Interpersonal Skills and Human Behavior

Copyright © 2011, 2007, 2004 by Saunders, an imprint of Elsevier Inc. All rights reserved. 1

Interpersonal Skills Interpersonal Skills and Human Behaviorand Human Behavior

Chapter 5


IntroductionIntroduction

The medical assistant’s interpersonal skills help to The medical assistant’s interpersonal skills help to set the tone of the office.set the tone of the office.

Interpersonal skills and human relations intersect, Interpersonal skills and human relations intersect, and the successful medical assistant will work to and the successful medical assistant will work to improve both sets of skills throughout his or her improve both sets of skills throughout his or her career.career.


This chapter will examine:This chapter will examine:

The importance of first impressionsThe importance of first impressions The differences between verbal and nonverbal The differences between verbal and nonverbal

communicationscommunications Spatial separationSpatial separation The value of touch while communicatingThe value of touch while communicating Elements of the transactional communication modelElements of the transactional communication model Barriers to effective communicationBarriers to effective communication Defense mechanisms, listening, and dealing with Defense mechanisms, listening, and dealing with

conflictconflict


Questions to consider…Questions to consider…

How can the medical assistant treat patients How can the medical assistant treat patients as individuals during a busy workday?as individuals during a busy workday?

How does the medical assistant communicate How does the medical assistant communicate effectively with the patient’s family members?effectively with the patient’s family members?

How will developing good listening skills How will developing good listening skills make the medical assistant more effective?make the medical assistant more effective?

How do friends and family members play a How do friends and family members play a role in the health of the patient?role in the health of the patient?


The Patient’s PerceptionThe Patient’s Perception

The patient’s perception of the physician’s office The patient’s perception of the physician’s office and the staff members is critically important.and the staff members is critically important.

Perception may not be accurate at all times, but Perception may not be accurate at all times, but what the patient perceives is just as important as what the patient perceives is just as important as what is actually happening.what is actually happening.


First ImpressionsFirst Impressions

First impressions are still lasting ones!First impressions are still lasting ones!


First ImpressionsFirst Impressions

First impressions are more than physical First impressions are more than physical appearance or dress.appearance or dress.

Opinions formed in the first few moments of Opinions formed in the first few moments of meeting last much longer in our thoughts than meeting last much longer in our thoughts than the actual time we spend with a person we have the actual time we spend with a person we have just met.just met.

The first impression includes attitude, The first impression includes attitude, compassion, and the smile!compassion, and the smile!


IntroductionsIntroductions

Always introduce yourself to patients Always introduce yourself to patients SmileSmile Wear a name badgeWear a name badge Show the patient around the officeShow the patient around the office Introduce other staff members to the patientIntroduce other staff members to the patient Put the patient at easePut the patient at ease


Medical Record as CommunicationMedical Record as Communication

Must be legibleMust be legible Spelling and grammar must be well-usedSpelling and grammar must be well-used If it isn’t in the medical record, legally, it did If it isn’t in the medical record, legally, it did

not happennot happen Anything that influences the patient’s mental, Anything that influences the patient’s mental,

physical, or even spiritual health can be physical, or even spiritual health can be added to the medical record, because all added to the medical record, because all affect the whole personaffect the whole person


Verbal CommunicationVerbal Communication

Speak clearly and enunciate properly.Speak clearly and enunciate properly. Vary the pitch of the voice.Vary the pitch of the voice. Use appropriate volume.Use appropriate volume. Speak at an audible level.Speak at an audible level. Make eye contact. Make eye contact. Speak in an animated fashion.Speak in an animated fashion. Show concern. Show concern. Do not interrupt a person who is speaking.Do not interrupt a person who is speaking.


Verbal CommunicationVerbal Communication

Tone of voice is very important in communication.Tone of voice is very important in communication. Never be sarcastic.Never be sarcastic. Never be rude.Never be rude. Never make an inappropriate remark and followNever make an inappropriate remark and follow it by saying, “I was just kidding.” it by saying, “I was just kidding.” Take care not to hurt anyone’s feelings withTake care not to hurt anyone’s feelings with words or phrases. words or phrases.

Verbal Communication depends on words and sounds.Verbal Communication depends on words and sounds.


Patients Need Tender CarePatients Need Tender Care

Remember that patients are in the office to be Remember that patients are in the office to be cared for.cared for. They may have great concerns.They may have great concerns. They may be very apprehensive.They may be very apprehensive. They may be fearful.They may be fearful.


Listen to PatientsListen to Patients

Allow patients to do most of the talking.Allow patients to do most of the talking. Do not offer personal information about your Do not offer personal information about your

own life and problems.own life and problems. Share only positive experiences, and then, only Share only positive experiences, and then, only

briefly.briefly. Do not burden the patient with your problems at Do not burden the patient with your problems at

any time!any time!


Nonverbal CommunicationNonverbal Communication

Nonverbal communications are messages that Nonverbal communications are messages that are conveyed without the use of words. are conveyed without the use of words. Transmitted by:Transmitted by: Body languageBody language GesturesGestures MannerismsMannerisms Eye movementEye movement


Body LanguageBody Language

Partly instinctivePartly instinctive Partly taughtPartly taught Partly imitativePartly imitative


Body LanguageBody Language

Involves:Involves: Eye contactEye contact Facial expressionFacial expression Hand gesturesHand gestures GroomingGrooming DressDress SpaceSpace Tone of voiceTone of voice PosturePosture TouchTouch


AppearanceAppearance

Appearance is a vital part of nonverbal Appearance is a vital part of nonverbal communication.communication.

Appearance can present conflicting nonverbal Appearance can present conflicting nonverbal information.information.


AppearanceAppearance

The successful medical assistant expresses:The successful medical assistant expresses: self-esteemself-esteem confidenceconfidence pleasant facial expressionspleasant facial expressions caring attitudescaring attitudes


Conservative AppearanceConservative Appearance

In the medical profession, patients expect In the medical profession, patients expect professionalism, and conservative appearance is professionalism, and conservative appearance is preferred to avoid blocks in communications.preferred to avoid blocks in communications.


ProxemicsProxemics

Proxemics is the study of the nature, degree, Proxemics is the study of the nature, degree, and effect of the spatial separation individuals and effect of the spatial separation individuals naturally maintain and how this separation relates naturally maintain and how this separation relates to cultural and environmental factors.to cultural and environmental factors.


Spatial BoundariesSpatial Boundaries

Public Space: 12-25 feetPublic Space: 12-25 feet Social Space: 4-12 feetSocial Space: 4-12 feet Personal Space: 1½ to 4 feetPersonal Space: 1½ to 4 feet Intimate Space: touching to 1½ feetIntimate Space: touching to 1½ feet


What Can Touch Mean?What Can Touch Mean?

Touch, in the medical profession, can be Touch, in the medical profession, can be comforting or can promote a sexual harassment comforting or can promote a sexual harassment lawsuit.lawsuit.


Avoid Claims of BatteryAvoid Claims of Battery

Be very careful when touching a patient. Be very careful when touching a patient. Non-consensual touching can be considered Non-consensual touching can be considered

battery in today’s litigious society.battery in today’s litigious society.


The medical assistant should not be afraid to The medical assistant should not be afraid to touch patients in an appropriate manner.touch patients in an appropriate manner.


Posture and PositioningPosture and Positioning

Can signal:Can signal: DepressionDepression AngerAnger ExcitementExcitement FearFear An appeal for helpAn appeal for help


The Process of CommunicationThe Process of Communication

To communicate well, we must have a general To communicate well, we must have a general understanding of the process of communication.understanding of the process of communication.

Usually when two people interact, they both Usually when two people interact, they both function as senders and receivers.function as senders and receivers.


ChannelsChannels

Channels can be:Channels can be: Spoken wordsSpoken words Written messagesWritten messages Body languageBody language


EncodingEncoding

Senders encode a message, which means that Senders encode a message, which means that they choose a specific method of expression they choose a specific method of expression using words and/or other channels.using words and/or other channels.


DecodingDecoding

The receiver decodes the message according to The receiver decodes the message according to his or her understanding of what is being his or her understanding of what is being communicated.communicated.


NoiseNoise

Noise contributes to the misunderstanding of Noise contributes to the misunderstanding of messages. Noise is anything that interferes with messages. Noise is anything that interferes with the message being sent.the message being sent.


FeedbackFeedback

Verbal expressionVerbal expression Body languageBody language Nod of understandingNod of understanding


Transactional Communication ModelTransactional Communication Model

From Adler RB, Towne N: Looking out, looking in: interpersonal communication, San Antonio, 1996, Harcout Brace.


ListeningListening

Listening is paying attention to sound or hearing Listening is paying attention to sound or hearing something with thoughtful attention. Listening is an something with thoughtful attention. Listening is an important skill that the medical assistant can develop.important skill that the medical assistant can develop.


What Prevents Us from Listening?What Prevents Us from Listening?

Our own thoughts distract us.Our own thoughts distract us. Situations in our lives make it hard to listen.Situations in our lives make it hard to listen. Conversation seems meaningless and unimportant.Conversation seems meaningless and unimportant. Too many messages are coming in at once.Too many messages are coming in at once. Emotions, such as anger, render us unable to Emotions, such as anger, render us unable to

listen.listen. Exhaustion makes listening difficult.Exhaustion makes listening difficult. We have prejudged the speaker and feel there is We have prejudged the speaker and feel there is

no need to listen.no need to listen.


Listening to PatientsListening to Patients

Patients must know that we are listening—not Patients must know that we are listening—not only hearing the words that are being spoken, but only hearing the words that are being spoken, but attempting to interpret what the patient is trying to attempting to interpret what the patient is trying to communicate.communicate.


ParaphrasingParaphrasing

Paraphrasing:Paraphrasing: Listening to what the sender is communicatingListening to what the sender is communicating Analyzing the wordsAnalyzing the words Restating them to confirm that the receiver has Restating them to confirm that the receiver has

understood the message as the sender understood the message as the sender intended itintended it

Clarifies speaker’s thoughtsClarifies speaker’s thoughts Helps to indicate that there is common Helps to indicate that there is common

understandingunderstanding


Ask Open-Ended QuestionsAsk Open-Ended Questions

Can you explain what the pain feels like?Can you explain what the pain feels like? When did you first notice these symptoms?When did you first notice these symptoms? What are you usually doing when you have What are you usually doing when you have

symptoms?symptoms? What do you think is causing the symptoms?What do you think is causing the symptoms?


Observing CarefullyObserving Carefully

Watch for signals from patients, such as tears, Watch for signals from patients, such as tears, sad expressions, or volatile temper.sad expressions, or volatile temper.


Defense MechanismsDefense Mechanisms

Verbal Aggression—A person attacks another Verbal Aggression—A person attacks another without addressing the original complaint or without addressing the original complaint or disregards it inappropriately.disregards it inappropriately.Sarcasm—A biting edge added to words that a Sarcasm—A biting edge added to words that a person states with the intent to cause pain or person states with the intent to cause pain or anger.anger.Rationalization—Attributing actions to rational and Rationalization—Attributing actions to rational and credible motives without analyzing underlying credible motives without analyzing underlying methods.methods.



Compensation—Making up for one behavior by Compensation—Making up for one behavior by stressing another.stressing another.Regression—The reversion to an earlier mental or Regression—The reversion to an earlier mental or behavioral level.behavioral level.Repression—Process whereby unwanted desires Repression—Process whereby unwanted desires or impulses are excluded from the consciousness or impulses are excluded from the consciousness and left to operate in the unconscious.and left to operate in the unconscious.



Apathy—A lack of feeling, emotion, interest, or Apathy—A lack of feeling, emotion, interest, or concern.concern.Displacement—The redirection of an emotion or Displacement—The redirection of an emotion or impulse from its original object, such as an idea or impulse from its original object, such as an idea or person, to another object.person, to another object.



Denial—A state in which confrontation with a Denial—A state in which confrontation with a personal problem or with reality is avoided by personal problem or with reality is avoided by denying the existence of the problem or reality.denying the existence of the problem or reality.Physical avoidance—Avoidance of any Physical avoidance—Avoidance of any representation of a painful event.representation of a painful event.Projection—The attribution of one’s own ideas, Projection—The attribution of one’s own ideas, feelings, or attitudes to other people or to objects.feelings, or attitudes to other people or to objects.


Dealing with ConflictDealing with Conflict

Conflict is the struggle resulting from incompatible Conflict is the struggle resulting from incompatible or opposing needs, drives, wishes, or external or or opposing needs, drives, wishes, or external or internal demands.internal demands.


Conflict can…Conflict can…

Be beneficial to relationshipsBe beneficial to relationships Be constructiveBe constructive Allow people to learn about each otherAllow people to learn about each other Promote stronger understandingPromote stronger understanding Promote deeper levels of intimacyPromote deeper levels of intimacy


Assertion—Stating or declaring positively, often Assertion—Stating or declaring positively, often forcefully or aggressivelyforcefully or aggressivelyNonassertion—The inability to express needs and Nonassertion—The inability to express needs and thoughts or the refusal to express themthoughts or the refusal to express them


Resolving ConflictResolving Conflict

Every relationship experiences conflictEvery relationship experiences conflict First impulse is often the “fight-or-flight” First impulse is often the “fight-or-flight”

syndromesyndrome Put aside thoughts of personal attackPut aside thoughts of personal attack Think logically Think logically


Tips for Resolving ConflictTips for Resolving Conflict

Expect conflict – do not fear or dread itExpect conflict – do not fear or dread it Realize that conflict can be healthyRealize that conflict can be healthy Accept that others have legitimate, viable Accept that others have legitimate, viable

opinionsopinions Listen and consider other’s opinionsListen and consider other’s opinions Never attack those with differing opinionsNever attack those with differing opinions Do not insist on being right all of the timeDo not insist on being right all of the time Avoid judgment or assigning blameAvoid judgment or assigning blame Deal with conflict quickly when it arisesDeal with conflict quickly when it arises


BoundariesBoundaries

Boundaries indicate a limit or fixed extent. Boundaries indicate a limit or fixed extent. Setting boundaries at work helps to avoid Setting boundaries at work helps to avoid awkward situations and misunderstandings. awkward situations and misunderstandings.


Examples of Workplace BoundariesExamples of Workplace Boundaries

Calling a person by a first name or Calling a person by a first name or Mrs./Ms./Mr.Mrs./Ms./Mr.

Refusing to listen to offensive jokesRefusing to listen to offensive jokes Refraining from forwarding emails that are not Refraining from forwarding emails that are not

business-relatedbusiness-related Leaving the office door open when speaking Leaving the office door open when speaking

with someone of the opposite sexwith someone of the opposite sex Dating people who work for the same facility Dating people who work for the same facility

or patients from the practiceor patients from the practice


Four Steps in Setting Workplace Four Steps in Setting Workplace BoundariesBoundaries

Know how you expect to be treated and Know how you expect to be treated and communicate that to others.communicate that to others.

Do not feel that you have to explain your Do not feel that you have to explain your boundaries to others.boundaries to others.

Be respectful, thoughtful, and responsible Be respectful, thoughtful, and responsible when setting boundaries.when setting boundaries.

Respect other people’s boundaries if you Respect other people’s boundaries if you want yours to be respected.want yours to be respected.


What to Say to Stop InappropriatenessWhat to Say to Stop Inappropriateness

““Stop! I am not interested in hearing this topic!”Stop! I am not interested in hearing this topic!”““Stop! I am not interested in seeing this Stop! I am not interested in seeing this behavior!”behavior!”


Self-BoundariesSelf-Boundaries

Self-boundaries are your own rules about how Self-boundaries are your own rules about how you will behave in the workplace and what you you will behave in the workplace and what you will and will not accept or condone.will and will not accept or condone.


CrazymakersCrazymakers

The Avoider:The Avoider:Refuses to fight; keeps from facing the problem at Refuses to fight; keeps from facing the problem at hand.hand.The Pseudoaccommodator:The Pseudoaccommodator:Refuses to face up to a conflict by either giving in Refuses to face up to a conflict by either giving in or pretending nothing is wrong.or pretending nothing is wrong.



The Guiltmaker:The Guiltmaker:Tries to make his or her partner feel responsible Tries to make his or her partner feel responsible for causing pain.for causing pain.The Subject Changer:The Subject Changer:Escapes facing up to aggression by shifting the Escapes facing up to aggression by shifting the conversation when it approaches an area of conversation when it approaches an area of conflict.conflict.



The Distracter:The Distracter:Attacks other parts of his or her partner’s life Attacks other parts of his or her partner’s life rather than expressing feelings of dissatisfaction.rather than expressing feelings of dissatisfaction.The Mind Reader:The Mind Reader:Refuses to allow his or her partner to express Refuses to allow his or her partner to express feelings honestly and goes into an analysis of feelings honestly and goes into an analysis of what the partner “really means.”what the partner “really means.”



The Trapper:The Trapper:Sets up desired behavior, then attacks that Sets up desired behavior, then attacks that behavior once it manifests.behavior once it manifests.The Crisis Tickler:The Crisis Tickler:Brings what is bothering him or her almost to the Brings what is bothering him or her almost to the surface but never quite expresses true feelings.surface but never quite expresses true feelings.



The Gunnysacker:The Gunnysacker:Does not immediately respond to anger. Directs Does not immediately respond to anger. Directs pent-up frustrations and aggression on the pent-up frustrations and aggression on the unsuspecting partner.unsuspecting partner.The Trivial Tyrannizer:The Trivial Tyrannizer:Does things that will bother the partner instead of Does things that will bother the partner instead of honestly sharing his or her own resentments.honestly sharing his or her own resentments.The Beltliner:The Beltliner:Hits the partner below the psychologic belt.Hits the partner below the psychologic belt.



The Joker:The Joker:Kids around when the partner wants to be serious, Kids around when the partner wants to be serious, instead of expressing true feelings.instead of expressing true feelings.The Blamer:The Blamer:More interested in finding fault than in resolving a More interested in finding fault than in resolving a conflict.conflict.The Contract Tyrannizer:The Contract Tyrannizer:Will not allow relationships to change from the Will not allow relationships to change from the way they once were.way they once were.



The Kitchen Sink Fighter:The Kitchen Sink Fighter:Brings up things that are totally off the subject Brings up things that are totally off the subject instead of dealing with the issues at hand.instead of dealing with the issues at hand.The Withholder:The Withholder:Punishes the partner by holding something back, Punishes the partner by holding something back, building up greater resentment.building up greater resentment.The Benedict Arnold:The Benedict Arnold:Gets back at partners by sabotage, failing to defend Gets back at partners by sabotage, failing to defend them and encouraging ridicule toward them.them and encouraging ridicule toward them.


Barriers to CommunicationBarriers to Communication

Physical impairmentPhysical impairmentLanguageLanguagePrejudicePrejudiceStereotypingStereotypingPerceptionPerception


Communication During Difficult TimesCommunication During Difficult Times

During AngerDuring Anger One of the most difficult times to communicateOne of the most difficult times to communicate Expression of anger is usually healthyExpression of anger is usually healthy Unexpressed anger causes or contributes to all Unexpressed anger causes or contributes to all

types of health problemstypes of health problems



AngerAnger Anger is usually not directed toward the medical Anger is usually not directed toward the medical

assistant.assistant. Be a good listener.Be a good listener. Use logic.Use logic. Do not use absolutes such as “never” and Do not use absolutes such as “never” and

“always.”“always.” Remain calm.Remain calm.



ShockShock Many types of shock can occur.Many types of shock can occur. Usually happens after some catastrophe.Usually happens after some catastrophe. Patient often cannot think or move.Patient often cannot think or move. Some scream in agony, others seem almost Some scream in agony, others seem almost

normal.normal. We never know how we might react in a deeply We never know how we might react in a deeply

stressful situation.stressful situation. Our reactions may differ from time to time.Our reactions may differ from time to time.



ShockShock Never leave a person in shock alone.Never leave a person in shock alone. Do not allow the person to speed off in a car.Do not allow the person to speed off in a car. Listen!Listen! Watch the person carefully.Watch the person carefully. Make sure the person is with a trusted relative Make sure the person is with a trusted relative

or friend before he or she leaves the office.or friend before he or she leaves the office.


Death and DyingDeath and Dying

Elisabeth Kübler-RossElisabeth Kübler-Ross

Dr. Kübler-Ross studied thanatology, the study of Dr. Kübler-Ross studied thanatology, the study of the phenomena of death and of psychologic the phenomena of death and of psychologic methods of coping with death. methods of coping with death.


Five Stages of GriefFive Stages of Grief

DenialDenialAngerAngerBargainingBargainingDepressionDepressionAcceptanceAcceptance


Multicultural IssuesMulticultural Issues

We sometimes think that people all over the We sometimes think that people all over the world think and behave as we do.world think and behave as we do.

We often stereotype those from other cultures We often stereotype those from other cultures and think that we understand them.and think that we understand them.

Those from other geographic areas, even within Those from other geographic areas, even within the United States, may experience culture the United States, may experience culture shock in new surroundings.shock in new surroundings.

Patience is an important trait when dealing with Patience is an important trait when dealing with those from other cultures.those from other cultures.


Communicating with Those from Communicating with Those from Other CulturesOther Cultures

Treat them as you would wish to be treated.Treat them as you would wish to be treated. Overcome language barriers.Overcome language barriers. Be patient when communicating.Be patient when communicating. Encourage patients to bring a translator, if Encourage patients to bring a translator, if

necessary.necessary. Understand the nonverbal communications of Understand the nonverbal communications of

other cultures.other cultures.


Non-English Speaking PatientsNon-English Speaking Patients

Patients who do not speak English should Patients who do not speak English should bring an interpreter to help with bring an interpreter to help with communication to each office visitcommunication to each office visit

If they do not bring an interpreter, attempt to If they do not bring an interpreter, attempt to find a person who can communicate, but this find a person who can communicate, but this is not the office’s responsibilityis not the office’s responsibility

Offices that serve a large population of Offices that serve a large population of non-English speakers should have a bilingual non-English speakers should have a bilingual person on staffperson on staff


Sensitivity to All PatientsSensitivity to All Patients

Any patient can feel anxiety when seeing the Any patient can feel anxiety when seeing the physicianphysician

Be very sensitive to the patient’s feelingsBe very sensitive to the patient’s feelings Explain steps of procedures to put them at Explain steps of procedures to put them at

easeease Always display a caring attitudeAlways display a caring attitude


Maslow’s Hierarchy of NeedsMaslow’s Hierarchy of Needs

Physical needs: food, rest, sleep, water, air, sexPhysical needs: food, rest, sleep, water, air, sex Safety needsSafety needs Social needs: sense of belonging, interaction Social needs: sense of belonging, interaction

with otherswith others Self-esteem needs: feeling good about Self-esteem needs: feeling good about

ourselvesourselves Self-actualization: maximized potentialSelf-actualization: maximized potential


Maslow’s Hierarchy of NeedsMaslow’s Hierarchy of Needs

Adler RB, Towne N: Looking out, looking in: interpersonal communication, San Antonio, 1996, Harcourt Brace.


Human NeedsHuman Needs

ApprovalApproval AcceptanceAcceptance AchievementAchievement


Stages of SleepStages of Sleep

Two Main Phases of SleepTwo Main Phases of Sleep NREM (non–rapid eye movement)NREM (non–rapid eye movement)

Four stages, during which the body slowsFour stages, during which the body slowsdown and relaxesdown and relaxes

REM (rapid eye movement)REM (rapid eye movement) Deep sleep when dreaming occursDeep sleep when dreaming occurs Brain is highly activeBrain is highly active Eyes move rapidlyEyes move rapidly Occurs in the last hours of sleepOccurs in the last hours of sleep


Summary of ScenarioSummary of Scenario

People who are facing death or other People who are facing death or other catastrophes want to be treated like everyone catastrophes want to be treated like everyone elseelse

Greet them warmly and make sure they know Greet them warmly and make sure they know that you care about themthat you care about them

Be sure the patients understand their Be sure the patients understand their medications and treatmentsmedications and treatments

Direct them to community resourcesDirect them to community resources Listening is one of the most important skills to Listening is one of the most important skills to

developdevelop


Closing CommentsClosing Comments

Interpersonal skills are critical to the medical Interpersonal skills are critical to the medical assistantassistant

Communication is a part of virtually every Communication is a part of virtually every event during every dayevent during every day

Enhance interpersonal skills and human Enhance interpersonal skills and human relations skills at every opportunity through relations skills at every opportunity through classes and continuing educationclasses and continuing education

All communications must be effective to be of All communications must be effective to be of benefitbenefit

Documents

Interpersonal Skills and Human Behavior