Welcome to Communication at its Best. This PowerPoint presentation is part of the ABR MOB module prepared by the American Association of Medical Assistants. The objectives for this presentation are to illustrate the rationale for effective communication in healthcare, to identify components of effective communication, to describe strategies to overcome barriers to communication in the medical practice, and to outline the role of medical practice staff in promoting effective communication in the medical practice. It is very important to discuss why communication does matter. Communication serves as the cornerstone of interactions that exist between the patient and the healthcare professional. Remember, patients are human too. They're not only a person with a disease. When we talk about our patients, sometimes we have a tendency to refer to them as what they're coming into the office with, such as the flu patient down in room 2, or the pediatric patient that's here for vaccinations in room 5. We also need to communicate effectively to help identify the needs of the patient, to develop that trusting and a very positive relationship with the patient, as trust is extremely important for the patient to provide full disclosure to us. Effective communication allows us to share valuable information among all the stakeholders of healthcare that will be offering care and delivering care to that patient. We also need to communicate effectively to promote transparencies, no secrets. Again, full disclosure and truthfulness among all the stakeholders. Effective communication leads to a positive impact on the healthcare provider's professional and personal development. We grow professionally and personally through effective communication. It also helps decrease errors and adverse events and improves and enhances customer service, which is a key foundation in today's medical practice. Customer service has never been more important than it is today. Patients are afforded many different choices. Many different care delivery models exist. Inpatient care, outpatient care, ambulatory care, home care, short stay rehab, surgery centers. Previously, patients stayed locally. They would go to the office or the hospital or the clinic that's in their immediate local area. But today, traveling to another town or city is much easier than before. Patients have many options when considering that care delivery of choice. They can look for second opinions or the treatment plan that matches their goals and budget. Therefore, competition is great among healthcare providers and everyone is looking to attract patients. Healthcare today is all about advertising through TV, through social media, billboards, the radio. You can find information on many different care delivery options just by looking at the internet, for example. Effective communication is tied to customer service. There are many benefits of effective communication. It increases the likelihood that patients may disclose more information, which enables us to deliver better, more accurate, thorough care. It enhances patient satisfaction, builds rapport between the patient and the healthcare professional. Effective communication increases the patient's involvement in their decision-making and allows them the opportunity to make informed decision-making. It leads to more accurate diagnoses, leads to more realistic patient expectations, improves patient adherence to treatment. We know that if patients understand their treatment, ultimately that may help decrease follow-up phone calls, return visits, and ultimately in-hospital admissions. Effective communication also increases patients' receptability to seeking further care as soon as their symptoms develop. Hopefully, they won't wait until they are so ill that early interventions could not have occurred. We spend quite a bit of time talking about stakeholders in healthcare. Who are actually the stakeholders as we deliver care to our patient? We have external stakeholders, our vendors, our pharmacies, our pharmaceutical representatives, our local emergency medical service and fire personnel. We know how important a good working relationship is with those entities. If we do have a medical or an environmental emergency, we have effective communication plans in place. We have to consider our partner offices within our own organization as well as those competing offices because of referrals coming into our own office. Our laboratories and those referral agencies such as hospice, palliative care, skilled facilities, and hospitals. We also then have internal stakeholders, the patients themselves, their families, friends of the patients, our own coworkers, physicians, our custodial staff, your IT folks that work on your computers that may come in from other locations within your organization. When we think of effective communication, we need to think about including all of these folks, both external and internal, because they all form the team that's going to help us deliver patient care. One key external stakeholder is our joint commission, one of perhaps our most important accrediting agencies. The joint commission tells us that listening and communicating will help enhance patient satisfaction and better care. And one of the tools that the joint commission has provided us with is a handoff. The handoff is a transfer of a patient from one caregiver to another through the sharing of information. It is in real time and it ensures the continuity of care and safety of each patient. This handoff can be between the medical assistant to the physician, the medical assistant to the nurse practitioner, the medical assistant to the laboratory technician, to an outside pharmacy calling in an order, and those roles can be reversed. As the medical assistant, we expect good handoff communication coming to us from others as well. Joint commission tells us that many adverse events occur during the handoff with the omission of very important information. And it is not a safe practice to assume that because information was placed in the electronic medical record or health record, that it automatically is being shared. Key vital information should also occur on a face-to-face or a voice-to-voice level, so we know that this information is not being lost during the patient experience. Proper communication is also legally regulated through HIPAA regulations. And HIPAA tells us that patient harm can also happen through a lack of privacy, confidentiality, or disclosure issues in the physician office setting because that is where most routine maintenance visits happen. Trust in the healthcare provider can be broken when patients hear hallway conversations about other patients or themselves through the closed exam room door. These types of conversations constitute HIPAA violations and are subject to regulations surrounding this law. We as healthcare providers need to be very mindful of what we are saying and the location in which we are saying it, not only in the hallway, in our break room, behind the reception desk where individuals in the waiting room could hear our conversations, elevator conversations, at our child's soccer game at night. We need to be very, very cognizant of what we are saying and where we are saying it. This is extremely important to protect patients' privacy and their confidentiality. It is very important to know who we can disclose information to regarding patient care. That is why signing the forms in the office allows us to know if we could leave lab results on a recording, if we can give lab results to a spouse, to a child, an adult child. All of this is key to helping prevent patient privacy and confidentiality. So how does communication take place? There are many, many different avenues of communication, especially today in the world of electronics. Communication can occur verbally, non-verbally, and many of us have been taught that non-verbal communication is extremely powerful, and that includes your body language, your facial expressions. We know that communication can be written face-to-face, over the telephone, and now we have areas, email, our social media platforms, texting, faxing, blogging, through portals, instant messaging, and of course our electronic health record. Many organizations have their own portals, such as MyChart is another way to implement communication with the patient. Your organization will have policies on the use of electronic devices and social media for communication. Please do not make the assumption that texting or email is always accepted. Please review your own organizational policies to make sure that you are within the expectations that your organization has set forth. We've been talking a lot about excellent customer service, so let's look at an example that was actually written by a patient. Sally, my medical assistant, is the best. She's a great listener, asks the right questions, and is genuinely concerned about my well-being. I had little to no wait time when I visited the office. The receptionists were friendly and answered my questions I had with a good attitude. I was suffering from a bad flu and uncontrollable cough. After this visit and the right medication, I was better in no time. I'm very pleased with my care. When we look at this statement by the patient, some very important facts stand out. First of all, they remembered the medical assistant's name, so the medical assistant had introduced themselves. She listened to what the patient had to offer. She then asked questions about what the patient had told her. She demonstrated well-being. My guess is she made good eye contact with the patient. She also was not working on her computer while the patient was speaking to her. She showed genuine interest in the patient as they were explaining why they were in the office. Wait time was very important. This patient did not have to wait very long. In the waiting room, the receptionists were friendly and answered their questions. I'm assuming they smiled and welcomed and greeted the patient. It sounds like they were given good education because after this visit and the right medication, I was better. I was pleased with my care. Some key factors stood out there in this patient testimonial that could help guide us all to delivering excellent customer service. Here is another example of a patient testimonial that is demonstrating excellent customer service. This individual says, From the time I walked into the office, I was greeted with beautiful smiles of the staff members. They were all very polite and very helpful. The staff took time to listen to my health needs as well as took the time to answer questions. This is the best experience I have had in a doctor's office. I felt like a person and not like someone sick. They didn't treat me like a disease but treated me like any normal person. Very important to make sure that we address the patient appropriately by their name. Communication should be involving the patient, not what symptoms they have in the office. So, what does effective communication look like? Well, first of all, keep it simple. Avoid the jargon. Avoid medical terminology as much as possible. Avoid the acronyms. Medical terminology is a specialized language. Sometimes I think we have our own secret language like a foreign language when we're speaking among ourselves. It is totally different than when we're talking with the patient. Be truthful and honest. I have seen individuals be handed a prescription for some pain medication. With the explanation that get this filled and it will take away your pain. That is not possible sometimes to totally obliterate pain. Perhaps a better statement may be if you get this prescription filled for the pain medication, it will probably help your pain be tolerable. So, we need to make sure we're telling the truth and not giving the patient false promises. Be hopeful and encouraging to the patient. Watch for visual clues. Are they understanding? Are they tilting their head and looking at you like they have another question? Be prepared for those reactions. Assess what they already know. If they're going to have an x-ray, ask them if they have had an x-ray before. What was that experience like? Be empathetic and think, how would I feel if I were in their shoes at this time? Slow down. I know you are so busy in the office. You've got multiple patients to see and a time limit. But if we can slow down and address the patient's needs at the time they're in the office, we will have less follow-up phone calls, less return visits, and less inpatient hospitalizations. One tool that can help promote effective team communication was implemented first in the military. And many healthcare organizations have adopted these practices. They consist of three separate entities. The brief, the huddle, and the debrief. The brief is done at the beginning of the shift. In the morning, where you set goals for the day, You may highlight specific patients that might be coming in. The assignments are made. Who would have what room? Who is responsible for what throughout the day? The huddle can occur at any time throughout the day. When you huddle, you need to regroup and check progress. Perhaps you may need to call out for help. Make changes to assignments. If you're finding that you've had two or three patients in a row that needed your phlebotomy skills, it may have set you behind. And you may need to call to your colleagues and say, oh, I am running behind. We might need to regroup here. I need your assistance. And the debriefing is at the end of the shift. How did it go? What did we do well? What could we have done a little better? And what would we like to implement the next shift so that shift runs a little smoother? These methods have been proven by the military for years. And they are very helpful in health care. And if we're all participating in the brief, the huddle, and the debrief, it should make patient flow go much better throughout the day. And at the end of the day, the health care professional can say, you know, we did a good job today. I hope we can do as well tomorrow. Effective communication is our goal because it enhances the patient experience. Unfortunately, there are some barriers to effective communication. And those barriers may originate with the patient, the provider, or could be a combination of both of them. When we think of our patients, we have to remember that they're in pain. They're not feeling well. They may not feel like communicating well. They're anxious. They're under stress. They didn't want to come to the doctor today. Maybe they're having financial worries and concerned about how they may pay for this. We think about English as a second language or the lacking of English proficiency and their ability to understand and their educational level. When we look at the health care provider, of course, time constraints are huge. Too much to do with too little time. So we need to be very aware of the need to utilize the time that we do have with that patient to effectively communicate. Some patients will see us as the authority figure that we are in charge and they will do what we want us to do. I had a patient one time who went home and they had a new medication in their hand, a blue colored pill. And the patient's daughter said, well, dad, what is that blue pill for? And the patient's response was, if they would have wanted me to know, they would have told me. Your generations, your older folks, are not going to question because they look at that health care provider as the authority figure. Sometimes we get frustrated. The day is not going well. We've had extra patients added to the schedule. We had a colleague not show up to work. And our frustration definitely can peak and it might be demonstrated to the patient. That can roll over into job dissatisfaction and burnout on the part of the health care provider. When we look at the combination of the patient and the provider's barriers, we have to think about their health beliefs and values, their past practices. Are there religious considerations? What is their ethnic background? And do they have specific guidelines they need to follow through on to be in alignment with their ethnic beliefs? Their personality, that power dynamic of the health care provider being in charge and the patient having to do what we say. Or the flip side of that, the patient believing that they are the ones that should be in charge because they are the ones paying for the service. There's all different types of barriers that we may encounter. Other barriers include physical barriers. That computer, how many times have you been so intent upon entering information into the computer? You didn't look at the patient. You didn't truly listen to what they were telling you because you had to get information into that computer. We talk about perceptual barriers. Keep an open mind. Don't make statements like, well, those people always, or they, the we, they concept that they are different than I am. Emotional barriers, show confidence in the information that you are sharing. Not always are we giving the patient good news. Sometimes the patient has just received bad news. Or we are the deliverer of bad news. We have to make sure that we are confident in what we are saying. Those cultural barriers come up more and more each day. We need to make sure we're showing respect for everyone. And of course, the language barriers again. Avoid as much medical terminology as possible. Think about using pictures, videos, drawings, brochures, and translators if needed. When we talk about the patient who may need an interpreter or a translator, the Joint Commission has set a guideline. And Joint Commission does not recommend that families serve as interpreters. Because important information may be eliminated during that conversation. The family member may be very anxious and upset. And because of that, they may forget some important information. Missing pieces are not provided. And unfortunately, sometimes the family member may intentionally leave out information in cases of abuse or domestic violence. This is extremely important today to consider with the increased cases of human trafficking that we are seeing in the offices. So let's talk about what poor communication is. I think all of us would agree that yelling, humiliation of others, swearing are all examples of very poor communication. Racial or ethnic insults. Probably at some time in our lives, we all may have been a victim of some sort of a joke that may have to do with our physical appearance or where we grew up, things such as that. Harassment or name calling. Hostile body language. Crossing your arms can be seen as a form of nonverbal communication too. Stay away from me. Don't approach me. And failure to recognize a job well done by our co-workers. There's a tool out there called Manage Up. And in Managing Up, you actually share with the patient a good attribute that is tied to a co-worker. So if I'm a medical assistant and we have a lab in our office and I am walking a patient over to the lab, while I'm walking that patient to the lab, I'm managing up my co-worker in the lab by saying, well, I'm going to take you to the lab now. And Loxie is over there today. Loxie's been with us about five years. And she really likes her job. So I think you'll have a positive experience here. That sets the patient and your colleague up for a good experience. And that's an example of effective communication. So how do we break down some of these barriers to communication? The experts tell us that one way is to ask your patient to be a parrot, to repeat what you've told them. If you're giving a patient instructions, ask them to repeat them back to you. This is a way for you to affirm that they do have a basic understanding of what you're asking them to do. It will also allow you the opportunity to go over and fill in the blanks on any information that they misinterpreted or that they missed. And think about visual communication. About 90% of information that enters the brain is visual. So think of visual prompts, your pictures, your brochures, your drawings. Those are very, very helpful. And accurately record each visit in the electronic medical record so it can be easily referenced at a later date. We need to make sure that we are patient and we're listening so we can ask the patient, do you have any questions? And then take the time to make sure that we answer those questions. Again, to reiterate, important steps to break down barriers. Use that easy to understand language. Try to avoid the medical terminology and the acronyms as much as possible. If the patients see that you're using clear, simple language, that will help them trust you and the outcomes will be much better. And again, learn to listen and understand. Truly listen to our patients. Make eye contact. Stand by them or sit by them. Do not hide behind the computer or stand at a distance away from them because that tells the patient that, ooh, maybe they're not really listening to me. Communication approaches do vary by generations. This slide tells us about four separate groups of folks, placing them in different generations. And more have been identified in recent years. But for today's purpose, we are going to look at four different groups of folks. Your veterans are considered to be folks ages 70 and up. They like pictures, illustrations, bulletin boards. They like memos. And we need to remember that oftentimes these folks have eyesight issues and hearing deficits. Your baby boomers, which is a huge group of individuals, they're late 50s to that age of 70. They like verbal communication, face-to-face, tell me. And they want to tell you back. They want to be that parrot to tell you that they understand. This individual group may be thinking about retirement and may be looking at financial issues. So they may have questions about their finances when they're in the office. Your Gen Xers, they're late 30s to late 40s. Now, they like email, electronic media. It's just fine with them. And they're going to question you. Why was this prescribed? And if they're given a prescription, they may say, what is this for and why am I expected to take it? Telling them that the doctor ordered it is not going to be effective communication for them. You're going to have to be prepared to offer them full disclosure so they can make that good informed decision to help with their care. Your Millennials or your 30 years and under, email's too slow. So they prefer texting, instant messaging. They're going to be using the MyCharts also. And chances are they already have been out on the internet looking for answers. And when they come into the office, they very well may have the solution in mind. And if that's not the solution they're offered, they're going to have a lot of questions. Effective communication also is dependent upon an individual's learning style. Each patient has their own preferred method of learning. And some of them are visual. They want to read it and see pictures. Some patients will be auditory learners. They want to talk through it. They want you to tell them how to do things. And they want to reiterate that back to you. And some patients will be hands on. They're going to say, let me have it. Give it to me. Let me do it. So sometimes it's best to ask the patient, how do you prefer to learn? That will help us as we go through this educational process. It's also very important for us to realize that sometimes patients have a combination of these. And we now know that the teacher has a tendency to teach in the way they learn the best. So if you yourself are a visual learner and you've got a patient who is a hands on learner and all you're doing is handing them a brochure, there may be a learning and a teaching gap there. They would rather have it in their hands. So ideally, they could have, for example, the glucometer in their hand doing a blood glucose test while they're holding the instructions in a brochure. And then you're talking through it. And that addresses all types of learners and all types of teachers. Another very important component of effective communication is the telephone. And telephone should be answered by the third ring. We need to make sure we're getting the caller's or the patient's name and relationship to the patient. Get a return number to call the patient back. And double check with the patient's date of birth, ID, and or health plan number. And always document the phone call. What the patient tells you, your follow-up actions, whom you referred the call to, and your name and credentials. Additional tips for telephone etiquette include answering the telephone quickly by the third ring. Be friendly and professional. Good morning. Thank you for calling the office. This is Loxie, the medical assistant. How may I help you? Have you ever called an office to set up an appointment, or you had an urgent question, or you had a limited amount of time to talk to the office, and the phone is answered, doctor's office, can you hold? And you're put on hold immediately. That can really break down communication. While you're on the phone, no eating or chewing gum. And believe it or not, but when you smile, when you're on the phone, it gives your voice a more pleasant sound. Speak at appropriate volumes, low tone, moderate volume. Clearly pronounce your words. Don't be turning your head away from the receiver so the call is muffled. And ask for permission before you ever place anyone on hold. Additional tips for telephone etiquette include checking back with a caller who's on hold. Apologize if the amount of time on hold has been extended. And if it's longer than 30 to 90 seconds, please consider some music. While you're on the phone, avoid the medical language and jargon, use non-technical times, and take notes while you're listening. This will help you to make sure that you meet all of the patient's questions that they have. After the call, at the end of the call, close it in a friendly manner. Thank the patient for calling, and reassure them that you will deliver the message on to the appropriate individuals. and ask them if there is anything else that they have to ask you while you're on the phone with them. With the implementation of the electronic health or medical record in the office, some different legal issues have developed, and these are closely linked under the category of effective communication. We need to make sure that the copy and paste function in the electronic medical record must be used with caution and according to strict and enforceable policy. For example, never copy the signature block into another note. Never copy data or information that identifies a health care provider as involved in care that they are not involved in. Do not copy entire lab findings, radiology reports, and other information in the record verbatim into a note. Do not re-enter previously recorded data. If a patient has been coming into the office for quite some time and their vital signs are always stable, do not ever just go in and copy and paste that set of vital signs because this may be the time that those vital signs may be different. To help avoid legal issues with the electronic health record, never audit or alter any of the documentation or signatures which has been completed. Your entries must be accurate, relevant, timely, and complete. Irrelevant text needs to be omitted. Concise notes are more readable than lengthy notes, and in your notes section, facts only. No opinions are appropriate. Additional tips to improve communication in the office include being polite and caring. Treat others as they want to be treated. Always address your patients formally, starting with Mr., Mrs., Ms., Ms., and ask them how they prefer to be addressed. Do not humiliate or question the use of alternative types of medicine. We do have patients that use herbs, tonics, they may be seeing a faith healer, they're taking vitamins. We should never humiliate or belittle those choices, but we need to ask about them because we need to make sure that they would not interfere or accentuate any of the prescription medication that your patients may be on. Lastly, ask the patient who else should be involved in their care. Is there another important family member that should be included in any educational events? Make sure you know who is important in helping the patient with their care needs. More and more frequently, we are encountering with patients with limited English proficiency. Some general rules and guidelines for those include speak slowly, not necessarily loudly, they're not necessarily hard of hearing, they're just hard of understanding. Face the person, make use of hand gestures, brochures, pictures. Be very careful about slang terms. For example, well, let's get your lab and the x-ray on the same day so we can kill two birds with one stone. They may not understand that phrase that you are using. If needed, use a language line or an interpreter and avoid the use of families as interpreters at all costs due to joint commission guidelines. Avoid the medical jargon. Use short, simple sentences. Try to avoid asking yes or no questions. We need to get information from our patient, so we need to think about open-ended questions. Summarize and paraphrase. Look at the patient and say, okay, let me go over this with you. You're telling me that for three days, you've had vomiting. Paraphrase and summarize with them and allow them to think about their answers. Don't force them into a quick decision. Another very important tool that many of you have already implemented into your office is the AIDIT process. The AIDIT process, which can be completed in about 30 seconds, is a tool that helps us build communication and trust with the patient. A for acknowledge, I for introduce, D for duration, E explanation, and T for thank you. Here is an example of an AIDIT event with a patient. Good morning, Mr. Smith. I'm looking at the patient and I'm smiling. My name is Loxie. I'm the medical assistant that will be working with you this morning. I've been here about five years in the office and I've been working with Dr. Jones most of that time. Over the next five to 10 minutes, I will be asking you some questions about your recent health, about your prescriptions, and I'll be getting your vital signs. I'll be gathering all that information and getting your vital signs so it can help Dr. Smith treat you better when he or she gets into the office. Then you want to summarize by saying, I'm really glad you came into the office today. You were due for your six-month checkup and you are right on target, so I really appreciate you coming in on time. In less than about 30 seconds, I have completed those steps with the patient. They feel comfortable. I've addressed them appropriately. They know who I am. They know what doctor's coming in. They know what I'll be doing in the next five to 10 minutes and why I'm doing that. Then they acknowledge that I made a good decision by coming into the office. Unfortunately, sometimes emotions can overcome a patient. We may have a patient in the office that we could call a difficult patient. There are warning signs to this. Look at their facial expressions. Do they look like they're angry? A tightened jaw? Are their fists clenched? Are they acting differently than they normally do? Are they loud? Are they demanding to see the physician now that they cannot wait? They threaten you or they have aggressive body language. They kicked a chair. They slammed the door. They picked up something off the sink and slammed it down. If you do encounter that difficult patient, first and foremost, we need to realize that we need to remain calm. The patient is not attacking us. They're frustrated at a situation that they are in. They feel as if they have lost control. We need to engage that patient in conversation. Phrase such as, please tell me why you feel this way. Please tell me what brought you into the office today. We don't want to approach them with negativity such as, your behavior is inappropriate. That may very well just escalate the situation. Try to listen to what that patient is telling you. Another strategy with that difficult patient is to be empathetic and ask yourself, how would I act right now? It's not easy to seek medical attention. Patients may be fearful of what may be discovered while they're in the office today. Maybe they had to take time off of work to be there with a child that is sick. Maybe there are financial issues. We need to engage that patient in conversation and try to find the root cause of their anger. At all costs, avoid arguing with the patient. That just gives them more fuel and may definitely turn that anger into something more dramatic. If your other strategies have not been successful, you may have to set some boundaries with the patient. You may need to tell them, I don't seem to be helping you at this point. Let me let you have a couple minutes to reflect and think. I will be back in three to four minutes and perhaps we can start talking again. Hopefully, by letting them reflect on this and setting a time limit so they know that you will be back, they'll start to realize that their behavior was inappropriate. Never put them in a room, shut the door with no indication of when you will be back. At the end of the day, when it's all over, just realize that was a real unpleasant situation. I did my best. It was not aimed at me. It was a patient reacting to a situation in which they felt they had no control. This is a very important time during the debriefing to talk with your colleagues and with your physicians and with your office management about how it made you feel and how you can realize that it's not your fault. It was not aimed at you and that I did okay and I need suggestions on how I could even be better if and when this happens again. If that unruly patient turns into an aggressive patient, first of all, we need to realize there may be a physical reason why. Their anger may be related to something physiologic. For example, hypoxia. Do they have COPD? Do they have pneumonia? Are they suffering from inadequate oxygen levels? Is it their blood sugar? Are they hypoglycemic? Have they had a fall? Could they have a bleed? Could they have had a stroke? Could it be an undiagnosed tumor? Think about sepsis. Did they have an infection that became systemic and now they're hypotensive and they're not getting perfusion to the brain? Is it a metabolic disturbance? Is it hyponatremia, low sodium? Is it a potassium that's too high? Could they be in some type of organ failure, liver failure, renal failure? We have to consider, could it be due to alcohol, some sort of medication withdrawal, opioids, steroids, some overdosing of a prescribed medication? So when we have a patient whose behavior is aggressive, we need to have in our mind, perhaps this is something that's physiologic. So I need to explore those causes as well. Sadly enough, this may turn into a situation in which there is a violent patient. Do not hesitate to call for help. If you have a patient who is threatening themselves or others, please call 911 and activate your facilities plan. Do not let that patient get between you and the door. You need to have a way to get out of the room. Do not become confrontational. Listen to what the patient is saying or what they're yelling at you about. Do not yell back at the patient. Offer them food, drink, a place to sit, a walk back out in the waiting room as long as there's no one in the waiting room that could be harmed. Avoid excessive stimulation. Make good notes, documentation of what they're saying, word for word, direct quotes. Try to maintain eye contact with that patient. If they have a family member, enlist their help. If you need to, ask your coworkers to help you. Again, address medical issues first, pain, overdoses, something physiologic, and try the entire time to think about what is this patient actually needing and what is the level of urgency here. To conclude this presentation, you're going to be given a series of six role play scenarios or examples of situations you may encounter in the office. We will cover those scenarios and then be given a few seconds to think about it, and then we'll discuss them briefly. As you work through your role play scenarios, be asking yourself the following questions. Is the communication effective or does it include barriers to communication? Were there HIPAA violations? What strategies could improve the situation, if any? If you observe this conversation, what would be your most immediate response? Role play scenario one, your NP has just finished in the room with a patient. You approach the NP and say, I'm really worried about this patient. What do you think is going on? The NP then shares in the hallway outside the room what she knows about this patient as their children attend the same school. Think about this one for about 10 seconds. Some facts that we can pull out of this. First of all, we approached the NP in the hallway, so privacy and confidentiality may be at risk. Nowhere does it say that that's even my patient as the medical assistant. The NP, of course, in the hallway is then telling me things about this patient, and I know this because our children attend the same school. We've got way too much information here in a venue where it should not be taking place. Obviously, there are some barriers here to conversation. There are HIPAA violations, and if I was observing this, I would try to get their attention to let them know that they need to not have this conversation in the hallway. If indeed they're going to continue this conversation, it should be in a private area. Role-play scenario two. We have an elderly patient with known mild dementia is brought in by her family because she has become increasingly agitated and is confused and aggressive. We have provided a calming, low-stimulus environment for the initial assessment. Please take a few seconds and think about this scenario. Okay, putting her in the calm, low-stimulus environment was a right move. I hope that the family gets to remain with her, or at least a family member. This is a patient that we know, and this behavior is not normal for her, so we need to make sure we are keeping her safe. Then we need to start thinking about, in elderly patients, the number one cause of confusion and agitation is some sort of an infection. Then we start to look for those physical signs of an illness, a urinary tract infection, a recent cough that could be a pneumonia, a wound that's infected, something like that. This scenario involves a new patient, and we are asked to use the aided approach when you first enter the room. Good afternoon. Take about 10 seconds and come up with your aided approach, and then we'll go over it together. Okay. Let's welcome Mr. Jones. Mr. Jones, thank you for coming into the office today. My name is Loxie. I'm the medical assistant who will be working with you. As a new patient, you filled out some paperwork in the waiting area, and I'm going to take a few minutes to go over that with you and get some of that information into the computer so I can use that information through the computer to communicate with the doctor and some other folks in the office that may need it. So, let me ask you some questions about some of the information. We're going to do that for probably the next couple of minutes, and then I'd like to get your vital signs and your height and your weight. This way, your record will be complete and we'll have the information that we need so the physician can do a better exam when he or she comes in. And I want to thank you for being a new patient, and please let me know if you have any questions while you're here. Our fourth role play scenario involves a couple that just moved here from India. The man refuses to leave the room, the woman is pregnant, and she's going to have a pelvic exam. So, how would we respond? Take a few seconds and think about this, and then we'll discuss it. Okay, this scenario gets into those areas of culture, ethnicity, and possibly limited English. Our main goal here is to protect the privacy and dignity and safety of the female patient and at the same time communicating effectively with both the man and the lady that are in the room. We need to talk to the patient and make sure that it is okay for the man to remain in the room. We do not want to become confrontational where the situation could escalate. If indeed she says that he is welcome to stay in the room, we need to then think about the privacy, the dignity, and the safety and explain things that during the exam he is more than welcome to stand at the head of the patient and comfort her, hold her hand, and we would be talking to both of them to explain things as this procedure is going on. We want to make sure he is not in the field where the exam is being done to interfere with the exam to make it longer or we do not want to take a risk of him contaminating any of the items. The next scenario again may involve a patient with limited English, so there may be some cultural and ethnic issues that we need to explore. This patient is a diabetic who is 74 years old, so she is in that baby boomer veteran age group, and we are teaching her about the usage of a syringe to inject insulin. So let's think about what your plan would be for educating this patient. Alright, let's look at this patient. So first of all, does she have a family member who will be helping her? And if so, and if they're available, let's bring them in on the process. We need to determine how much she knows already, if she's ever done this before. And we need to start thinking about the most effective way to complete her education. Visually, auditorily, or hands-on, probably a combination of all three. So we want to think about a brochure, a checklist, we want to have those pictures, we want to be talking and explaining, and let her feel and use the syringe, have it in her hands as we are explaining. After this is done, we probably should ask her to demonstrate back to us. So we want to make sure that we're using that parrot-type philosophy where she's talking back to us, and we can determine how much she actually is retaining. Our final scenario involves a patient who's called into the office, questioning a lab result that they got through the patient portal. We are going to need to put this patient on hold, so let's think about proper telephone etiquette as you place this patient on hold. Okay, prior to placing this patient on hold, we need to have the information that we need. Their name, some sort of ID, their date of birth, some type of indicator that we know who we are actually talking with. We need to get their questions, take good notes so we can get all their questions answered. What is the lab test that they're questioning, when was it drawn, things such as that. Ask for permission to put them on hold. After the patient is on hold, if it is more than 30 to 90 seconds, we need to get back on the phone, communicate with them and reassure them that we are still seeking answers to their questions and that we will get back with them. If it is more than 30 to 90 seconds, consider using some music. And if this is something that is going to take longer than just a short amount of time, we may need to have a return call to the patient later in the day. But confirm that and reassure the patient that you will be back with them. You will call them back or the physician will, one or the other. I hope that during your attendance at the presentation, you have gathered some tools that can help you better communicate with your patients and colleagues while you are in the office. Thank you.

effective communication

healthcare

building trust

patient needs

communication barriers

patient satisfaction

customer service

HIPAA regulations

verbal communication

tailoring communication