Verbal Communication

The medical assistant can develop enough perception to determine the type of verbal communication that a patient uses most often. Then, by studying these four types, it will be easier to communicate verbally with each of the personality types. Think about family members and close friends – what personality type might they be?

The pitch of the voice is a part of verbal communication. The voice lifts at the end of a question. It drops at the end of a statement. Usually when a speaker intends to continue a statement, the voice holds the same pitch, the head remains straight, and the eyes and hands are unchanged. This is not an appropriate time to interrupt. If the message is interrupted, the train of thought may not be completed. The tone of voice and choice of words also affect messages.

The medical assistant should speak clearly and enunciate words properly. Speak loudly enough that the patients are able to hear clearly, and pay particular attention to those who wear some type of hearing assistance device. It is wise to note this information on the patient’s medical record to jog the memory when a patient with a hearing problem visits the office. Never assume that just because a patient is elderly, he or she has a hearing problem. When talking with patients, be sure to use the volume of speech to an advantage. Always speak at a clearly audible level, but at times it will be necessary to increase or decrease the volume of speech. When a patient is upset, for instance, it often helps to lower the volume of speech, because the patient tends to get quieter to hear the person speaking.

Eye contact is critical, especially in the age of electronic medical records. Look at the person to whom you are speaking and do not forget a genuine smile. Look at the person more than at the computer. Many people feel that a person who speaks and cannot look another in the eyes is being deceptive. It also can mean that the speaker is very shy and has little self-confidence. Use gestures where appropriate to liven speech and animate the conversation.

Remember that patients are in the facility to be treated by the physician and staff. They usually are concerned about their illness and may have great apprehension and fear about the future. It is completely out of place for the medical assistant to talk about his or her personal life and challenges with the patients. Allow the patient to speak, and listen instead of offering personal information. Often patients casually mention details to the medical assistant that might influence their care. The saying that we are given “one mouth and two ears” stresses which should get more use!

Nonverbal Communication

Appearance is an integral part of nonverbal communication. Our appearance influences the way others view us and can present a conflicting message, or even a totally incorrect message. When we see someone who dresses or grooms in a way that is very different from our own style, we tend to assume that the personalities are also very different. This is not always true. Although we should not judge people by the way they dress, it is difficult not to form opinions based on what we see. Visible piercings and tattoos often are regarded unfavorably in the medical profession, as are long, brightly painted nails. Although these do not signify that the wearer is not professional, many patients, especially older patients, are uncomfortable with these trends. For this reason alone, the medical assistant who is less conservative may diminish his or her chances for certain jobs and advancements. Expressing oneself is healthy, yet in the medical profession, a conservative appearance is mandatory so as not to raise obstacles to communication.

The need for boundaries, or personal space, is demonstrated by how patients in the reception area choose a seat. Proxemics is the study of the nature, degree, and effect of the spatial separation individuals naturally maintain and how this separation relates to heredity, cultural, and environmental factors. Seldom does a person sit in a space next to a stranger if another option is available. Although the need for space varies with the individual culture, some might even remain standing to satisfy the need for personal space. Public space usually is accepted as a distance of 12 to 25 feet, and social space usually is considered to be 4 to 12 feet. Personal space ranges from 1½ to 4 feet, and intimate contact includes physical touching to approximately 1½ feet. The medical assistant often can tell when he or she has invaded someone’s personal space, because the person tends to back up a step or two. If this happens, take a small step back and respect the boundaries being set. The more familiar and comfortable patients are with the medical assistant, the closer the space they allow. Other types of boundaries are discussed later in the chapter.

Touch is a powerful communicator. The soft acceptance of shaking someone’s hand, to the good-natured pat on the back, to the harsh slap on the face all relay different messages that need no words to express accurately. In the medical profession, as in any business, touch can be comforting or can lead to a sexual harassment suit. Individuals who have experienced sexual abuse or other traumatic experiences may not want to be touched at all. Unfortunately, one must be extremely careful when using this effective communication tool. In today’s litigious society, any nonconsensual touching may be considered battery, and touch should be used with great discretion and caution.

Posture can signal depression, excitement, anger, or even an appeal for help. When the physician sits at the front of the chair and leans forward, he or she is sending a message of care and interest. Positioning also is important. Sitting behind a desk promotes an air of authority. Standing or sitting across a room may convey a negative message of denying involvement or reluctance to talk. Sitting side by side with a patient helps initiate trust and promote open conversation. The medical assistant should practice good postural techniques as a part of projecting a positive image and for personal health reasons.

Listening

Listening is just as important to good communication as the spoken word. Hearing is the process, function, or power of perceiving sound, whereas listening is defined as paying attention to sound or hearing something with thoughtful attention. Patients need to know that the medical assistant is listening. This is actually true in all interpersonal relationships, including husband-wife, parent-child, supervisor-employee, and doctor-patient interactions. When listening to someone who is attempting to communicate, the first rule is to look at the speaker and pay attention. Sometimes it is important not to respond immediately but to remain silent and offer an understanding and reassuring nod.

Sometimes it is hard to listen. We may not be able to listen effectively, because we are distracted by our own thoughts. Perhaps the situations occurring in our own lives make the conversation we are hearing seem meaningless and unimportant. Or so many messages may be attacking at once that we are unable to focus on any specific one to listen to what is being communicated. At other times, such as in anger, we are so rapidly preparing our response that we cannot listen to what is being said. We may simply be too tired to listen, or we may have prejudged the speaker and decided that we do not need to listen. However, while working with patients, the medical assistant must be diligent not only in hearing the words being spoken, but also in listening to them and to what the patient is attempting to communicate.

Active listening is a skill that enables a person to paraphrase and clarify what the speaker has said. Paraphrasing is listening to what the sender is communicating, analyzing the words, and restating them to confirm that the receiver has understood the message as the sender intended. This process clarifies the speaker’s thoughts and helps indicate that a common understanding of the message exists between the speaker and the receiver. When communicating in this way, the receiver should reword what the sender has said and then ask a clarifying question. Consider the following example:

This type of communication may seem awkward at first, because most of us believe that listening involves lack of speech. Active listening means that the speaker’s words are heard, and a restatement is used to verify that the message was understood correctly. This statement gives the speaker the opportunity to correct any misconceptions or misunderstandings. Consider the following example:

It would have been easier if the patient had said, “I have had a sharp pain in my back that lasts up to 15 minutes, and it happens about six times a day.” This example shows how the medical assistant can continue clarifying until the answer is specific enough, which is critical when obtaining information from the patient.

It also is best to ask “open” rather than “closed” questions. An open question requires more than a “yes” or “no” answer. It forces the patient to provide more detail and expand on his or her thoughts. A closed question can be answered with “yes” or “no” and compels the medical assistant to spend more time obtaining the answers needed to document the patient’s needs thoroughly.

Often when a person or patient is talking with the medical assistant, the person is looking for a specific type of response. Some patients want advice, some want sympathy, and others are looking for reassurance. Many patients open up more quickly and more completely to the medical assistant than to the physician. This can be a very positive aspect of the relationship the medical assistant has with patients, because it is important to build good rapport with them. However, the medical assistant should never agree to withhold information from the physician under any circumstances. If the patient asks that the assistant not reveal something to the physician, the medical assistant should politely explain that he or she has an ethical obligation to report any and all pertinent information to the physician, especially if it affects medical care. For example, if the patient asks the medical assistant not to tell the physician that the patient has been smoking against medical advice, the assistant could be jeopardizing the patient’s care if the information is not reported.

This does not mean that specific details must always be aired. If the patient reveals that her stress levels have been high because she has filed a sexual harassment suit against her boss, but she does not want to share each detail with the physician, the medical assistant could report to the physician that the patient is having some legal problems that have resulted in additional stress at work. The physician will understand that the patient’s stress level is elevated and can effectively treat the patient without knowing the specific, intimate details of the acts between the patient and her employer. However, the medical assistant must never agree to lie to the physician. The patient must understand that if the physician questions any information given by the patient, it must be revealed so that the physician is assured that the care provided is appropriate. Remember that the physician may have worked with the patient for a long time and has a better understanding of the patient’s needs than the medical assistant. One patient may be able to handle a high stress level, and another may crumble at the first sign of stress. Good physicians know their patients and keep accurate, complete records that aid decision making in these situations.

If the medical assistant is ever in doubt about telling the physician something a patient has said, the best solution is to tell. Medical professionals are legally bound to confidentiality, and the patient may need to be reminded of this. Encourage the patient to talk to the physician and communicate all concerns, no matter how insignificant they may seem. Never display a judgmental attitude or express negativity about the patient’s activities, thoughts, or behavior. Offer to be with the patient, if he or she desires, during difficult discussions with the physician or to make arrangements for a special counseling session with the physician if this is indicated. Some patients are hesitant to initiate a conversation with the physician because they feel they are taking too much time. The medical assistant can help ensure that critical issues receive the doctor’s attention.