Transcript Chapter Five Interpersonal Skills and Human Behavior

Interpersonal Skills
and Human Behavior
Chapter 5
Copyright © 2011, 2007, 2004 by Saunders, an imprint of Elsevier Inc. All rights reserved.
1
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.
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This chapter will examine:
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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
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Questions to consider…
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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?
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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.
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5
First Impressions
First impressions are still lasting ones!
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First Impressions
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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!
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Introductions
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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
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Medical Record as Communication
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Must be legible
Spelling and grammar must be well-used
If it isn’t 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
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Verbal Communication
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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.
Do not interrupt a person who is speaking.
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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.
Verbal Communication depends on words and
sounds.
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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.
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12
Listen to Patients
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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!
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Nonverbal Communication
Nonverbal communications are messages that
are conveyed without the use of words.
Transmitted by:
 Body language
 Gestures
 Mannerisms
 Eye movement
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Body Language
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Partly instinctive
Partly taught
Partly imitative
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Body Language
Involves:
 Eye contact
 Facial expression
 Hand gestures
 Grooming
 Dress
 Space
 Tone of voice
 Posture
 Touch
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Appearance
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Appearance is a vital part of nonverbal
communication.
Appearance can present conflicting nonverbal
information.
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Appearance
The successful medical assistant expresses:
 self-esteem
 confidence
 pleasant facial expressions
 caring attitudes
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18
Conservative Appearance
In the medical profession, patients expect
professionalism, and conservative appearance is
preferred to avoid blocks in communications.
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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.
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Spatial Boundaries
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Public Space: 12-25 feet
Social Space: 4-12 feet
Personal Space: 1½ to 4 feet
Intimate Space: touching to 1½ feet
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What Can Touch Mean?
Touch, in the medical profession, can be
comforting or can promote a sexual harassment
lawsuit.
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Avoid Claims of Battery
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Be very careful when touching a patient.
Non-consensual touching can be considered
battery in today’s litigious society.
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The medical assistant should not be afraid to
touch patients in an appropriate manner.
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Posture and Positioning
Can signal:
 Depression
 Anger
 Excitement
 Fear
 An appeal for help
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The Process of Communication
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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.
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Channels
Channels can be:
 Spoken words
 Written messages
 Body language
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Encoding
Senders encode a message, which means that
they choose a specific method of expression
using words and/or other channels.
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Decoding
The receiver decodes the message according to
his or her understanding of what is being
communicated.
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Noise
Noise contributes to the misunderstanding of
messages. Noise is anything that interferes with
the message being sent.
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Feedback
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Verbal expression
Body language
Nod of understanding
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Transactional Communication Model
From Adler RB, Towne N: Looking out, looking in: interpersonal communication, San Antonio, 1996, Harcout Brace.
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Listening
Listening is paying attention to sound or hearing
something with thoughtful attention. Listening is an
important skill that the medical assistant can develop.
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What Prevents Us from Listening?
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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.
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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.
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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
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Ask Open-Ended Questions
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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?
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Observing Carefully
Watch for signals from patients, such as tears,
sad expressions, or volatile temper.
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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.
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39
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.
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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.
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41
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.
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42
Dealing with Conflict
Conflict is the struggle resulting from incompatible
or opposing needs, drives, wishes, or external or
internal demands.
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Conflict can…
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Be beneficial to relationships
Be constructive
Allow people to learn about each other
Promote stronger understanding
Promote deeper levels of intimacy
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Assertion—Stating or declaring positively, often
forcefully or aggressively
Nonassertion—The inability to express needs and
thoughts or the refusal to express them
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Resolving Conflict
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Every relationship experiences conflict
First impulse is often the “fight-or-flight”
syndrome
Put aside thoughts of personal attack
Think logically
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Tips for Resolving Conflict
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Expect conflict – do not fear or dread it
Realize that conflict can be healthy
Accept that others have legitimate, viable
opinions
Listen and consider other’s opinions
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
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47
Boundaries
Boundaries indicate a limit or fixed extent.
Setting boundaries at work helps to avoid
awkward situations and misunderstandings.
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Examples of Workplace Boundaries
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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
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Four Steps in Setting Workplace
Boundaries
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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.
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What to Say to Stop Inappropriateness
“Stop! I am not interested in hearing this topic!”
“Stop! I am not interested in seeing this
behavior!”
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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.
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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.
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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.
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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.”
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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.
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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.
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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.
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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.
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59
Barriers to Communication
Physical impairment
Language
Prejudice
Stereotyping
Perception
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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
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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.
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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.
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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.
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Death and Dying
Elisabeth Kübler-Ross
Dr. Kübler-Ross studied thanatology, the study of
the phenomena of death and of psychologic
methods of coping with death.
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Five Stages of Grief
Denial
Anger
Bargaining
Depression
Acceptance
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Multicultural Issues
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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.
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Communicating with Those from
Other Cultures
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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.
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Non-English Speaking Patients
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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
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Sensitivity to All Patients
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Any patient can feel anxiety when seeing the
physician
Be very sensitive to the patient’s feelings
Explain steps of procedures to put them at
ease
Always display a caring attitude
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Maslow’s Hierarchy of Needs
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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
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Maslow’s Hierarchy of Needs
Adler RB, Towne N: Looking out, looking in: interpersonal communication, San Antonio, 1996, Harcourt Brace.
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Human Needs
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Approval
Acceptance
Achievement
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Stages of Sleep
Two Main Phases of Sleep
 NREM (non–rapid eye movement)
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Four stages, during which the body slows
down and relaxes
REM (rapid eye movement)
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Deep sleep when dreaming occurs
Brain is highly active
Eyes move rapidly
Occurs in the last hours of sleep
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Summary of Scenario
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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
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Closing Comments
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Interpersonal skills are critical to the medical
assistant
Communication is a part of virtually every
event 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
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