Interacting Successfully

Chapter 7


Interacting Successfully



Themes to Consider



image Take responsibility for the success of interactions between you and your clients and between you and your co-workers.


image Uncover more information by being an active listener.


image Listen to drive conversations forward.


image Recognize communication challenges related to people with disabilities or language barriers, and know what to do to solve them.


image Use communication strategies to respond to diversity in the workplace.


image Become aware of the power of body language.


image Empower your communication strategies with body language.


image Use body language to strengthen rapport with others.


Communication is a two-way street. When communication is working really well, the message sent is the same as the one received. Communicating effectively involves choosing your words carefully, saying them clearly, and supporting them with appropriate body language. The other half of good communicating involves paying attention in order to accurately interpret the other speaker’s words and body language.


The importance of having great interpersonal communication skills is often underestimated. Many people think that if they keep their heads down and do their work, everyone should be satisfied with their performance. In reality, nothing will contribute more to your chances of being hired, your job satisfaction, and the respect you receive, than your ability to communicate effectively. Employers know this. They know, too, that they can teach job skills but they can’t teach interpersonal skills. Interpersonal skills are especially essential in the health professions because health problems can make it difficult for people to communicate effectively. Health professionals must listen carefully, read body language, and develop intuition in order to detect problems.


It may take time and experience to develop interpersonal skills, but embracing any on-the-job communication challenges as learning experiences will accelerate your development.



Listening Actively



The most precious gift we can offer anyone is our attention.


—Thich Nhat Hanh




Learning Objectives for Listening Actively




Yogi Berra said, “You can see a lot just by observing.” He could have said, “You can hear a lot just by listening.” Listening is an art that enables you to hear a lot more than what is being said. Only a portion of what people say is actually heard, and different listeners hear different amounts, depending on their listening skills.


Instead of worrying about what to say next, good listeners ask questions based on what they are hearing. Good listeners are curious. They want to learn more, understand, and gain insights they can use in the future. As a health professional, you should listen for context, anticipate, project warmth, and be helpful even while you are listening. Good listening skills are the foundation for all the positive and effective interactions you have as a clinician and as a co-worker.



image Journaling 7-1


Complete this sentence: “Today I learned …” Plan to practice your listening skills during a conversation with a friend. Record what you learned about your friend as a result of your new skills.



Starting a Conversation


In order to listen, you have to be in a conversation, and you will often initiate the conversation. After all, to a patient visiting a health care setting, you will be the host.



Introduce Yourself


Did you know that there is more than one way to introduce yourself? There is definitely more than one side to you, which is apparent during your daily interactions. For example, you should have a specific short introduction ready to use every time you greet a new patient, focusing right away on your name and your role. Plan what to say in advance, so it comes automatically. On the other hand, introducing yourself to co-workers requires a more detailed approach. For example, when you meet people at a new job, you might use a longer introduction because your new co-workers want to get to know you.



image What If?


What if you encounter a co-worker at your new place of employment and he doesn’t introduce himself? How would you handle that situation?


Here are a few tips that can help new colleagues get to know you:



What kind of sharing fits your personal style? Consider using three or four sentences to introduce yourself to a new colleague. Be ready to share this information naturally, with a smile on your face and a handshake. From there on, listen, answer questions, and ask questions.




The Listening Process


Why is it so easy to get lost in your own thoughts when you are supposed to be listening to someone? Distraction has a lot to do with the difference between the speed of speech and the speed of thought. You usually think at a rate of about 500 words per minute, while most of us speak at about 130 words per minute. People who speak at 150 words per minute are fast talkers. It is impossible for humans to speak at 200 words per minute and still be intelligible. Because we think at 500 words per minute, we must concentrate in order to actively listen to someone speaking at a much slower pace than our thoughts.


Teach yourself powerful concentration skills by practicing the art of mindful listening—a three-phase conversation that goes deeper than the surface layer of conversation to understand a person’s feelings, identify common ground, and make a plan to go forward.


The three phases of a productive conversation are listening, summarizing, and asking questions (Figure 7-1). As a conversation deepens, you will often repeat these three phases. We’ll look closer at all three phases now.


image
FIGURE 7-1 The listening process will repeat itself several times in a conversation.





The Pause


The pause—a natural break in conversation—is a signal to change speakers and listeners. Never interrupt; wait for that pause. People who interrupt have already stopped listening. They have already decided what they want to say in response, even before the other person has completed her thought and paused. Even an encouraging interjection, like “Uh-huh,” should wait for a pause. If you speak after a pause, it shows that you were listening actively, especially if you make a logical comment, make an observation, or ask a relevant question. Then, once you pause, you have invited your partner to respond, and you can again encourage them to continue. Figure 7-2 shows two health professionals listening successfully to a patient.


image
FIGURE 7-2 Two health professionals listening to a patient.


Two monologues don’t make a dialogue.


—Jeff Daly



Listening to Someone Who’s Upset


Listening is the best approach to resolving conflict or responding to strong emotions. When a patient or co-worker is angry or emotional, your job is not to solve their problem or even get the facts (which will surface in due course), but to first simply support the person who is experiencing such discomfort. Their feelings are real and part of their current experience. At this point, they are not looking for advice, pat answers, or an easy dismissal of their feelings or problems. They want to be accepted and understood. Encourage them to vent first, then ask thoughtful questions when they’re done.


Once you have finished listening and eliciting all the information you can, summarize what you have heard. Summarizing clarifies issues, validates the speaker, and calms emotions by remaining neutral. Start by saying, “If I understand you correctly …” followed by your accurate summary.



image What If?


What if you don’t understand what someone is saying? What strategies could you use to get the conversation back on track?


Your real objective is not to solve the person’s problem or stop any irrational emotions, but to help the person do that for themselves. Here’s the difference: Solving someone else’s problem for them can foster a dependent relationship in which the other person approaches you to resolve every problem they encounter. By simply listening and questioning, you empower them to solve their own problems. Besides, if you’re tempted to give the person advice and your advice doesn’t work, you will own the person’s problem.


Listening patiently helps the person talk themselves into a calm state—like the state you are modeling as you listen—and develop their own solutions. You cannot reason with an emotional person, but you can help an emotional person calm down and become reasonable. Once you master this skill, encourage your co-workers to observe your communication style as you interact with patients.



Listening When You Are Busy


Sometimes we feel we don’t have time to listen. Health care settings can be chaotic. Who has time for listening?


A 1984 study examined the listening behavior of doctors in a health clinic by measuring and recording the time patients were permitted to speak at the beginning of their appointment. Although the doctors were aware of the study, they only let the patients talk for an average of 18 seconds before interrupting them. The doctors responded to the findings by denying that they interrupted their patients that quickly. They also explained that they were busy and that patients would talk endlessly about their problems if they weren’t interrupted. The researchers repeated the study, but instructed the doctors to let the patients speak without interruption, no matter how long the patients took. The average patient only talked for 30 seconds, and the longest amount of time only lasted 90 seconds (Beckman and Frankel, 1984).


So are you really too busy to listen? Will you interrupt your patients to speed things along? Are you willing to forego the information you would have gathered, if you had listened just a little longer?



Case Study 7-1   A Deep Discovery


Alicia was dreading her 3:00 appointment with Mr. Cruz. Her employer, Dr. Lin, charged a $75 fee when a patient missed a dental appointment without 24 hours’ notice. Mr. Cruz had missed an appointment several months ago, and exploded at Alicia when she told him about the fee. She couldn’t get him to calm down long enough to explain that the fee was waived the first time it happened.


Unfortunately, Mr. Cruz also missed his next appointment. Alicia thought they had seen the last of Mr. Cruz, but then his wife called and rescheduled.


Mr. Cruz seemed to be in a good mood when he arrived. He even waved at Alicia. Alicia thought he might not even be aware he had missed his last appointment, even though she called him the day before to remind him.


Mr. Cruz was still smiling as he approached her counter. “Good afternoon, Mr. Cruz. How are you?”


“Better than you might think for somebody who has to see the dentist.”


“That’s great,” said Alicia. “Now, when was your last appointment?”


“I was here in September or October, I think. I’m not quite sure.”


“Hmmm,” said Alicia, looking at his chart. “It says here that you had an appointment in December, but you didn’t come.” She looked up at him with a neutral expression.


“I don’t see why I have to pay this $75 penalty,” he said as he recalled his missed appointment. “Things come up, you know. Nobody’s perfect. My schedule is very unpredictable.”


Alicia suspected that Mr. Cruz’s unexpected friendliness was probably a ruse, but she forced herself to hear him out.


“I’m an insurance adjuster,” he was saying. “When there is a claim—an accident, a flood, a fire—I have to be on the scene right away, while the circumstances and evidence are still fresh. I have a responsibility to my company,” he said. “I try to keep these appointments, but my job is a higher priority.”


Alicia noticed that he was talking faster now, and more color rose in this face, but she just nodded and said, “Uh-huh.”


“I always have my cell phone,” he said. “I guess I could have called, but would that have helped? I mean, if I called, and it wasn’t the day before, you would still charge me, right? Even though I called?”


At this point, he paused, and Alicia knew she had to choose her reply carefully. She saw that he was trying to contain his emotions, but she knew that he had a short fuse.


“I think you are right,” she said. “Calling always helps.”


“But you still would charge me the penalty if it wasn’t the day before, right?”


Alicia smiled at him. “Mr. Cruz, what we really want to do is treat as many patients as we can. We don’t want to charge penalties. I would be happy if we never had to charge a penalty.”


Mr. Cruz took a deep, deep breath. “I understand.”


The waiting room was empty, so Alicia joined Mr. Cruz in the lobby. She asked Mr. Cruz to sit in a chair so they could face each other. “Mr. Cruz, do you know why we have this policy?”


“Yes, but I don’t see why you have to charge money for nothing. That is a steep price to pay.”


Mr. Cruz seemed a bit calmer now and the edge had gone out of his voice.


“Mr. Cruz,” she said, lowering her voice a bit and pointing to the sign taped to the window that stated the policy, “We don’t charge if you call the day before. We would not charge you a penalty if you called ahead of time because we might be able to schedule another patient in your place. Unfortunately, Mr. Cruz, you didn’t call.”


“I understand.”


“Thank you for understanding,” said Alicia. “I think the doctor is ready to see you know. We can make payment arrangements when you are through.”




Down a Dark Road


Prima finally got a job as a sonography technician at the obstetric practice of Drs. O’Malley, Kendrick, and Anselmo. She had done very well in her program, but she knew she had a lot to learn on the job. She had already learned how to use a more advanced sonography imaging machine than the ones she had seen at school and at her internships. She had encountered some anomalies—that was what Dr. Anselmo called them—in some of the sonograms she had taken. She wasn’t sure Dr. Anselmo was using that term correctly. Some of the patients had to have amniocentesis, and it struck her that there were many more complications than she had originally anticipated. Prima pursued sonography because she liked babies, and she thought it would be a very positive profession, with a lot of happy moms as well as opportunities to learn and advance. She had not seen a miscarriage yet, but she dreaded the day when that would come. She told her boyfriend that the job was a lot more complicated than she thought.


At the end of her third week, Prima did a sonogram for a woman who was logged in as Dr. Alison DeMoure.


“Are you a medical doctor?” she asked when Dr. DeMoure arrived.


“No, I teach engineering at the University. You can call me Alison.” She pointed in the direction of the man who was with her. “That’s Mitch, my husband.” She was soft-spoken, and she seemed to lower her voice even more as she shared that this was their first child.


“Wow, that’s great,” said Prima. “Let’s see, your birth date is April 2, 1971—is that right?”


“Yes.”


“Wow, and this is your first baby? You’re getting a late start.”


Alison exchanged a glance with Mitch, who stepped forward. “The baby will be fine,” he said to both of them.


“Sure she will,” said Prima with sudden enthusiasm. “What are you guys hoping for, a boy or a girl?”


“A healthy baby,” said Alison.


“We don’t care about the gender,” said Mitch. “We want to be surprised.” He nodded at Alison, as if to reassure her.


“Well, you’re far enough along that we can probably tell,” said Prima.


“We don’t want to know, one way or the other,” said Alison.


“Sure, you want to have a healthy baby. Let’s get started.”


Pretty soon, they all heard a healthy heartbeat. “He’s got a great heartbeat,” said Prima. “Oh my God, look at him!” Prima felt happy that the baby seemed healthy. “Do you want to take a print of this, so you can put the little guy on your refrigerator?”


Alison and Mitch seemed relieved that the baby seemed healthy, but Alison said she didn’t want the image.


A half-hour later, Dr. O’Malley came out and asked to speak to Prima in his office. “Did you tell the DeMoures that they are having a boy?”


“No, I mean, they were so happy about the heartbeat. I hope the little guy is going to be OK.”


“The little guy?”


“The baby. You know.”


“Didn’t they tell you they didn’t want to know what the sex was?”


“I don’t think I heard that.”


“No, you didn’t listen.”


“Well, the important thing is that the baby is OK, right?”


“Yes, the baby is fine, but you didn’t listen to them and respect their wishes. That’s not the way we do things around here. Make sure it doesn’t happen again,” said Dr. O’Malley, and he rose from his desk, indicating their meeting was over.




image Experiential Exercises




1. Listen to your friends or clients talk without interrupting them. How long do they talk before they pause?


2. Write two introductions for yourself, one introducing yourself to a patient and one introducing yourself to a new co-worker. Memorize them and say them out loud until they sound natural.


3. Use your “co-worker” introduction on a partner. Observe where the conversation goes from there.


4. Compliment a friend or family member. Observe where the conversation goes from there.


5. Watch the evening or Sunday morning news. Pay close attention to the questions the reporters ask. Are they open-ended questions? Are they good questions? Do the questions elicit interesting or revealing information?


6. Watch a late night talk show. Evaluate the questions asked in a similar fashion.



image Cross Currents with other Soft Skills







Communicating With Special Groups of Clients



Something there is that doesn’t love a wall.


—Robert Frost




Learning Objectives for Communicating with Special Groups of Clients




We take our sensory organs and communication abilities for granted until we encounter someone who has lost these senses. What a gift we have in being able to hear, see, and speak! Keep in mind, however, that people with disabilities take pride in their many abilities; many have creative ways to accommodate for a particular challenge and may not want help if they don’t need it. Always take your cues from the person, and ask before helping.



Communicating with People Who Are Hearing-Impaired


People who are hearing-impaired have made many adjustments that make it easier for them to function. Nevertheless, they frequently encounter ignorance and rudeness that can create feelings of helplessness. Be empathetic to these challenges.



Recognizing People With Hearing Impairments


The first challenge is to recognize that a person is hearing-impaired. For instance, some people still have trouble hearing even with hearing aids, while hearing aids can actually correct hearing for others. These days, hearing aids are so small and discreet that many people do not even notice them.


You also cannot tell by speech quality alone that a person is hearing-impaired. For example, if a person loses hearing after age 12 years or so, his or her speech is likely to be unimpaired. If a person loses hearing after age 5, he or she will have some noticeable speech impairment, but will likely be easy to understand. People who are born deaf or lose their hearing early in life will have significant speech impairment, and you may have great difficulty in understanding them.


A hearing-impaired person who visits a health care facility usually simply tells you that he or she cannot hear normally. If you do encounter someone with speech impairment, it is important for you to understand that the impairment is the result of hearing loss and not intellectual disability.



Strategies for Communicating With Hearing-Impaired People


Once you realize that you are communicating with a hearing-impaired person, adopt a strategy to communicate effectively. It is natural for you to raise the volume of your voice, and this may be helpful for some hearing-impaired people. It is best, however, to simply ask such clients how they prefer to communicate.



The problem with communication is the illusion that it has taken place.


—George Bernard Shaw

Related posts:

  1. Being Easy to Deal With
  2. Dealing with Others
  3. Planning for Career Success
  4. Building Personal Emotional Strengths

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Apr 8, 2017 | Posted by in MEDICAL ASSISSTANT | Comments Off on Interacting Successfully

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