Interpersonal Communication in Medical Assisting
Chapter 4: Interpersonal Communication Overview
Source Material: Medical Assisting: Administrative and Clinical Procedures with Anatomy and Physiology, Seventh Edition.
Authors: Kathryn A. Booth, RN-BSN, RMA (AMT); Leesa G. Whicker, BA, CMA (AAMA), RPT, CPhT, MS; Terri D. Wyman, CPC, CMRS.
Learning Outcomes:
Identify elements and types of communication.
Relate communication to human behavior and needs.
Categorize positive and negative communication.
Carry out therapeutic communication skills.
Use effective communication strategies with patients in special circumstances.
Carry out positive communication with coworkers and management.
Introduction to Professional Communication
Requirements for Medical Assistants:
Recognize human behaviors.
Communicate effectively in a professional and diplomatic manner.
Recognize and navigate obstacles that affect communication.
Elements of the Communication Cycle
The Communication Cycle:
Starts with a message from the sender.
Ends with a response from the receiver.
Modes of delivery: Oral, written, or non-verbal communication.
Definition of Effective Communication: Occurs when both the sender and the receiver assign similar meanings to the conveyed message.
Medical Assistant Responsibilities:
Interacting with patients and families.
Providing information.
Making sure the patient understands the information.
Receiving information from the patient.
Feedback and Noise
Feedback:
Verbal or nonverbal evidence of understanding of the message.
Serves as a verification of understanding.
Noise:
Anything which blocks the message between the source and destination.
Cannot always be avoided or eliminated, but can be controlled or reduced.
Examples of Noise:
Physical or emotional discomforts.
General noise (environmental sound).
Posture, gestures.
Beliefs, attitudes, and behaviors.
Complicated medical terms.
Deafness or blindness.
Human Behavior and Maslow’s Hierarchy of Needs
Core Principle: When you understand why a person is behaving in a certain way, you can adjust your communication style to adapt to that person.
Adaptability: Different personality types require different communication styles. The goal is to help patients feel attended to and respected as individuals.
Maslow’s Hierarchy of Human Needs:
Physiological Needs: Food, air, water, shelter, clothing, sleep.
Safety/Security: Personal security, employment, resources, health, property.
Love/Belonging: Friendship, intimacy, family.
Esteem: Respect, self-esteem, status, recognition, freedom.
Self-actualization: Desire to become the most one can be.
Hierarchy Dynamics:
Basic needs must be met before higher needs are addressed.
Not all individuals will achieve the higher needs.
Illness can significantly affect an individual's needs.
End of Life and the Five Stages of Grief
Aging and Health Care:
As persons age, they require more health care services.
Increased reflection on mortality.
Experience grief due to surrounding deaths.
Prevalence of chronic diseases and terminal illnesses.
Elisabeth Kübler-Ross’ Five Stages of Grief:
Denial: The person cannot believe the loss; they deny the existence of illness and refuse to discuss interventions.
Anger: The person aims feelings of hostility at others.
Bargaining: The person attempts to avoid loss by making deals.
Depression: Reality takes hold and the person feels sad, lonely, and helpless. Self-blame and withdrawal from others are common.
Acceptance: The person comes to terms with the loss, plans for the future, makes arrangements, and reaches out to friends and family.
Individual Variation: Each person grieves differently. Some follow stages in sequence, some skip stages, and some may get stuck in one specific stage.
Medical Assistant Professional Conduct:
Use a warm welcome and treat patients with kindness.
Offer support and empathy.
Standard Restriction: Never say, ‐I know how you feel.‐
Listen carefully, maintain eye contact, and ask how to help.
Support Services for Chronic/Terminal Illness:
Hospice referrals.
Meal delivery services.
Home health assistance.
Support groups and community services.
Defense Mechanisms
Purpose: Used by patients who have illnesses or experienced trauma as a means of coping, protecting egos, and surviving.
Categorization: Some are healthy, while others can result in unsafe situations. Assistance or adjunct communication may be needed based on patient actions.
Types of Defense Mechanisms:
Denial: An unconscious attempt to reject the unacceptable (e.g., a patient refuses to believe a disease diagnosis).
Regression: Unconsciously returning to more infantile behaviors or thoughts. Often seen in children (e.g., a child reverts to bed wetting or sucking their thumb due to a change in family status like a new sibling).
Repression: Putting unpleasant thoughts, feelings, or events out of your mind (e.g., associated with child abuse, war, or PTSD).
Projection and Displacement: Placing blame on something or someone else.
Example: A patient is asked to get a chest X-ray for a cough but doesn't. Later diagnosed with lung cancer, they blame the physician.
Sublimation: An individual uses an acceptable and constructive substitute for an unacceptable action.
Example: A patient angry about a diagnosis does not blame the physician for a late test but instead becomes a spokesperson for breast cancer detection.
Positive and Negative Verbal Communication
Positive Verbal Communication: Promotes the patient’s comfort and well-being. The Medical Assistant is responsible for setting this stage.
Examples:
Being friendly, warm, and attentive.
Verbalizing concern for patients.
Encouraging patients to ask questions.
Asking patients to repeat instructions to ensure understanding.
Looking directly at patients when speaking.
Smiling naturally (not forced).
Speaking slowly and clearly; pronouncing words correctly.
Listening carefully.
Negative Verbal Communication: Rudely treating patients is unacceptable. Habitual negative communication must be curbed.
Examples:
Mumbling.
Speaking in harsh tones.
Avoiding eye contact.
Interrupting patients as they speak.
Rushing through explanations or instructions.
Treating the patient impersonally.
Making patients feel they are taking up too much time.
Forgetting common courtesies.
Showing boredom.
Nonverbal Communication (Body Language)
Facial Expression: The most expressive part of the body; serves as a form of feedback.
Eye Contact: Essential for positive communication; look directly at the person when speaking.
Posture Types:
Open Posture: Demonstrates receptiveness, friendliness, and interest. Characterized by arms comfortably at sides or in lap, facing the person, and leaning forward.
Closed Posture: Negative effect on communication; conveys anger or disinterestedness. Characterized by rigid or folded arms across the chest, leaning back, turning away, or slouching.
Improving Communication and Listening Skills
Passive Listening: Hearing what someone says without replying; the communication is one-way.
Active Listening: Two-way communication involving responses and feedback; the listener is actively involved.
Steps to Improve Listening:
Prepare to listen.
Relax and listen attentively.
Maintain eye contact.
Maintain personal space.
Think before you respond.
Provide feedback.
Professional Interviewing Techniques
Building Positive Relationships: Based on trust, professionalism (appearance and contact), and avoiding judgments.
Specific Interviewing Guidelines:
Mirroring: Restating what the patient said to gain understanding.
Reflecting: Encouraging patients to think through and answer their own questions.
Exploring: Attempting to get as much detail as possible about the patient’s complaint while avoiding probing if the patient is unwilling.
Clarifying: Asking patients to explain more clearly.
Summarizing: Summing up the important points of the discussion.
Collaboration: MA, patient, and physician work together; allowing patients to be part of decision-making.
Communication Styles
Analytical: Prefers working with real numbers, facts, and data. Places very little emphasis on feelings or emotions.
Intuitive: Prefers to look at the ‐big picture.‐ This can result in more questions.
Functional: Prefers an organized approach with timelines and detailed plans. Uses step-by-step methods. Can feel overwhelmed by too many details or sudden change.
Personal: Uses emotional language and connections. Cares about what people think and feel. Good at listening and resolving conflict.
Diversity and Figurative Language
Diverse Audiences: Be conscious of viewpoints and personal biases to avoid miscommunication. Use patience and provide explanations for medical terms.
Language Barriers: Use an interpreter if necessary.
Avoid Figurative Language: Do not use jargon or idioms that could be misunderstood.
Don't Say: "He passed away."
Say: "He died."
Don't Say: "I'm all ears."
Say: "I'm listening."
Don't Say: "You're as fit as a fiddle."
Say: "You're in good health."
Special Circumstances
Patients with Limited Reading Skills:
Review all information with the patient for understanding.
Check for comprehension of any reading materials provided.
Mentally or Emotionally Disturbed Patients:
Determine the level of communication the patient can understand.
Remain calm even if the patient becomes agitated or confused.
Avoid raising your voice.
Avoid appearing impatient.
Communicating with Coworkers and Management
Goal: Develop a good rapport with coworkers.
Professional Rules for the Medical Office:
Use proper channels.
Maintain a proper attitude.
Plan an appropriate time for communication.
Keep your supervisor informed.
Ask questions and minimize interruptions.
Show initiative and willingness to perform extra duties.
Key Terms and Definitions
Communication Cycle: Starts with a message from the sender, ends within a response from receiver.
Feedback: Verbal or nonverbal evidence of understanding of the message.
Noise: Anything which blocks the message between the source and destination.
Maslow’s Hierarchy of Human Needs: Theory stating actions are motivated by physiological needs; categories include physiological, safety, love and belonging, esteem, and self-actualization.
Elisabeth Kübler-Ross’ five stages of grief: Denial, anger, bargaining, depression, acceptance.
Active listening: Two-way communication that involves responses and feedback.
Mirroring: Restating what the patients said to gain understanding.
Reflecting: Encourage patients to think through and answer their own questions.
Exploring: Getting as much detail about the patient’s complaint.
Clarifying: Asking patients to explain more clearly.
Summarizing: Summing up the important points of the discussion.