The basic units of the communication process are the sender,  message, channel, and receiver. Use the acronym “SMCR” as  a memory aid. 

S stands for the sender of the communication. Who is  sending the message? 

M represents the message. The message can be conveyed by  written or spoken words or by behavior. 

C indicates the channel or method by which the message  moves from the sender to the receiver. Channels  include the senses: sight, smell, taste, hearing, and  touch. Another set of channels are pathways such as  the telephone or interoffice mail. 

R stands for the receiver of the message. 

 

For example, a physician (S) writes a prescription (M)  that the medical assistant then reads over the telephone (C)  to the pharmacist (R). If any link in this chain is broken,  an incorrect message is relayed. What could go wrong?  The physician might write the prescription incorrectly, or  the medical assistant might relay it incorrectly, or the  phone system might break down, or the pharmacist might  record the prescription incorrectly. A breakdown at any  point in the process would result in miscommunication of  the message.

 

The same holds true if you  relay a message to a patient. If the  medical assistant (S) explains a  procedure (M) verbally to a  patient who has a hearing loss (C),  then the patient (R) may not hear  the message as it was intended.  The communication process,  then, is a chain that links a  sender (S) and a receiver (R). The  sender (S) acts on a stimulus to  transmit (encode) a message (M)  in a particular form such as verbally or in writing. The message  can be transmitted in a variety  of ways (C), including face to  face, over the telephone, or in a  memorandum or an email. The  way the receiver (R) translates  (decodes) the message may be  influenced by the person’s age,  emotional state, perceptions, education, socioeconomic  background, culture, and many other factors.

 

 

 

 

 

 

 

 

Channels of Communication 

 

Channels of communication include the various means by  which the spoken or written word is communicated from  one person to another. Information is said to be “rich” if it  accurately conveys to the listener or reader the intent of the  speaker. The “richest” information is gained from face-toface discussion (Figure 5-1). The least rich information is  generally obtained from documents that contain a lot of  numbers, columns, and tables, such as budget reports.  When you want to convey an important message to someone,  it is better to do it face-to-face than to put the information  into writing. 

 

The face-to-face “rule” of communication is important to  remember when you are deciding how to adequately educate  patients about their medications. If you put all the important facts into a pamphlet or brochure, the patient may never  read it or might look at it but not understand what it means.  Face-to-face communication allows you to sense how well  the patient understands what you are saying, to ask the  patient questions to help confirm understanding, and to  give the patient a chance to ask you about anything he  doesn’t understand.  The three learning styles we discussed earlier—auditory,  visual, and kinesthetic—are another important concept to  remember when you consider how to communicate information to a patient. Keep in mind that using a variety of styles is a good way to reinforce the message. For example, when  providing a written document to the patient (visual), verbally review the information and ask if the patient has any  questions about that information (auditory) and, as appropriate, help the patient to practice any actions that will have  to be done at home, such as walking with crutches  (kinesthetic).  Table 5-1 illustrates the varying degrees of “richness” of  various information channels.

 

Figure 5-1 Face-to-face communication is the richest channel to relay a message from the sender to  a receiver.

 

Table 5-1 | Information Richness Channels

Information Channel  (Method of Delivery)  Level of Richness 

Face-to-face discussion Highest 

Telephone conversations High 

Written letter/memo  (individually addressed)  Moderate 

Formal written document  (general bulletins or reports)  Low 

Fax (facsimile) Low 

E-mail Low  Internet Low 

Formal numeric document  (printouts, budget reports)  Lowest

 

 

 

 

 

 

 

VERBAL AND NONVERBAL  COMMUNICATION 

 

Virtually everything a person does from birth to death is a  form of communication. Smiling is a form of nonverbal  communication, whereas talking “with a smile in your  voice” is verbal communication. Verbal communication is  the use of words to convey a message. Nonverbal communication is the language of gestures and actions, which includes  body language. In many cases, people are not aware of the  image they are projecting with their bodies. The way you  hold your arms, make eye contact, gesture, frown, or turn  toward or away from the patient frequently conveys much  more than mere words could (Figure 5-2).  Box 5-1 offers some examples of messages that convey  impatience.

 

Verbal Communication

Verbal communication involves spoken words, sounds, and  tone of voice. Good verbal communication includes appropriate word selection, a positive attitude, and self-boundaries.  The sounds a person makes when speaking cover a wide  range and can convey vastly different meanings. The tone in  which you speak to a patient is vitally important in making  a positive impression on the patient and the patient’s family.  Generally, people will raise their tone at the end of a statement when asking a question and drop their tone when completing a sentence. When the speaker’s tone drops, it is  appropriate to begin your part of the conversation. Interrupting speakers is a negative behavior that creates a barrier  to good communication.

 

The medical assistant should speak loudly enough to be  heard but not so loudly that a patient’s confidentiality is compromised. When communicating with patients, you should  always be in a private area if the message includes the patient’s  protected health information (PHI). Speaking clearly and  pronouncing your words properly are very important.

 

 

FIGURE 5-2 Nonverbal communications convey strong, powerful messages that may be positive or negative.

 

Word Selection 

Choosing the right words is critical. We can all think of  instances when we called a medical facility only to have been  spoken to as though we were an annoyance to the person at  the front desk. Other times, telephoning the medical assistant was a pleasant experience, and when the conversation  was completed, we had a positive feeling. Sarcasm and ridicule have no place in the professional setting. The goal of the  medical assistant is to promote an open, comfortable environment for the patient while keeping in mind that the  patient is the customer. Choose your words carefully, and  take care not to be rude or impatient. 

 

Also be careful not to use technical words or medical language that the patient might not understand. Be aware of  the patient’s education level and age. For example, when  talking with an adult, using the words stomach or abdomen is  appropriate; however, if the patient is a three-year-old child,  you might consider using the word tummy. 

 

Positive Attitude 

 

The ability to convey a positive attitude is very important.  When a patient is present, always involve the patient in your  conversation. Excluding the patient—for example, talking  about the patient to the patient’s parent or spouse but not to  the patient himself—is rude. Talking in a manner that is  incomprehensible to the patient—“over the patient’s head”—  is disrespectful. It is important to talk face to face with a  patient who is ill or upset, listening carefully and showing  concern for the patient’s welfare (Figure 5-3). You should be  able to demonstrate empathy and sympathy, but be cautious  about conveying an attitude of pity for your patients. 

 

 

 

**BOX 5-1 | Communication Messafges Conveying Impatience

• Interrupting people when they are speaking
• Answering telephone calls curtly
• Finishing another person’s sentence
• Rushing the patient
• Looking at your watch or the clock
• Doing two things at once
• Not looking up from your work when someone approaches
• Rushing around the office

 

FIGURE 5-3 It is important to act concerned when a patient is upset.

 

 

Self-boundaries 

 

Word selection and positive attitudes are important aspects  of verbal communication. An equally important component  of verbal communication is the concept of self-boundaries.  This concept will help you to be aware of topics you should  not discuss with patients. A medical assistant may think  that sharing personal information is a way to build rapport  with a patient, but this is not professional. In fact, sharing  personal information can make patients uncomfortable and  may be viewed as a violation of respect and trust from too  much intimacy being introduced to the relationship.  Recognizing and adhering to self-boundaries will help you,  as a medical assistant, to protect your privacy and keep  your work and personal lives separate. Also, patients will  feel that their health care needs are being met in a secure  and therapeutic environment when self-boundaries are  maintained.

 

JUDGMENT CALL 

When you are working with others in the office, you should  also be aware of their interactions with patients. Let’s say  you observe another medical assistant talking with a patient,  and you hear the patient talking about the recent loss of her  husband. The medical assistant responds to the patient, stating, “You poor thing.” The medical assistant also starts to cry  with the patient. What would you do, if anything, to intervene in this situation? Think about the differences between  empathy, sympathy, and pity—and how these attitudes may  affect the patient—to help you decide on your action.

 

*** Professionalism The Life Span

Medical assistants devote a significant amount of  time interacting with and caring for older adult  patients. As the baby boomer generation reaches  retirement age and more than likely will have an increased  need for medical care, the medical assistant will encounter  more older adult patients. Older adults should be treated  with respect, as should all patients. It is important not to  generalize and treat all older adult patients as frail, confused, and “over the hill.” Quite a few people over age 65  are employed full-time, are physically and sexually active,  and are raising young families.  Many patients in this age bracket live alone and are eager  for conversation and a kind word. Taking a few extra minutes  can mean a great deal to the lonely patient.  It is demeaning to call the patient “dear” or “honey.” The  terms “Mr.,” “Ms.,” or “Mrs.” should be used when addressing patients unless they instruct you to use their first name.

 

 

Nonverbal communication

 

Nonverbal communication is unspoken mannerisms that  convey thoughts and feelings. Nonverbal communication  generally is unconscious and not easily “faked.” For this reason, nonverbal communication often is considered to be a  more genuine indicator of a person’s feelings than spoken  words. It is important that verbal and nonverbal communication send the same message. Nonverbal communication  includes the eight behaviors summarized in Table 5-2. 

 

Body language is learned through imitation, by being  taught, and by instinct. Patients expect certain types of  behaviors, attitudes, and appearance in the health care setting. Medical assistants must be aware of the body language  they are using and modify any behavior that could be perceived by patients as inappropriate or negative. For example,  appearance is a nonverbal form of communication. Unprofessional attire, visible tattoos, and overpowering perfume  can send a negative message. 

 

The gesture of touch is a form of nonverbal communication and a form of body language. Some gestures can be  interpreted differently than what the medical assistant  might intend. Gently touching a distraught patient’s arm  can provide reassurance and comfort. However, you must be  cautious that the receiver does not misinterpret a touch. In  some cultures, for instance, it is considered rude to touch a  child’s head without permission. At times, abused children  can be fearful of even innocent touching. Use caution when  touching a patient unless you know that patient well.

 

ACTIVE LISTENING 

 

The ability to encourage a patient to communicate effectively is critical when you wish to determine the patient’s  problems. For example, how can you redirect a patient who  is talking about seemingly irrelevant issues? Or how can you  get uncommunicative patients to tell you exactly how they  are feeling and what they are especially concerned about  during today’s visit? Each communication experience has  unique qualities and must be considered carefully. Before we  discuss specific techniques, we need to consider several questions about the overall communication process: 

• What is the goal of your communication?
• What message do you want to send?
• What channel or method will be used to deliver the message (written, verbal, face to face, etc.)?
• How will you listen to the response (listening and observational skills)?
• How will you get clarification and feedback?
• Did you meet your goal, or do you need to revise the message (assess or evaluate)?

 

 

TABLE 5-2 | Nonverbal Communication

Behavior                                                Examples 

Posture               Standing or sitting upright,  slumping, slouching 

Position              Crossed arms or legs, facing a  person or turning away 

Facial expression       Smiling, frowning, rolling eyes 

Territoriality/  physical boundaries  Standing too close or too far from  someone  Gestures           Waving, pointing, using fingers to  indicate numeric amounts 

Touch                    Physically touching or not  touching another person, firm or  weak handshake 

Mannerisms Clothing, hairstyle, tattoos; tone  of voice; tapping of fingers 

Eye contact    Looking toward or away from  someone, especially while they  are talking

Listening Skills 

 

Listening involves understanding verbal and nonverbal cues  from the patient. You must pay attention to both.  Listening is either active or passive. Active listening  involves paying complete attention to the speaker, concentrating on the verbal message, watching for nonverbal cues,  and offering a response. At times, it is difficult in a medical

office to actively listen when so much activity is happening at  once. One skill you will gain with experience is the ability to  prioritize simultaneous events. Passive listening is listening  to someone without having to reply or respond in any way,  such as when you are listening as a member of an audience. 

How you hear a message is often colored by the message  that is being delivered. If it is criticism of your work and you  disagree, you hear it one way. If it is praise for your work,  you hear it another way. Sometimes you begin formulating a  response before the speaker is finished. In any circumstance,  if the listener’s mind or thoughts wander, the message is  received ineffectively, or it may be missed completely by the  listener (receiver). Part of effective listening is allowing  enough time for the message to be completed and knowing  when it is your turn to speak. 

With practice we can all become good listeners. Procedure 5-1 provides steps to practice active listening skills to  employ with patients as well as with those you will encounter in the workplace. The following are some additional  guidelines for good listening: 

• Avoid distractions.
• Face the speaker.
• Give the person your full attention.
• Maintain the type of eye contact that is suitable for the culture of the patient.
• Do not be judgmental about what is said.
• Be aware of nonverbal cues.
• Note anything that seems unclear.
• Do not interrupt.
• Maintain personal space.
• Ask questions if you do not understand.