*FIGURE 5-8 Emotion: anxiety.

**PROFESSIONALISM THE LAW

Medical assistants must use caution when communicating with patients. Providing false hopes for  recovery or implying that the physician may be able  to cure a patient is not only unethical but also can result in  liability for the physician and the medical assistant.  Documenting incidents in writing involves careful thought  and caution. It is important to chart exactly what occurred  and what the patient stated rather than your feelings about  the situation. Recording the patient’s comment exactly; “I  have an overwhelming feeling of hopelessness” is a better indication of the patient’s emotional state than the comment “I  think the patient is depressed.” The latter comment reflects  the medical assistant’s judgment of the patient’s appearance  or statement, not what the patient said. As with everything  that transpires in the medical environment, the HIPAA regulations regarding confidentiality must be kept in mind.

 

*FIGURE 5-9 Signs of stress.

 

Stress 

Stress is the body’s reaction to the world around it. Stress  can be emotional, intellectual, or physical. It can also be  spiritual, economical, or social. Everyone experiences stress  at one time or another (Figure 5-9).  Depending on the level of stress, it can be energizing,  motivating, or exhausting. Medical research has shown that a  certain amount of stress is not a bad thing. The body’s reaction  to stress determines if it is good stress (eustress) or bad stress  (distress). Stress has also been implicated in various illnesses.  A stressor is a real or even an imaginary event that causes  stress.

Certain major life events such as the death of a loved  one, divorce, an unexpected move away from family and  friends, unemployment, illness, getting married, delivering  a baby, studying for an examination, or purchasing a new car can be stressors. Each of these life events or others may be  positive or negative. For a life event to be stressful, it does  not always have to be a negative event.  Certain predisposing factors create a tendency or susceptibility to become stressed. These include attitudes and feelings (e.g., emotions such as optimism or pessimism), health  habits (e.g., smoking, exercise, drug use, diet), the individual patient’s methods for coping, economic and social  resources (e.g., income, kind of job, security), and the state  of the patient’s immune system. 

Many patients with a major illness go through a period of  depression. The disease may cause emotional changes. In  turn, worry about the disease may cause unhealthy habits  such as an increase in smoking or drinking alcohol. Patients  who have a physical illness such as heart disease, diabetes, or  AIDS may become additionally stressed when confronted  with the loss of income or a job. 

Before you or a patient can cope with stress, you must be  able to recognize it and know how you are being affected by  it. You will also need to know what event or events are causing the stress. Recommendations for coping with stress  include the following: 

• Develop a strong support system, including family and friends.
• Find a balance between perfection and fear of failure.
• Eat nutritious meals.
• Avoid harmful habits such as smoking and drinking.
• Participate in physical exercise such as walking, jogging, dancing, biking, and swimming. • Look outward to develop a social interest by understanding other people’s problems and needs.
• Try to see the humor in situations.
• Limit the number of activities to a manageable few.

 

When you are working as a medical assistant, it will be  important for you not to let personal stress affect your job  performance. You also will experience stress that is related  to work. This type of stress must be left at work when you  go home for the night. Personal stress and work stress  need to be kept separate and should never interfere with  one another. 

 

As part of your job, every day you will be taking care of  patients who are sick. This can be emotionally, mentally, and  physically draining. Anytime your stress level is too high  and you have trouble coping, you must seek support from a  close friend or family member. If a close friend or family  member is not able to help you, seek help from a  professional. 

Encountering a patient who is experiencing stress provides an opportunity for patient teaching. After allowing the  patient to discuss the stress and stressors, assess the patient’s  knowledge of the topic of stress. Doing so will establish a  starting point for educating the patient. Next, determine  the appropriate reading, language, and education level of the  patient so that you can select and prepare materials to use to  teach the patient about stress. Some of the educational materials that are used in a medical office include videos and  patient teaching handouts. When you have completed the  patient teaching, you must document it in the patient’s  medical record. 

 

Symptoms of stress vary from person to person. It is  important for you to know what is normal for you and your  body. Box 5-2 lists symptoms of stress.

 

 

 

 

 

Use of Medical Language 

As a medical assistant, you will become adept at understanding and using the language of medicine. Medical  abbreviations are often used in communications among  people working in the health care field. Most of your  patients, however, have little understanding of medical  terminology. You may wish to teach patients a few simple  terms so they can better understand the physician’s  instructions about prescriptions, preparation for tests, or  follow-up care at home. Otherwise, you must make an  effort to avoid using medical terminology or abbreviations  when speaking with patients. For example, abbreviations  such as NPO, meaning “nothing by mouth,” are not readily recognized or understood by patients. Always write out  or state clear instructions regarding preparations for tests  and taking medications. Patients may be reluctant to  admit they do not understand, in which case you might  assume that they have been properly instructed when they  have not. Failure to inform patients in terms they are able  to understand could be construed as negligence on the part of the health care provider and increase the risk of a  lawsuit.

 

Coping Mechanisms/Defensive Behaviors 

A coping mechanism is a conscious or unconscious behavior used to respond to a challenging situation. Coping  mechanisms can be adaptive (positive and helpful) or nonadaptive (negative, defensive, and unhelpful). For example, when trying to meet a short deadline, a nonadaptive  coping mechanism could be becoming cross with others  because of the added stress. An adaptive coping mechanism could be to plan out tasks in advance and ask for  assistance when needed. Nonadaptive coping mechanisms,  also known as defensive behaviors, can create barriers to  communication, whereas adaptive coping mechanisms can  enhance communication. 

 

Defense mechanisms operate at a subconscious level to  manage stress and anxiety by denying, misinterpreting, or  distorting reality. They often hinder self-awareness by preventing people from being sensitive to anxiety. Defense  mechanisms can be helpful in dealing with anxiety; however, consistent use of certain defenses leads to the development of either good or self-destructive behavior patterns.  For example, the basic human need to be loved and cared  for by another person can result in a variety of behaviors  when the fear of losing love produces anxiety. One person  may be driven to constantly look for love and affirmation  by engaging in frequent one-night sexual encounters.  Another person may seek and develop a warm, intimate  relationship. A third person may be so frightened of not  finding love and so fearful of rejection that the person  avoids relationships to decrease the anxiety. The management of defense mechanisms may become so time consuming that little energy remains for other aspects of living. 

 

Medical assistants need to be aware of their own and  others’ coping mechanisms. Patients, when stressed by illness or uncertainty, might exhibit a variety of nonadaptive coping mechanisms. Medical assistants should anticipate this  and be prepared to respond in a positive, supportive, compassionate manner. As a member of the health care team, you  must beware of using defensive behaviors as coping mechanisms in the professional setting as well as at home. Some  examples of negative coping mechanisms are discussed in  Table 5-6.

 

**BOX 5-2 | Symptoms of Stress

Fatigue  Exhaustion  Difficulty falling asleep  Difficulty staying asleep  Restlessness  Tension  Boredom  Lack of interest  Inability to concentrate  Depression  Cramps  Constipation  Diarrhea  Flatulence  Sore muscles  Increased blood pressure  Increased heart rate  Change in eating habits  Increased use of alcohol

 

 

Responding to an Angry Patient 

One of the most challenging communication problems is  the angry patient. It can be a difficult task for a medical  assistant to refrain from taking the patient’s comments personally. People have different styles and coping mechanism  when they are frightened (Figure 5-10). Many patients who  enter the physician’s office are fearful of the diagnosis they  may hear. Some patients become frightened of the equipment in the office or have a high fear of pain. In addition to  fear, another cause of anger is loss of control. If you have been  hospitalized, you may be able to relate to this feeling. All  these sources of fear or anxiety may make the patient short-tempered about issues such as being misunderstood over the  phone, being asked to fill out paperwork when they arrive  for an appointment, having to wait too long to see the physician, not understanding instructions from the medical assistant or physician, or not getting the appointment time they  want for their next visit. 

 

The responsibility of the medical assistant is to remain  calm and use positive communication and professional  techniques to direct the patient’s anger into a positive channel. Try to defuse the patient’s anger. For instance, many  patients will gain control over their anger when the medical  assistant offers a comment such as “I’m really sorry you feel  this way. Let’s see if we can solve the problem.” You may  have to take the patient into a private office if you cannot  calm him or her immediately. Disruptive patients can upset

others who are waiting to see the physician. Although it is  not necessary to give in to a patient’s unreasonable demands,  it is important to realize that an upset patient is often  expressing the need for you to listen carefully, without judging, and to assist in solving the problem. Whenever  possible, try to direct the patient’s comments about a problem to a solution. 

 

In the case of an angry caller, you must remember that no  matter how angry or rude a patient becomes, you cannot  respond in anger. The role of the medical assistant is to assess  or evaluate the situation. Remain calm and speak to the  patient in a quiet, calm tone of voice, projecting your concern  for the patient in the present situation. Often this will be  enough to calm the patient. If that does not work, however,  ask your supervisor or office manager for assistance. Alternatively, ask the patient if you may return the call after you  have been able to gather more information that will enable  you to be of help. 

In the case of a patient who becomes abusive or violent, it  is necessary to consider the safety of yourself, other staff  members, and patients. In such a case, follow office protocols  to call for whatever assistance you need. Once the incident  has been resolved, be sure to document it appropriately,  according to office policies.

 

**TABLE 5-6 | Nonadaptive coping Mechanisms

Behavior                                                                  Description                                                          Example

Compensation                Substitution of an attitude, feeling, or  behavior with its opposite                Mrs. Matthews believes the lump in her breast is cancer.  However, she smiles and laughs whenever you talk to her  about it. 

Denial                                     Unconsciously avoiding an unwanted feeling  or situation                                  Mr. Morgan cancels an appointment to have a PSA blood  test for prostate cancer in spite of having symptoms  associated with prostate trouble. 

Displaced Anger            Expressing angry feelings toward persons or  objects that are unrelated to the problem                                                                                                                                                                                Mrs. Matthews is angry at being diagnosed with cancer.  She takes this anger out on her family members. 

Dissociation                      Not connecting one event with another                                                                                Mary Sims is a nurse who works with alcoholic patients.  In her free time, she drinks to excess. 

Introjection                        Adopting the feeling of someone else                                                                                     Mr. Morgan’s friends have said that the PSA test is reliable and could relieve his anxiety about having prostate  cancer. He believes them and has the test. 

Projection          Placing your own feelings on another person                                                                                     Mr. Morgan becomes irritated when the medical assistant calls to remind him of his appointment. He wrongly  decides that she is irritated with him or dislikes him. In  reality, he is upset with himself. 

Rationalization               Justifying thoughts or behavior to avoid the  truth 

Mary Sims believes that the appetite-suppressant  benefit of smoking offsets the risk of developing cancer. 

Regression        Turning back to former behavior patterns in  times of stress                                               Jimmy, who is toilet trained, reverts to bed-wetting  during hospitalization. 

Repression Keeping unpleasant thoughts or feelings out  of one’s mind 

Mr. Morgan denies any urinary frequency when  questioned by the physician. 

Sublimation Directing or changing unacceptable drives for  security, affection, or power into socially or  culturally acceptable channels 

Mrs. Matthews is worried about having cancer and uses  up energy cleaning her house.

 

 

*FIGURE 5-10 The medical assistant often has to reassure and comfort  the patient before effective communication can take place.

 See Procedure 5-2 for a role-play situation in which a  patient is feeling fright, anger, and anxiety.

Responding to an Anxious Patient 

Many patients exhibit what is known as white coat syndrome.  This term was derived from the anxiety a patient feels  when encountering medical staff, who would generally  wear a white coat; however, attire is often more varied in  today’s medical atmosphere. Some signs of anxiety are  trembling, flushing, perspiring, fidgeting, talking excessively, and remaining unusually quiet. Hypertensive  patients who suffer from white coat syndrome should have  their blood pressure measured at the beginning and the  end of the visit to get a more representative value when the  patient has had the opportunity to calm down and feel at  ease. To deal with anxious patients, use the communication  skills you have learned in this chapter: Speak calmly, reassure patients, smile, touch them respectfully on the  hand, and be empathetic.