In our day-to-day lives we communicate on a social level in many different situations. This communication requires no special set of skills or knowledge. However, in the professional world of health care, you, as a medical assistant, will be called on to use therapeutic communication with patients, families, and other professionals. Therapeutic communication occurs when patients who have particular concerns or needs seek your help to resolve or alleviate their problem. This specialized form of communication requires that you be open to others, be respectful of cultural and ethnic diversity, be a good listener, be aware of your own biases, and be truly interested in helping others. In a therapeutic encounter, you will also need to avoid becoming overly involved in a patient’s emotional and physical distress. Such a level of involvement may cause you to lose objectivity or become codependent and be unable to provide the necessary assistance.
The best communication occurs when the entire exchange of information adheres to the “five Cs.” This means that the communication is complete, concise, concrete, clear, and considerate. Therapeutic communication can be most effective when you pay attention to the message that you are sending. A message must be empathetic to the patient and must involve reflexive communication skills. You will need to pay attention to your nonverbal communication patterns as well as those of your patient. You should be aware of the impact that environmental and cultural differences may have on your therapeutic communication.
Empathy means that you are in touch with and aware of the feelings your patient is experiencing. It implies that you are able to “walk in her shoes” and that you appreciate and accept her feelings. Empathy is often compared to and contrasted with sympathy, which is responding to the emotional state of another person with your own emotional reaction. During a time of stress or illness, patients are best served by professionals who can empathize with their situation. An excellent strategy for conveying empathy in a sincere and honest way is through reflective communication. Remember that you cannot always say, “I know how you feel,” because it is likely that you have not been in that situation, so you really do not know. An empathetic response would be, “I understand how that must make you feel.”
The techniques and talent of reflective communication may seem simple; however, they will require a great deal of practice and attention to be used well on the job. Reflective communication involves listening to the patient closely and carefully while observing their nonverbal cues such as facial expressions, gestures, and body language. During reflective communication, you are not only taking in the message, but its meaning to the patient and how the message seems to be influencing the patient’s emotional state. Your sincere interest is conveyed by head nodding, direct eye contact, and paraphrasing what the patient said. In paraphrasing, you state back to the patient in your own words what you heard him say. You may also comment on the feelings that seem to be conveyed in the message. For example, if an elderly patient tells you that he is being urged by his family to give up his home and move into an assisted-living facility, you may reflect by stating, “Your daughter feels that you would be safer in an assisted-living facility.” Restating the patient’s words, tying the words together with their emotional meaning, and reflecting this back to the patient is a core skill for medical assistants. To be good at reflective communication you need to listen actively, pay attention to the spoken word, and observe the patient carefully.
You may be familiar with the saying, “Actions speak louder than words.” This saying underscores the meaning and importance of all forms of nonverbal communication. As a medical assistant, you will need to attend to both your own nonverbal cues and to those of your patients and coworkers. Nonverbal communication includes appearance and style, facial expressions, hand gestures, body position, and movements. Often gestures and stance send more meaning than the spoken message in a conversation.
Dress and appearance convey a great deal of information and, like it or not, we all tend to form our first and lasting impression of people based on their physical appearance. Grooming, appropriateness of dress, accessories, and ornamentation will influence your impression of the patient and his impression of you. As a medical assistant, you will need to be well groomed and neat. Avoid extremes in jewelry, nail length, hair styles, and ornaments in the workplace. In today’s world, men and women are freer in expressing their individual styles through body piercing, tattoos, hair color, and fashion. It is likely that you will see a wide variety of states of personal grooming, dress, and appearance. Many people make judgments and interpretations of others based on their appearance. You need to be aware of what your own biases are in regard to style and appearance and take care to act professionally with all patients.
Body language includes posture, stance, gesturing, eye contact, and movement. During therapeutic communication you will want to sit on the same level as the patient, facing the patient, making direct eye contact, and respecting the patient’s personal space. You need to observe how congruent the patient’s words are with the facial expression and body stance. Arms folded across the chest may indicate a closed or defensive posture. Downcast eyes may be a sign of embarrassment or discomfort. Sitting with arms and legs crossed may be a sign of avoidance. If a patient tells you that she is okay during a procedure but you observe that her fists are clenched, you may want to ask if she is uncomfortable or in pain.
There are no hard and fast rules in interpreting nonverbal communication. If you do not see consistency between a patient’s words and gestures or expressions, ask a question before you assume that there is a meaning behind the message you are getting. You will want to validate your observations and give feedback about the communication from your sender.
To enhance communication in the medical office, you want to create an environment that supports interaction. Some environmental factors that will contribute to open and free communication include a professional office space, privacy, secure storage of documentation and medical records, and avoidance of noise, distractions, and interruptions during patient contacts. Patients should be interviewed and examined in private. You should knock, announce yourself, and wait for the patient to acknowledge you before entering the exam room. If at all possible, arrange seating so that the patient is directly across from you and at eye level during your conversation. You want to convey your full attention, and even in a hectic office practice, the habit of sitting down and making eye contact will convey your attention to the patient. If possible, avoid interruptions during a patient visit. If you are documenting information in a patient file during the interview, make sure that you look up regularly and make eye contact with the patient. To protect patient confidentiality, you should give the patient instructions, test schedules, and other information in a private location.
Major demographic changes in the U.S. population have occurred, producing a wide diversity of cultural and ethnic groups. It is likely that you will be treating a mix of patients from different countries, speaking different languages, and engaging in different social behaviors and practices from those of your own family. It is important that you take time to learn some basics about the culture and belief systems of the patients in your workplace. While there are no hard and fast rules, you need to appreciate that people from around the world will not always think and act as you do. This information will assist you in gaining the trust and confidence of those you serve.
Many individuals new to the United States will need time to translate your words and their meaning into their own language and then translate their response into English. This is a complex process and there may be phrases or figures of speech that do not translate. For some, English as a second language means that they do not think in English and must decode your words and meaning into their own language. It is important that you ensure that you are being understood clearly. Speaking slowly may help with the decoding; speaking louder will not.
In some cultures, issues as fundamental as time and its meaning are less precise. In Native American or Mexican cultures, arriving at the office for an appointment at a specific time may not be valued and will need to be explained to patients. This will prevent confusion and help them understand the office’s expectations. Facial expressions and conversational etiquette are also a cultural variation. For example, in some Asian countries such as Cambodia and Laos, making prolonged direct eye contact is interpreted as a sign of disrespect and is impolite. As this example demonstrates, effective communication across cultures will require that you take the time to understand and appreciate the cultural aspects and diversity in the patients you treat on a regular basis.