COMMUNICATION AND DIVERSITY
As a medical assistant, you will encounter special circumstances when dealing with patients. It is likely that at some time you will encounter a patient who is terminally ill, is visually or hearing-impaired, is mentally or emotionally impaired, or is physically challenged in some other way. Regardless of the circumstances, all these patients must be treated with respect, understanding, and professionalism. Medical assistants act as a coach, of sorts, to their patients. Although this concept is further described in the “Patient Education” chapter, it is essential to understand that the medical assistant must help coach their patients in regards to providing encouragement and support and adapting to their specific needs. Making adaptations in communication techniques to help a patient in a challenging situation is a necessary component of the medical assistant’s skill set.
**PROCEDURE Assisting an Angry or Anxious Patient
Objective ◆ Interact with a patient who is frightened, angry, or depressed.
EQUIPMENT AND SUPPLIES Pen; medical record
METHOD
- Choose a classmate.
- Select a quiet part of the classroom to conduct the procedure.
- Determine who will be the medical assistant and who will be the patient.
- Have the student who is pretending to be the patient express the emotions of being frightened, angry, and anxious.
- Once you recognize one of these emotions, remain calm.
- If the patient is not displaying destructive behaviors, allow the patient to express his feelings without being interrupted (Figure A).
- Let the patient know that you understand.
- Inquire about the issue so you can solve it.
- During the conversation make sure you are empathic so the patient knows you are concerned about the issues.
- Notify the physician of the conversation.
- Document the conversation in the medical record.
CHARTING EXAMPLE 3/4/YY 4:00 p.m. Patient expressed concern about not seeing doctor immediately on arrival. Explained physician was delivering baby at hospital and offered patient another appointment later in the day. Patient refused later appointment and agreed to wait in the reception area until physician returned. M. Tyler, CMA (AAMA) 5-2 Assisting an Angry or Anxious Patient PROCEDURE FIGURE A Medical assistants must calm angry patients.
FIGURE A Medical assistants must calm angry patients.
Patients with Sensory Impairment
Patient with special needs may require extra sensitivity, patience, and empathy on the part of the medical assistant. Here we consider several types of individual patients, along with some procedural guidelines.
The Hearing-Impaired Patient Hearing loss can vary from a slight loss to total deafness. Total hearing impairment is considered by many to be the most difficult of all handicaps, because it can keep people isolated from communication and social interaction. A child who cannot hear will have difficulty speaking, because learning speech involves imitating the speech of others. Many hearing-impaired individuals communicate by means of sign language. Figure 5-11 shows the alphabet in sign language. Basic sign language is not difficult to learn. Simple phrases in sign language should be a part of every medical professional’s knowledge base. Hearing-impaired patients often bring an interpreter to the medical office. Figure 5-12 shows a medical assistant using an interpreter with a patient who has hearing loss.
The manner in which you try to communicate will differ depending on whether the patient has a hearing aid, can lipread, or has a family member or interpreter along for the appointment. Loss of hearing is a frequent but frustrating result of aging.
The following are some guidelines to help someone with hearing impairment:
- Select a quiet environment to communicate with the patient.
- Reduce outside noise as much as possible.
- Never shout. Speak slowly and clearly.
- If the patient does not understand you the first time, rephrase the statement.
- Explain everything carefully before performing a procedure.
- Face the patient when speaking.
- Make sure light is on your mouth and not behind you. Light behind you may put shadows over the mouth and inhibit the patient’s ability to lip-read.
- Have a paper and pen available so that the patient can communicate in writing.
- Always provide written instructions or pamphlets for patient education purposes.
**FIGURE 5-11 The American Sign Language alphabet.
** FIGURE 5-12 A hearing-impaired patient using an interpreter.
Basic hearing tests or screening tests are often performed by the medical assistant in the physician’s office. An audiogram may be ordered by the physician when there is a suspicion of moderate to severe hearing loss. This test will determine the faintest sounds a patient can hear during audiometric testing. Audiometric testing, conducted by an audiologist, tests hearing ability by determining the lowest and highest intensities and frequencies that a person can distinguish. The patient may sit in a soundproof booth and receive sounds through earphones as the technician decreases the sounds or tones. Procedure 5-3 provides the steps to assist a hearing-impaired patient.
The Visually Impaired Patient
Blindness can be present at birth or may develop as a result of a disease, such as diabetes mellitus. Patients who are blind or are partially sighted can remain independent. Specially trained service animals can help the visually impaired patient to be more independent. Figure 5-13 shows a patient with a service dog. The visually impaired patient cannot rely on nonverbal cues that make up much of the communication process for those with sight. The medical assistant can communicate and help the visually impaired patient by remembering to follow the following suggested guidelines:
- Always speak to announce your presence when you are near a blind person.
- Offer to guide the patient into the examination room by offering your arm. Do not grab the patient without offering your arm first.
- Face the patient, and speak clearly.
- Describe the patient’s surroundings.
- Explain all procedures in detail before beginning.
- Try not to leave the patient alone for any length of time.
- Have available large-print educational materials for patients who might benefit from them.
- Do not be condescending toward the patient.
**FIGURE 5-13 A visually impaired patient is assisted by a service dog.
**PROCEDURE 5-3 Assisting the Hearing-Impaired Patient
Objective ◆ Use effective communication skills to assist a hearing-impaired patient to prepare for a physical examination.
EQUIPMENT AND SUPPLIES Paper and pencil
METHOD
- Identify the patient.
- Reduce external noise as much as possible.
- Smile, establish eye contact, and face the patient.
- Speak slowly, and do not shout.
- Provide a careful explanation of the procedure.
- Provide paper and pencil for the patient to use if desired.
- Use written information to reinforce the message for the patient.
- If possible, have the patient repeat your response to ensure that the message was received accurately.
- Give directions using actions as well as words.
- Be sensitive to the patient’s needs.
- Employ an empathetic, professional attitude.
- Notify the physician of any patient concerns.
CHARTING EXAMPLE 6/24/XX 3:00 p.m. Patient is hearing impaired, so gave patient copy of attached handout on preparation for barium enema diagnostic testing. Patient was able to restate preparation steps. Eric Williams, RMA (AMT)
The Mentally or Emotionally Impaired Patient
Psychology is the science of behavior and the human thought process. This behavioral science is primarily concerned with human beings acting alone or in groups. Normal behavior and abnormal behavior are distinguished from each other in psychology. All social interactions, such as those that occur during the communication process, may pose a problem for some people. As a medical assistant, you will encounter patients, family members, staff, and caregivers who exhibit a wide scope of behavior patterns. Abnormal behavior patterns may be caused by diseases, mental disorders, anxiety, drug abuse, trauma, the aging process, cultural customs, or a combination of several of these causes. Although it is difficult to deal with abnormal behavior, you must be tolerant and respectful of others in all circumstances.
When dealing with an emotionally or mentally impaired patient, it is important to determine, if possible, what level of communication the patient can understand. If a patient has a caregiver, that person may be able to give you tips regarding how to communicate with the patient. In most cases, you should speak slowly and clearly, stay calm, and keep your messages short. If you have to touch the patient for a procedure, be sure first to explain what you are going to do. A caregiver may be able to give you assistance in calming the patient, if needed.
The Physically Challenged Patient
Patients may have a permanent or temporary disability that pose a challenge in mobility. The patient may be using an assistive device, such as a cane or walker, or the patient may be in a wheelchair. Always allow the patient to ambulate and move on their own, offering assistance only when it appears necessary. When communicating and interacting with the patient, treat the patient with respect and dignity. Allow extra time with this patient, and do not appear to be impatient or rushed.
The Illiterate Patient
Illiteracy is the inability to read and write. Just as you cannot assume that everyone speaks English, you cannot assume that everyone knows how to read and write. This can be a challenge when filling out the many forms required in a medical office. If you notice that a patient is not filling out paper work or is taking a long time to do so, you should discreetly ask how they are coming along with the task and if they need any assistance. Perhaps there is a word or question they do not understand and a simple, polite explanation will clarify the meaning and enable them to move ahead. In other cases, it might be appropriate to move the patient to a private area and assist them to read the questions and write down the answers. In all situations, treat patients with respect and never do anything that might make them feel ashamed or inadequate.
The Seriously Ill or Terminally Ill Patient
As a medical assistant, you will come into contact with patients who have a terminal illness. A terminal illness is one that is expected to end in death. This includes many conditions and diseases, including cancer and progressive heart disease.
In cases in which the dying process is slow for the patient, you may have the opportunity to be with the patient on several occasions during office visits. Although there is always hope of recovery or finding a cure through research, it is wise to listen to the patient express her fears and concerns rather than to offer false hope for recovery. When there is no hope of recovery and death is expected within a year, you may be instructed by the physician to refer the patient to the services of Hospice. Hospice can provide the patient with comprehensive physical, palliative, psychologic, and spiritual care until death. After the death, Hospice will support the family, caregivers, and loved ones.
Death is a natural process that everyone must face. People have various ways of coping with their own death based on a variety of influences, including culture, religion, personal experience, and age.
Influence of Culture People learn what their own culture expects of them at a very early age by observing family and friends as they handle life events such as births and deaths. In some cultures, death is considered a normal end to the life process and is therefore accepted with peace. In other cultures, death may be feared. The terminally ill patient and family may have already established a very personal approach or method for handling death and dying. You may also have a strong cultural attitude toward death.
Influence of Religion Religious beliefs play an important role in how patients handle death and dying. Some patients have a strong belief in an afterlife. Other patients follow no particular religious belief. In both cases, the patients’ dying process and death can be meaningful and peaceful.
It is considered unacceptable for the medical assistant to attempt to convert the patient to the medical assistant’s religious faith. Professionalism mandates that the medical assistant and other staff members recognize and support the patient’s right to embrace different religious beliefs.
Influence of Personal Experience
The past experiences of the patient and the medical assistant mold how they approach the topic of death. If the patient has been closely involved with the care of someone who died a painful death, the patient may fear the same kind of death for himself or herself. These patients must be able to discuss their fears. In the same manner, if the medical assistant has had past experiences with the deaths of friends or relatives, it may be easier to assist the patient. On the other hand, patients who have had little exposure to death may have a more difficult time understanding their feelings or expressing their experience.
Influence of Age
Older adults usually have less fear of death than younger people. In some cases, an older adult may not feel well. Also, the patient may have failing eyesight, hearing, and memory and may look at death with relief. If the patient wishes to discuss his approaching death, you should be ready to listen.