**Professionalism
Professionalism As a health care representative, the medical assistant should set a good example. The medical assistant sets the first impression of the office and in many ways is the marketing representative of the practice. The medical assistant must always present a professional appearance. Good personal hygiene and grooming are a must. Office policy regarding fingernails, jewelry, and general appearance must be followed.
Directive Communication Techniques
The medical assistant can often assist the communication process by directing the patient’s comments, using specific communication techniques so that the sharing between the patient and the medical assistant is productive.
Types of Questions
Asking questions is a directive technique. The medical assistant will ask many questions of each patient. It is helpful to keep in mind the goal of your question before you choose the type of question to ask. Four types of questions are discussed here: close-ended, open-ended, exploratory, and leading.
Closed-ended questions can be answered with a yes or a no. Often these types of questions are appropriate to obtain background information, such as “Is your mother still living?” However, at times you may ask a patient, “Do you understand what I mean?” and the patient will answer, “Yes” even if the patient does not comprehend what you are saying. Usually this happens because the patient does not want to be bothersome or appear unintelligent. You need to consider the situation carefully when you use close-ended questions.
Open-ended questions are those that require more than a yes or no response. Such questions can be useful in gaining feedback or drawing out patient information. An example of an open-ended question is “What were you doing when you got dizzy?” By applying the directive method of using openended questions, you will be able to obtain information that the physician will require to treat the patient.
Exploratory questions are used to ask the patient for further information to more fully discuss the subject. For example, if a patient says, “My head hurts,” an exploratory question would ask, “Where does it hurt?” or “How long have you had this pain?” In this example, other exploratory questions would seek information about type of pain, when it started, and when it occurs. The medical assistant is often the person the patient feels more comfortable speaking to and questioning. It is important to be empathetic and endeavor to put the patient at ease.
Leading questions are those questions in which part of the answer is in the question. For example, when asked, “Do you have to urinate two, three, or four times a night?” the patient then has to select one answer from your choices. This may be helpful in dealing with patients who do not understand English. However, the medical assistant must be careful not to ask a particular leading question in order to get the desired answer instead of a true answer that wasn’t included in the question.
Feedback
Feedback, any response to a communication, is critically important when working with patients because you must determine if they truly understand what was said. Feedback can be either verbal or nonverbal. Sometimes the verbal message and the nonverbal message that patients send do not agree. For instance, as a medical assistant you may ask, “How are you feeling?” and the patient might state, “Fine.” Because the patient is walking with a painful limp, you doubt the verbal statement. Always try to ask specific questions (e.g., “Do you have pain?” “Tell me about your medication,” or “Tell me why you came in to see the doctor.”).
When you document the information the patient provides, write the patient’s exact words in quotation marks.
Reflecting
Reflecting is a directive technique in which you mirror the patient’s message back to the individual to ensure that you have understood the message correctly. For example, you may say in response to a patient who says he needs an appointment but not on a Wednesday, “You say you can’t come in on Wednesdays?” The reflecting technique is also helpful in resolving conflicts and clearing up confusing statements, and it requires more detail from the other person.
Restating
Restating or paraphrasing is repeating the patient’s message in your own words. For example, if the patient says, “I won’t have any money till next month,” you might reply, “I understand you’re saying that you won’t be able to pay your bill this month. Is that correct?” This technique helps to confirm that both parties understand the message clearly.
Clarification
The ultimate goal in effective communication is to deliver the message so that it is understood clearly. Clarification is a directive technique in which the medical assistant requests more information to better understand what the patient has stated. Many times patients use words such as a lot or much worse in explaining their symptoms. It is important to ask them to be more specific in order for the physician to accurately diagnose and treat the patient. For example, the patient says, “My right arm hurts a lot.” The medical assistant should employ the directive techniques mentioned to clarify this information. The following questions are examples of follow-up questions and statements useful in this situation:
- “You say that your right arm hurts. Is that correct? Show me on your arm where you feel the pain.”
- “What kind of pain is it? When did it start? Does it hurt all the time?”
- “Does the pain interrupt your sleep?”
- “Are you taking any medications, including over-the counter drugs, for the pain?”
Another form of clarification is asking the patient to repeat back to you the instructions you have just given. This will reveal if the patient has clearly understood what you said and gives you the opportunity to repeat anything the patient didn’t grasp.
TABLE 5-3 | Directive Communication Techniques
Technique Description Example
Open-Ended Question Encourage the patient to discuss freely. “Please describe your pain for me.”
Closed-Ended Question Direct the patient to make a yes/no or simple response. “Are you having pain?”
Exploratory Question Ask the patient for further information. “When did the pain start?” Reflecting Direct the conversation back to the patient by repeating the patient’s words. Patient: “I’m afraid of what the doctor will find.” MA: “You’re afraid of what the doctor will find?”
Acknowledgment Indicate understanding. “I understand what you are saying.”
Restating State what the patient has said but in different terms. Patient: “I can’t sleep.” MA: “You say you’re having trouble getting to sleep at night?”
Add to an Implied Statement Verbalize implied information. Patient: “I’m usually relaxed.” MA: “And today you’re not relaxed?”
Seek Clarification Request more information to better understand. Patient: “I don’t feel good.” MA: “Tell me what kind of symptoms you are having.”
Silence Remain silent, or make no gesture in response to a statement. Patient: “I don’t know what’s
See Table 5-3 for a list of other directive communication techniques, including a description and an example of each technique.
FIGURE 5-4 Empathy draws a more positive response from the patient because it is based on the willingness of the medical assistant to understand what the patient is experiencing.
Empathetic Listening
Empathy is the ability to understand what the patient is feeling because you have experienced the same feelings. (“I know how hard it is to lose weight. It’s a constant problem for me, but I keep trying because it’s important for my health.”) Or you can truly imagine yourself in the patient’s shoes (thinking, “I don’t have that problem, but I can imagine how tough it must be”). Compassion is taking positive action based on the empathy you feel (offering a patient in pain to wait in a quiet private area, if available). Sympathy is acknowledging the patient’s feelings and difficulties even though you have not had the same experience or can’t really imagine yourself being in that person’s position (thinking, “Wow, it must be really hard to have that kind of weight problem”). Pity is feeling sorry for a person, usually in a condescending way (thinking “What a poor soul this person is; I’m glad I never let myself go like that”). Patients react much better to an empathetic or sympathetic listener, who really seems to understand their problems, than to a pitying listener, who may seem to be looking down on them.
You can acquire the skill of empathetic or sympathetic listening by using some simple nonverbal techniques: nodding, leaning toward the patient, positioning yourself so you are at the patient’s eye level, and indicating by your facial expression that you understand what the patient is saying (Figure 5-4). Because we all share human emotions, at times you will become distressed over a patient’s situation. It is not possible to be a concerned health care provider and remain totally unemotional at all times. If you become upset, you can excuse yourself for a few moments. Realize that your emotions and concerns are another indication why you are the right kind of person to have chosen the field of health care, a person who is truly concerned for others. Your genuine caring will come across to and be appreciated by the patient.
Discussing Sensitive Issues
Frequently, sensitive issues arise during contact with patients. Discussing issues involving money, such as the patient’s bill and personal financial responsibility, can be very sensitive. Before the first office visit, patients should be advised of the physician’s charges for specific services or treatment. Inquiries regarding the patient’s medical insurance and procedures for payment of fees should also be reviewed before the first visit. Compliance with federal regulations regarding the patient’s right to privacy for all health-related information should be addressed at the first visit. This includes reviewing the Health Insurance Portability and Accountability Act (HIPAA) and how the office follows the HIPAA guidelines. When you need to discuss sensitive topics such as these with a patient, the abilities you develop to be assertive without being aggressive will stand you in good stead.