Interpersonal Skills and Human Behavior Chapter 5 Chapter 5 Interpersonal Skills and Human Behavior

Introduction The medical assistant’s interpersonal skills help to set the tone of the office. Interpersonal skills and human relations intersect, and the successful medical assistant will work to improve both sets of skills throughout his or her career. Provide this overview for the chapter content. Assign the study guide that corresponds with this chapter if not assigned in advance, as well as any additional assignments that are associated with this chapter.

Questions to consider… How can the medical assistant treat patients as individuals during a busy workday? How does the medical assistant communicate effectively with the patient’s family members? How will developing good listening skills make the medical assistant more effective? How do friends and family members play a role in the health of the patient? Ask these questions to the class and discuss their answers together.

This chapter will examine: The importance of first impressions The differences between verbal and nonverbal communications Spatial separation The value of touch while communicating Elements of the transactional communication model Barriers to effective communication Defense mechanisms, listening, and dealing with conflict Briefly discuss each of the points listed on the slide.

The Patient’s Perception The patient’s perception of the physician’s office and the staff members is critically important. Perception may not be accurate at all times, but what the patient perceives is just as important as what is actually happening. Suggest to the students that they begin to really look at the medical offices with which they come into contact. Perhaps it would be beneficial to take a few notes. Discuss the students’ perception of the office, with regard to cleanliness, reception room layout, etc. What does the office communicate to patients and visitors?

First Impressions First impressions are still lasting ones! First impressions are important and some individuals will have a difficult time moving past a negative first impression. First impressions are more than physical appearance or dress. Opinions formed in the first few moments of meeting last much longer in our thoughts than the actual time we spend with a person we have just met. The first impression includes attitude, compassion, and the smile! Discuss some of the first impressions the students had of their physician and office staff. Were they negative or positive? Suggest that the students stand and consider their attire. What type of impression would their appearance make to a patient?

First Impressions Introductions Medical assistants may have to make introductions to patients several times, especially if there are multiple staff members. Always be pleasant with the patients. Offer them the type of customer service that one would receive in a high-end retail store. Treat them in a way that lets them know they are appreciated. The patients are not a hindrance to the practice – they ARE the practice. Introductions Always introduce yourself to patients Smile Wear a name badge Show the patient around the office Introduce other staff members to the patient Put the patient at ease

First Impressions Medical Records as Communication Written communication and its perception are also important and will be covered later in the course (Chapter 13). Must be legible Spelling and grammar must be well-used If it is not in the medical record, legally, it did not happen Anything that influences the patient’s mental, physical, or even spiritual health can be added to the medical record, because all affect the whole person

Verbal Communication Verbal Communication depends on words and sounds. Speak clearly and enunciate properly. Vary the pitch of the voice. Tone of voice is very important in communication. Use appropriate volume. Speak at an audible level. Make eye contact. Speak in an animated fashion. Show concern. Do not interrupt a person who is speaking. Discuss persons that the students may know who are difficult to communicate with. Talk about whether their voice is a factor. Are the students familiar with a person whose voice is a negative aspect of their ability to communicate?

Verbal Communication Medical assistants should not say anything to the patient that they feel a supervisor or the physician would regard as inappropriate. Patients will not cooperate with a physician that they do not trust or respect. They will not trust or respect a medical assistant who is rude or sarcastic. Remember that the medical assistant is employed to serve the patient. Never be sarcastic. Never be rude. Never make an inappropriate remark and follow it by saying “I was just kidding.” Take care not to hurt anyone’s feelings with words or phrases.

Verbal Communication Listening is one of the medical assistants most valuable skills. Ask clarifying questions and restatement to ensure that you understand what the patient has said and that it is charted accurately. Allow patients to do most of the talking. Do not offer personal information about your own life and problems. Share only positive experiences, and then, only briefly. Do not burden the patient with your problems at any time! Remember that patients are in the office to be cared for. Treat patients as you would a treasured member of your own family. They may have great concerns. They may be very apprehensive. They may be fearful

Nonverbal Communication Nonverbal communication is said to be more accurate than verbal communication. Medical assistants must learn to observe patients, and sometimes the people that accompany the patient to the office, very carefully. Look for body language that verifies or negates what the patient says verbally. Nonverbal communications are messages that are conveyed without the use of words. They are transmitted by: Body language Partly instinctive Partly taught Partly imitative Gestures Mannerisms Eye movement

Nonverbal Communication Remember that the medical assistant’s body language is seen by the patient the same way that the patient is seen by the medical assistant. Project a positive image with body language. Involves: Eye contact Facial expression Hand gestures Grooming Dress Space Tone of voice Posture Touch

Nonverbal Communication Appearance often influences the patient’s opinion of office staff members. What does your appearance communicate about you? Appearance is a vital part of nonverbal communication. Appearance can present conflicting nonverbal information. The successful medical assistant expresses: self-esteem confidence pleasant facial expressions caring attitude

Nonverbal Communication Conservative Appearance In the medical profession, patients expect professionalism, and conservative appearance is preferred to avoid blocks in communications. If in doubt about an article of clothing or accessory, do not wear it to the office. Patients respond more positively to medical professionals who look professional and are conservative in dress.

Nonverbal Communication Facial expressions often convey our true feelings and are not masked by the words we use. Our eyes often tell the truth when our words are misleading or false. Use open body stance when dealing with patients. Nonverbal and verbal communication are interdependent; they must be in harmony to convey an accurate message that the receiver can easily interpret. If the two are not congruent, the nonverbal presentation usually is dominant and expresses the true message.

Nonverbal Communication Proxemics The study of the nature, degree, and effect of the spatial separation individuals naturally maintain and how this separation relates to cultural and environmental factors. Be aware of proxemics in the office to avoid repetitive motion injuries, back injuries, or strains and sprains. Learn the spatial separation measurements and do not invade the patient’s (or co-workers) personal space. Spatial Boundaries Public Space: 12–25 feet Social Space: 4–12 feet Personal Space: 1½–4 feet Intimate Space: touching to 1½ feet Discuss what individuals might be allowed in each category of the spatial boundaries.

Nonverbal Communication What Can Touch Mean? Touch, in the medical profession, can be comforting or can promote a sexual harassment lawsuit. Avoid Claims of Battery Be very careful when touching a patient. Nonconsensual touching can be considered battery in today’s litigious society. Talk about acceptable touching in the medical office. Discuss how touch might be misinterpreted. Explain how touching could be considered to be battery.

Nonverbal Communication Posture and Positioning These nonverbal communications should be questioned verbally. If the medical assistant suspects any of the above situations, talk to the patient. Remember to tell the patient that the physician can refer the patient to various resources to help with most situations. Can signal: Depression Anger Excitement Fear An appeal for help

The Process of Communication To communicate well, we must have a general understanding of the process of communication. Once a message is sent, it cannot be retrieved and restated. One exception is an email program that allows a message to be recalled. That message can be deleted prior to being read. Usually when two people interact, they both function as senders and receivers. During everyday communication in talking, the sender speaks, then listens as the other person speaks. Both are senders and receivers. The sender sends a message through a channel. Channels can be: Spoken words Written messages Body language Talk about appropriate channels. Should some written messages only be spoken? Discuss the channels and examples of messages that should be spoken and written.

The Process of Communication Encoding Senders encode a message, which means that they choose a specific method of expression using words and/or other channels. Decoding The receiver decodes the message according to his or her understanding of what is being communicated. Remember that perception is important. The sender must make certain that the receiver perceives the correct message. Talk about how we choose our method of expression. How do we choose whether a written message or verbal message is best?

The Process of Communication Noise Anything that interferes with the message being sent. Noise contributes to the misunderstanding of messages. External – literal noise (radio, other people talking, overhead projector) Internal – the receiver’s own thoughts, prejudices, or opinions. Physiologic – any biologic factor such as not feeling well or being tired. Feedback Ask for feedback. It helps the sender to determine if the message was received and whether it was accurately received. Verbal expression Body language Nod of understanding Talk about the different types of noise. Some noises can be blocked out and sometimes we have selective hearing. Mention white noise and its benefits in an office environment.

Transactional Communication Model Explain the components of the transactional communication model. Adler RB, Towne N: Looking out, looking in: interpersonal communication, San Antonio, 1996, Harcourt Brace.

Listening Listening is paying attention to sound or hearing something with thoughtful attention. It is one of the most important skills that the medical assistant must develop and hone. Remember to pay attention to the patients’ body language while listening to their verbal communications.

Listening What Prevents Us From Listening? Hearing is the process, function, or power to perceive sound. Listening is paying attention to sound or hearing something with thoughtful attention. Comprehension is listening with understanding. What Prevents Us From Listening? Our own thoughts distract us. Situations in our lives make it hard to listen. Conversation seems meaningless and unimportant. Too many messages are coming in at once. Emotions, such as anger, render us unable to listen. Exhaustion makes listening difficult. We have prejudged the speaker and feel there is no need to listen. Discuss common distractions that the medical assistant may experience when trying to communicate with patients. Talk about situations that can take the medical assistant’s mind off a task, such as interruptions and phone calls.

Listening Listening to Patients Patients must know that we are listening—not only hearing the words that are being spoken, but attempting to interpret what the patient is trying to communicate. Using the phrase “I hear you” can reassure the patient that their concerns are important. Remember to use restatement and clarifying statements to make certain that the patient is understood and that the medical assistant charts accurately. Discuss common distractions that the medical assistant may experience when trying to communicate with patients. Talk about situations that can take the medical assistant’s mind off a task, such as interruptions and phone calls.

Listening Paraphrasing is… Listening to what the sender is communicating Analyzing the words Restating them to confirm that the receiver has understood the message as the sender intended it Clarifies speaker’s thoughts Helps to indicate that there is common understanding Discuss examples of paraphrasing and how this skill can be used to verify information given by the patient.

Listening Open-ended questions allow an answer other than “yes” or “no.” Closed questions can be answered with only “yes” or “no.” Medical assistants should ask open-ended questions with patients. Can you explain what the pain feels like? When did you first notice these symptoms? What are you usually doing when you have symptoms? What do you think is causing the symptoms?

Listening Many patients open up more quickly and completely to the medical assistant than to the physician. This is important in developing a rapport with the patient. The medical assistant should never agree to withhold information from the physician under any circumstances. But specific details don’t always have to be shared. The medical assistant must never agree to lie to the physician! The best solution is to always tell the physician what the patient has shared. Never display a judgemental attitude or express negativity about the patient’s activities, thoughts, or behavior.

Warnings Against Advising the Patient Medical assistants are not qualified to give any type of advice to a patient. Medical assistants cannot encourage the patient to choose one option over another. You can offer a listening ear. Patients must make their own decisions about treatment options. All communication with the patient must be professional and accurate. Always attempt to get the patient to discuss all concerns with the physician. When giving written instructions to the patient, keep a copy in the patient’s medical chart. Treat all patients with respect and compassion. An open and trusting relationship prevents legal issues in the future.

Observing Carefully Watch for signals from patients, such as tears, sad expressions, or volatile temper. Remember that nonverbal communication is usually more accurate than verbal communication. What is the woman in the photo communicating?

Abnormal Behavior Pattern A mental disorder is a psychological or behavior pattern that occurs in an individual and is thought to cause distress or disability that is not expected as a part of normal development and culture. Some behavior patterns are better studied and understood. Some can be contained or controlled with medication. Phobias Obsessive-Compulsive Disorder Antisocial Behavior Panic Disorder General Anxiety Disorder Major Depressive Disorder

Defense Mechanisms Defense mechanisms are psychological methods of dealing with stressful situations or stressors, that are encountered in day-to-day living. They are often subconscious reactions designed for emotional protection. Verbal Aggression—A person attacks another without addressing the original complaint or disregards it inappropriately. Sarcasm—A biting edge added to words that a person states with the intent to cause pain or anger. Rationalization—Attributing actions to rational and credible motives without analyzing underlying methods. Compensation—Making up for one behavior by stressing another. Regression—The reversion to an earlier mental or behavioral level. Discuss defense mechanisms that students and their families or friends use often.

Defense Mechanisms Repression—Process whereby unwanted desires or impulses are excluded from the consciousness and left to operate in the unconscious. Apathy—A lack of feeling, emotion, interest, or concern. Displacement—The redirection of an emotion or impulse from its original object, such as an idea or person, to another object. Denial—A state in which confrontation with a personal problem or with reality is avoided by denying the existence of the problem or reality. Physical avoidance—Avoidance of any representation of a painful event. Projection—The attribution of one’s own ideas, feelings, or attitudes to other people or to objects. Ask students if they can provide a real life example for each of the defense mechanisms.

Conflict Conflict is the struggle resulting from incompatible or opposing needs, drives, wishes, or external or internal demands. Conflict is not always negative and can lead to needed change and good decisions. Conflict can… Be beneficial to relationships Be constructive Allow people to learn about each other Promote stronger understanding Promote deeper levels of intimacy Discuss examples of conflict that have led to positive change. Discuss how conflict can be beneficial for each of the listed points.

Conflict Assertion — Stating or declaring positively, often forcefully or aggressively. Nonassertion — The inability to express needs and thoughts or the refusal to express them. Aggression – hostile, injurious, or destructive behavior or outlook, especially when caused by frustration. Can make a person seem pushy. Direct – occurs when one directly attacks another, causing the victim to feel embarrassment, shame, anger, or a range of other emotions. Passive – when one expresses themselves in an obscure ambiguous way. They may have feelings of rage, inadequacy, or resentment that they cannot articulate in a direct manner. Discuss assertion and nonassertion from the patient’s viewpoint. Are patients assertive or nonassertive?

Resolving Conflict Every relationship experiences conflict Put aside thoughts of personal attack First impulse is often the “fight-or-flight” syndrome In the fight-or-flight syndrome, some individuals will “fight,” which means to stay and face conflict aggressively. In “flight,” individuals run from and avoid conflict. Most people tend to do one or the other consistently even in different situations. Think logically

Tips for Resolving Conflict Expect conflict – do not fear or dread it Realize that conflict can be healthy Accept that others have legitimate, viable opinions Listen and consider the opinions of others Never attack those with differing opinions Do not insist on being right all of the time Avoid judgment or assigning blame Deal with conflict quickly when it arises Talk about other methods of conflict resolution that students may have used in the past.

Boundaries Examples of Workplace Boundaries Boundaries indicate a limit or fixed extent. Setting boundaries at work helps to avoid awkward situations and misunderstandings. Examples of Workplace Boundaries Calling a person by a first name or Mrs./Ms./Mr. Refusing to listen to offensive jokes. Refraining from forwarding emails that are not business-related. Leaving the office door open when speaking with someone of the opposite sex. Dating people who work for the same facility or patients from the practice. Discuss the boundaries that students have had in the past. Will these boundaries change upon entering the medical profession?

Boundaries Being called by the first name, a nickname, or by the surname. Refusing to be responsible for driving others to or from work on a regular basis. Insist on a 5-minute time limit or breaks for visiting with co-workers. Be respectful of all co-workers. Refrain from any public display of affection at the office, even with a spouse. Make politics and religion off-limits subjects. Using inappropriate language, including curse words. Making coffee or getting coffee for a supervisor or co-worker. Taking on a co-worker’s responsibilities. Being berated for taking vacation or sick time when earned. Discuss examples.

Boundaries Five Steps to Setting Boundaries in the Workplace Know how you expect to be treated and communicate that to others. Do not feel that you have to explain your boundaries to others. Be respectful, thoughtful, and responsible when setting boundaries. Respect other people’s boundaries if you want yours to be respected. Be proactive when dealing with other people’s boundaries. Talk about respecting other people’s boundaries and the difficulties involved with doing so.

Self-Boundaries Self-boundaries are your own rules about how you will behave in the workplace and what you will and will not accept or condone. What to Say to Stop Inappropriateness “Stop! I am not interested in hearing this topic!” “Stop! I am not interested in seeing this behavior!” Explain the difference between self-boundaries and workplace boundaries. Talk about situations in which these phrases might be used.

Crazymakers The Avoider: The Pseudoaccommodator: The Guiltmaker: George Bach describes dirty fighting passive-aggressive behavior as “crazy- making”, which is a detrimental behavior for all involved. The Avoider: Refuses to fight; keeps from facing the problem at hand. The Pseudoaccommodator: Refuses to face up to a conflict by either giving in or pretending nothing is wrong. The Guiltmaker: Tries to make his or her partner feel responsible for causing pain. The Subject Changer: Escapes facing up to aggression by shifting the conversation when it approaches an area of conflict. Allow students to give examples of a situation involving each type of crazymaker.

Crazymakers The Distracter: The Mind Reader: The Trapper: Attacks other parts of his or her partner’s life rather than expressing feelings of dissatisfaction. The Mind Reader: Refuses to allow his or her partner to express feelings honestly and goes into an analysis of what the partner “really means.” The Trapper: Sets up desired behavior, then attacks that behavior once it manifests. The Crisis Tickler: Brings what is bothering him or her almost to the surface but never quite expresses true feelings. Allow students to give examples of a situation involving each type of crazymaker.

Crazymakers The Gunnysacker: The Trivial Tyrannizer: The Beltliner: Does not immediately respond to anger. Directs pent-up frustrations and aggression on the unsuspecting partner. The Trivial Tyrannizer: Does things that will bother the partner instead of honestly sharing his or her own resentments. The Beltliner: Hits the partner below the psychological belt. The Joker: Kids around when the partner wants to be serious, instead of expressing true feelings. Allow students to give examples of a situation involving each type of crazymaker.

Crazymakers The Blamer: The Contract Tyrannizer: More interested in finding fault than in resolving a conflict. The Contract Tyrannizer: Will not allow relationships to change from the way they once were. The Kitchen Sink Fighter: Brings up things that are totally off the subject instead of dealing with the issues at hand. The Withholder: Punishes the partner by holding something back, building up greater resentment. The Benedict Arnold: Gets back at partners by sabotage, failing to defend them and encouraging ridicule toward them. Allow students to give examples of a situation involving each type of crazymaker.

Barriers to Communication Physical impairment – patients may have physical conditions that impair their ability to communicate effectively, such as a vision or hearing condition. Language – may need to use gestures or body language to convey messages. A family member or bilingual employee can also assist. Prejudice – personal and social bias that brings about discrimination. Subtle and blatant discrimination can be equally painful. Stereotyping – viewing someone on preconceived and often incorrect assumptions. Perception – comprehension of what is being communicated based on the receiver’s point of reference. Talk about how each of these barriers hinder communication.

Communication during Difficult Times Medical assistants must develop communication skills that can be used in times of trouble. They must be able to understand why a patient or co-worker is unable to communicate. Always remain calm when dealing with someone who is experiencing a traumatic event. Listening is the key! Pay attention to non-verbal cues.

Communication during Difficult Times Anger Anger is a normal emotion but can be dangerous if not expressed in a healthy manner. The medical assistant may feel anger from time to time at the workplace. When angry, your blood pressure and heart rate increases. Speak calmly Anger is usually not directed toward the medical assistant Be a good listener Do not use absolutes such as “never” and “always.” Address the problem and use logic Talk about how he or she can control inappropriate anger. Discuss how to recognize and how to deal with uncontrolled anger. Talk about the absolutes listed above. Discuss why they should not be used. Explain that absolutes are rarely “absolute.” If a medical assistant states in court that they always take a blood pressure reading on every patient, the likelihood is that there are medical records that do not show a blood pressure reading. Discuss other examples.

Communication during Difficult Times Shock When an event or a circumstance occurs that is especially painful, an individual may experience emotional shock. Patient often cannot think or move. Some scream in agony, others seem almost normal. We never know how we might react in a deeply stressful situation. Our reactions may differ from time to time. May have insomnia. Talk about specific situations when students have seen a person in shock. Discuss the reaction, and whether the initial reaction was different than that after an hour or a day had passed. Talk about how to deal with shock at the physician’s office. Suggest phrases to say to a patient in shock.

Communication during Difficult Times Shock Never leave a person in shock alone. Do not allow the person to speed off in a car. Listen! Watch the person carefully. Make sure the person is with a trusted relative or friend before he or she leaves the office.

Death and Dying Five Stages of Grief Denial Anger Bargaining Elisabeth Kübler-Ross Dr. Kübler-Ross studied thanatology, the study of the phenomena of death and of psychological methods of coping with death. Five Stages of Grief Denial Anger Bargaining Depression Acceptance Talk about the different reactions to death that students have experienced. Allow some open discussion on this subject. Continuing the open discussion, talk about how students recognized the different stages of grief that they may have experienced.

Multicultural Issues We sometimes think that people all over the world think and behave as we do. We often stereotype those from other cultures and think that we understand them. Those from other geographic areas, even within the United States, may experience culture shock in new surroundings. Patience is an important trait when dealing with those from other cultures. Talk about how we can respect over cultures in our actions and words.

Communicating with Those from Other Cultures Treat them as you would wish to be treated. Overcome language barriers. Be patient when communicating. Encourage patients to bring a translator, if necessary. Understand the nonverbal communications of other cultures. Discuss situations in which students have interacted with people from other cultures and how they felt, as well as the difficulties they faced.

Communicating with Those from Other Cultures Non-English-Speaking Patients Patients who do not speak English should bring an interpreter to help with communication to each office visit. If they do not bring an interpreter, attempt to find a person who can communicate, but this is not the office’s responsibility. Offices that serve a large population of non-English speakers should have a bilingual person on staff. Talk about how the medical assistant can deal with patients who do not have an interpreter, and if this is a recurring problem with a patient, what the physician can do. Discuss whether it would be ethical to refuse to treat the patient.

Communicating During the Patient Encounter Sensitivity to All Patients Any patient can feel anxiety when seeing the physician Be very sensitive to the patients’ feelings Explain steps of the procedures to put them at ease Always display a caring attitude Talk about ways to express sensitivity and caring toward all patients.

Maslow’s Hierarchy of Needs Believed our human needs fit into five categories. The needs on each level must be satisfied before we can move to the next level. Physical needs: food, rest, sleep, water, air, sex Safety needs Social needs: sense of belonging, interaction with others Self-esteem needs: feeling good about ourselves Self-actualization: maximized potential Review the diagram in the textbook. Discuss how the students can prove that the theory is correct; in other words, provide an example of when food came before safety, etc. Continue discussion of the diagram. Adler RB, Towne N: Looking out, looking in: interpersonal communication, San Antonio, 1996, Harcourt Brace.

Approval, Acceptance, and Achievement We seek the approval of specific people. We have a healthier self-esteem if we feel accepted by others. We have an inner need for achievement. We all enjoy praise for a job well done. Everyone benefits when legitimate praise is shared freely and appreciated. All humans need approval, acceptance, and achievement. Discuss the results when these needs are not met.

Approval, Acceptance, and Achievement All humans need approval, acceptance, and achievement. Discuss the results when these needs are not met.

Stages of Sleep Two Main Phases of Sleep NREM (non-rapid eye movement) - Four stages, during which the body slows down and relaxes REM (rapid eye movement) - Deep sleep when dreaming occurs - Brain is highly active - Eyes move rapidly - Occurs in the last hours of sleep Talk about sleep patterns and how sleep affects the work performance.

Healthy Nutrition A balanced diet is essential to ensure that the organs and systems within us function at optimal levels. Vitamin and mineral deficiencies can lead to health conditions or diseases. Talk about how our bodies are machines and their performance depends on good health.

Positive Relationships The effects of a problem relationship is reflected in our attitude, which greatly influences our performance at work. Carefully and wisely choose to be involved in healthy relationships. We must learn coping techniques for dealing with our difficult relationships. Open, honest communication is paramount.

Healthy Self-Esteem Self-esteem is confidence and satisfaction in oneself. You must honestly recognize your strengths and weaknesses to be self-aware. No one can make you feel a certain way; it is a choice YOU make. We control two things in life – our attitude and actions. Think before speaking Take a timeout Choose y0ur battles wisely

Healthy Self-Esteem

Improving Yourself Fear and doubt can sabotage efforts to improve your self-image, confidence, and potential. Almost every failure or mistake can be traced to fear or doubt. Blaming the circumstances around us is no excuse for poor performance. Self-esteem improves with adapting. Failure teaches us more than success. Procrastination is a symptom of the fear of failure and success.

Comfort Zones Facing new ideas or experiences places you outside the comfort zone. A comfort zone is a place in the mind where we feel safe and comfortable. Blaming the circumstances around us is no excuse for poor performance.

Closing Comments Interpersonal skills are critical to the medical assistant Communication is a part of most events during every day Enhance interpersonal skills and human relations skills at every opportunity through classes and continuing education All communications must be effective to be of benefit

Summary of Scenario People who are facing death or other catastrophes want to be treated like everyone else Greet them warmly and make sure they know that you care about them Be sure the patients understand their medications and treatments Direct them to community resources Listening is one of the most important skills to develop Discuss the communication process and how a busy office environment hinders the process. Talk about the delicate balance of communicating with patients who are at odds with family members.