples, the listeners are not listening well at all. Rather, they are attending to what they want to say, or even their
desire to end the conversation and move on to other things. As a result, a speaker can feel unheard, unacknowledged,
and uncared for. True active listening requires more energy than most people realize. It entails attending to the
speaker’s words and body language, allowing the speaker adequate time to formulate and articulate the message, and
then reflecting, or paraphrasing, the message that was heard to verify understanding and seek clarification as needed.

Giving Advice
Medical assistants are commonly asked for medical advice by family and friends as well as patients. As much as a
medical assistant may feel tempted to respond with advice, she must proceed cautiously. She must diligently avoid
the appearance of dispensing medical advice outside of her scope of practice. Such action could put herself and her
employers in legal jeopardy. While on the job, the medical assistant must take care to dispense information that is
appropriate and consistent with her level of education and role within the medical practice. While away from her
job, the wisest policy she can follow is to avoid dispensing any medical advice at all and, instead, suggest that
people contact their own health care providers.

Overcoming Barriers to Communications

Communication Challenges
Most individuals are not nearly as good at communication as they believe. This misperception sets the stage for
miscommunication and misunderstanding, even in the best circumstances. In addition, many people unintentionally
block effective communication without realizing it. However, the medical assistant who understands these
challenges to communication and has strategies for dealing with them will be a successful communicator.

Defense Mechanisms
Defense mechanisms are unhealthy coping strategies that people employ to protect themselves when they feel
emotionally threatened. Some of the most common types of defense mechanisms include: rationalization
compensation regression repression displacement denial projection.

Rationalization
When a person makes excuses to justify inappropriate behavior, that person is making rationalizations for her
behavior. For example, when an employee steals supplies from the workplace, she might rationalize such actions by
stating, “They don’t pay me enough anyway.”

Compensation
Compensation is a psychological response in which a person attempts to offset feelings of inadequacy in one aspect
of life by achieving success in another. This response is not always unhealthy, but certainly may be. For example, a
parent who feels guilty for not spending time with his or her child might attempt to compensate by buying the child
expensive toys.

Regression
When a person reverts to behavior associated with earlier (younger) developmental stages, he or she is exhibiting
signs of regression. For example, a 12-year-old child might regress to thumb-sucking behaviors when hospitalized or
when dealing with family trauma, such as death or divorce. Self-limiting regressive behaviors provide emotional
protection and comfort during a time of emotional trauma. The behavior usually disappears when the emotional
turmoil ends. However, prolonged periods of regression may signal serious adjustment difficulties and the need for
therapy.
Repression
Repression occurs when a person eliminates from conscious thought traumatic memories or painful or conflictual
thoughts or impulses that the person believes are unacceptable. For example, an adult who forgot for many years
about experiencing sexual abuse as a child has repressed those memories. Yet the experience has the potential to
have a lasting impact on his or her ability to form healthy relationships. A man who finds himself physically
attracted to his wife’s best friend and recognizes his impulse to act on these feelings as unacceptable may
continually forget the woman’s name.

Displacement
When a person expresses anger or another emotion at a person or object that is not the cause of those feelings, he or
she is employing the defense mechanism of displacement. For example, a man who is angry at his boss goes home
and vents his anger on his family by picking a fight with his wife and yelling at his children. In the workplace, this
behavior sometimes manifests in coworkers mistreating one another, rather than addressing issues they have with
the manager.

Denial
When a person refuses to acknowledge the validity or reality of something that is obvious to everyone else, he or she
is said to be in denial; for example, a person who suffers health problems, relationship problems, and professional
problems due to chronic alcoholism but refuses to acknowledge that he or she has an alcohol problem. Friends,
family and coworkers are usually well aware of the problem that the individual himself or herself refuses to
acknowledge. In some cases, those persons closest to the individual join in the denial. For example, the wife of an
abusive alcoholic who makes excuses for her husband’s actions is also in denial.

Projection
When a person accuses others of having certain feelings, attitudes, or behaviors that he or she has, he or she is
projecting. For example, a man who projects feelings of guilt about cheating on his wife might accuse her of being
unfaithful to him.

Moving to a Solution
A medical assistant is most effective when she learns to avoid getting stuck in argumentation with patients,
coworkers, or physicians. When she is in a conversation involving conflict, the medical assistant should direct the
conversation toward clarifying the problem without pointing blame. Then she can begin discussing possible
solutions. If an upset colleague or patient seems intent on laying blame, the medical assistant should tactfully, yet
assertively, change the subject by asking a question such as
“What solution to this problem do you have in mind?” In
addition, the medical assistant should learn to monitor her
own behavior. When she notices herself feeling upset or
starting to assign blame, she should refocus her attention on
finding a positive solution instead.

Setting Boundaries
While a medical assistant should always behave in a tactful,
professional manner, she is not obligated to subject herself to
verbal or physical abuse. Whether the aggressor is a patient,
colleague, or even a physician, the strategies above should be
employed. Medical assistants must sometimes set or enforce
boundaries, or physical or psychological space that indicates
the limit of appropriate versus inappropriate behavior. If such interventions fail to work and the behavior escalates,
the medical assistant should solicit the intervention of the department or office manager. This person may have the
ability to provide a fresh, unbiased perspective and also has a greater level of authority to help identify a solution to
the problem. The medical assistant should report any threats of physical violence per office policy. If a patient or
another person becomes physically violent, the medical assistant should immediately summon help, such as calling
security or even calling the police, per office policy.
Maslow’s Hierarchy of needs

In a 1943 paper titled "A Theory of Human

Motivation," American psychologist Abraham
Maslow theorized that human decision-making is
undergirded by a hierarchy of psychological
needs. In his initial paper and a subsequent 1954
book titled Motivation and Personality, Maslow
proposed that five core needs form the basis for
human behavioral motivation.
What Is Maslow’s Hierarchy of Needs?

Maslow's hierarchy of needs is a theory of

motivation which states that five categories of human needs dictate an individual’s behavior.
Those needs are physiological needs, safety needs, love and belonging needs, esteem
needs, and self-actualization needs.

What Are the 5 Levels of Maslow’s Hierarchy of Needs?

Maslow's theory presents his hierarchy of needs in a pyramid shape, with basic needs at the
bottom of the pyramid and more high-level, intangible needs at the top. A person can only
move on to addressing the higher-level needs when their basic needs are adequately fulfilled.

1. Physiological needs: The first of the id-driven lower needs on Maslow's hierarchy are
physiological needs. These most basic human survival needs include food and water,
sufficient rest, clothing and shelter, overall health, and reproduction. Maslow states
that these basic physiological needs must be addressed before humans move on to
the next level of fulfillment.
2. Safety needs: Next among the lower-level needs is safety. Safety needs include
protection from violence and theft, emotional stability and well-being, health security,
and financial security.
3. Love and belonging needs: The social needs on the third level of Maslow’s hierarchy
relate to human interaction and are the last of the so-called lower needs. Among these
needs are friendships and family bonds—both with biological family (parents, siblings,
children) and chosen family (spouses and partners). Physical and emotional intimacy
ranging from sexual relationships to intimate emotional bonds are important to
achieving a feeling of elevated kinship. Additionally, membership in social groups
contributes to meeting this need, from belonging to a team of coworkers to forging an
identity in a union, club, or group of hobbyists.
4. Esteem needs: The higher needs, beginning with esteem, are ego-driven needs. The
primary elements of esteem are self-respect (the belief that you are valuable and
deserving of dignity) and self-esteem (confidence in your potential for personal growth
and accomplishments). Maslow specifically notes that self-esteem can be broken into
two types: esteem which is based on respect and acknowledgment from others, and
esteem which is based on your own self-assessment. Self-confidence and
independence stem from this latter type of self-esteem.
5. Self-actualization needs: Self-actualization describes the fulfillment of your full
potential as a person. Sometimes called self-fulfillment needs, self-actualization needs
occupy the highest spot on Maslow's pyramid. Self-actualization needs include
education, skill development—the refining of talents in areas such as music, athletics,
design, cooking, and gardening—caring for others, and broader goals like learning a
new language, traveling to new places, and winning awards.