1. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Chapter 4 Professional Behavior in the Workplace

2. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 2 Meaning of Professionalism Professionalism is exhibiting a courteous, conscientious, and generally businesslike manner in the workplace. It is characterized by or conforms to the technical or ethical standards of a certain profession.

3. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 3 Why Is Professionalism Important? Patients expect medical personnel to be professional. Patients place their trust and confidence in those they deem to be professional. Attitudes are conservative in the medical field, mandating professionalism.

4. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 4 Characteristics of Professionalism Loyalty Dependability Courtesy Initiative Flexibility Credibility Confidentiality Attitude

5. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 5 Obstructions to Professionalism Sometimes it is difficult to be professional. Obstructions to professionalism include: Personal Problems and Baggage Rumors and “the Grapevine” Personal Phone Calls and Business Office Politics Procrastination

6. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 6 Personal Problems and Baggage Situations medical assistants face outside of work may be difficult to leave at home. These situations can interfere with the ability to perform at work. Take a moment to discuss the situation with supervisors. Use discretion when talking about the issues at hand. Most supervisors will want to work with good employees through difficult times

7. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 7 Rumors and the “Grapevine” Rumors and gossip must be avoided in a professional medical facility. These issues cause negative employee morale. Rumors often become more exaggerated with each telling. Medical assistants must be friendly and cordial to everyone. Never take part in rumor-mongering or gossip in the office.

8. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 8 Personal Phone Calls and Business Avoid receiving personal calls at work unless a serious emergency occurs. This rule includes both the office phone and personal cell phones. Do not conduct any type of personal business during working hours. Use personal time to check personal email.

9. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 9 Office Politics Office politics can be positive or negative. Positive office politics can lead to promotions and wage increases. Negative office politics can lead to dissention and low employee morale.

10. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 10 Procrastination Procrastination is a sign of the fear of failure. Never put off duties that can be done immediately. Stop procrastination by doing something now. Divide projects into small segments.

11. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 11 Professional Attributes Professional attributes include: Teamwork Time Management Prioritizing Goal Setting

12. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 12 Teamwork Possibly one of the most important attributes to develop. Staff members must work together for the good of the patients. Cooperate with co-workers. Teamwork promotes good employee morale. Never say, “That’s not my job.”

13. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 13 Time Management Use time efficiently. Plan tasks that must be done. Key to time management is prioritizing.

14. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 14 Prioritizing Prioritizing is deciding which tasks to do first. Make a list of tasks. Decide what must, should, and could be done today. Place each task in numeric order within the “must,” “should,” and “could” categories. Assign letters and numbers to categorize tasks. Complete the tasks in order, and accomplish more every day.

15. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 15 Goal Setting Goals should be: Reasonable Measurable Written down Monitored for progress Set for all areas of an individual’s life Celebrated when reached, even if it is a small accomplishment

16. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 16 Knowing the Facility and Its Employees It is important to know the people who work in the medical facility and their general job descriptions, so that patients can be referred to the person who knows the most about their problems.

17. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 17 Documentation When documenting medical information: write legibly. be complete. state facts, not opinions. never use sarcastic language. make corrections as directed.

18. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 18 Note Taking Always have pen and paper ready for note taking in meetings and seminars. Keep a small pad and pen in a pocket for quick notes.

19. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 19 Work Ethic A person with a good work ethic: arrives on-time. is rarely absent. has a strong work output. is honest. is able to solve ethical problems. has a character that is above reproach.

20. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 20 Communication The success of any business is related to its ability to communicate effectively.

21. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Interpersonal Skills and Human Behavior Chapter 5

22. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 22 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.

23. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 23 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

24. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 24 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.

25. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 25 First Impressions First impressions are still lasting ones!

26. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 26 First Impressions 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!

27. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 27 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

28. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 28 Communication Paths Verbal Communication Depends on words and sounds Do not interrupt a person who is speaking

29. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 29 Verbal Communication Speak clearly and enunciate properly. Vary the pitch of the voice. Use appropriate volume. Speak at an audible level. Make eye contact. Speak in an animated fashion. Show concern.

30. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 30 Verbal Communication Tone of voice is very important in communication. 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.

31. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 31 Patients Need Tender Care Remember that patients are in the office to be cared for. They may have great concerns. They may be very apprehensive. They may be fearful.

32. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 32 Listen to Patients 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!

33. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 33 Nonverbal Communication Nonverbal communications are messages that are conveyed without the use of words. Transmitted by: Body language Gestures Mannerisms Eye movement

34. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 34 Body Language Partly instinctive Partly taught Partly imitative

35. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 35 Body Language Involves: Eye contact Facial expression Hand gestures Grooming Dress Space Tone of voice Posture Touch

36. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 36 Appearance Appearance is a vital part of nonverbal communication. Appearance can present conflicting nonverbal information.

37. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 37 Appearance The successful medical assistant expresses: self-esteem confidence pleasant facial expressions caring attitudes

38. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 38 Conservative Appearance In the medical profession, patients expect professionalism, and conservative appearance is preferred to avoid blocks in communications.

39. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 39 Proxemics Proxemics is 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.

40. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 40 What Can Touch Mean? Touch, in the medical profession, can be comforting or can promote a sexual harassment lawsuit.

41. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 41 Avoid Claims of Battery Be very careful when touching a patient. Non-consensual touching can be considered battery in today’s litigious society.

42. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 42 The medical assistant should not be afraid to touch patients in an appropriate manner.

43. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 43 Posture and Positioning Can signal: Depression Anger Excitement Fear An appeal for help

44. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 44 The Process of Communication To communicate well, we must have a general understanding of the process of communication. Usually when two people interact, they both function as senders and receivers.

45. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 45 Channels Channels can be: Spoken words Written messages Body language

46. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 46 Encoding Senders encode a message, which means that they choose a specific method of expression using words and/or other channels.

47. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 47 Decoding The receiver decodes the message according to his or her understanding of what is being communicated.

48. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 48 Noise Noise contributes to the misunderstanding of messages. Noise is anything that interferes with the message being sent.

49. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 49 Feedback Verbal expression Body language Nod of understanding

50. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 50 Transactional Communication Model

51. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 51 Listening Listening is paying attention to sound or hearing something with thoughtful attention. Listening is an important skill that the medical assistant can develop.

52. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 52 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.

53. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 53 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.

54. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 54 Paraphrasing Paraphrasing: 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

55. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 55 Ask Open-Ended Questions 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?

56. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 56 Observing Carefully Watch for signals from patients, such as tears, sad expressions, or volatile temper.

57. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 57 Defense Mechanisms 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.

58. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 58 Defense Mechanisms Compensation—Making up for one behavior by stressing another. Regression—The reversion to an earlier mental or behavioral level. Repression—Process whereby unwanted desires or impulses are excluded from the consciousness and left to operate in the unconscious.

59. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 59 Defense Mechanisms 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.

60. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 60 Defense Mechanisms 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.

61. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 61 Dealing with Conflict Conflict is the struggle resulting from incompatible or opposing needs, drives, wishes, or external or internal demands.

62. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 62 Conflict can… Be beneficial to relationships Be constructive Allow people to learn about each other Promote stronger understanding Promote deeper levels of intimacy

63. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 63 Assertion—Stating or declaring positively, often forcefully or aggressively Nonassertion—The inability to express needs and thoughts or the refusal to express them

64. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 64 Crazymakers 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.

65. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 65 Crazymakers 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.

66. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 66 Crazymakers The Distracter: 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.”

67. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 67 Crazymakers 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.

68. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 68 Crazymakers The Gunnysacker: 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 psychologic belt.

69. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 69 Crazymakers The Joker: Kids around when the partner wants to be serious, instead of expressing true feelings. The Blamer: 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.

70. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 70 Crazymakers 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.

71. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 71 Barriers to Communication Physical impairment Language Prejudice Stereotyping Perception

72. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 72 Communication during Difficult Times During Anger One of the most difficult times to communicate Expression of anger is usually healthy Unexpressed anger causes or contributes to all types of health problems

73. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 73 Communication during Difficult Times Anger Anger is usually not directed toward the medical assistant. Be a good listener. Use logic. Do not use absolutes such as “never” and “always.” Remain calm.

74. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 74 Communication during Difficult Times Shock Many types of shock can occur. Usually happens after some catastrophe. 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.

75. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 75 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.

76. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 76 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.