Dynamics of
Care in Society
Communication
1
Objectives:
Identify & define the concepts & elements of
communication theory
Recognize a communication dilemma
Identify nonverbal aspects of communication
Utilize sensitivities & problem solvng skills to
achieve interpersonal communication that occurs
in the health delivery process
Formulate appropriate communication strategies to
detect & avert breakdowns in communication
Differentiate between open & closed ended
questions
Develop skills to design open-ended questions
Determine the appropriate questions to ask patients
Be familiar with appropriate, caring responses
Know how to obtain help if there is a language
barrier
Communication defined:
 a sharing of information or ideas, including
content as well as the feelings or emotions
 Verbal & nonverbal behavior within a social
context
Listen…Talk to your doctor
Methods of COMMUNICATION
•One on one
•Small group
•Large audience
•Mass communication
TV, radio, film, newspapers, internet
FORMS OF COMMUNICATION:
1. VERBAL: spoken words, manner,
tone, non-language sounds
(sighs or sobs)
2. NON-VERBAL: touch, eye contact,
kinesics (body movement), proxemics (personal
space)
3. WRITTEN: letters, memos, chart
documentation, agendas, reports…
COMMUNICATION PROCESS
Channel: medium
Communication
Process
 Flow of
communication
between a
medical
assistant and a
patient
THE SENDER…
The one who initiates the message or
communication.
Puts the thought, idea, experience or act into a
form that can be transmitted.
THE MESSAGE…
The thought, idea or expression from the
sender.
Often a dual message, verbal and nonverbal
simultaneously.
THE RECEIVER…
The one to whom the message is sent.
The receiver is prompted (by the message), to
analyze, interpret and respond.
THE FEEDBACK…
COMMUNICATION CHALLENGES:
•Educational/intellectual level: ex. medical
terminology unfamiliar to patient
•Psychological/Emotional: grief, anger, anxiety,
perceptions, pride, financial concerns
•Physiological: Impairments in cognition or
hearing, age, sex , developmental stage
•Culture/language barriers:
•Stereotyping, prejudice, bias
•Distractions: Attention, Environment,
Hunger, Pain
(Texting…where does it fit?)
Be an active & critical listener
•Be attentive
•Ask questions
•Concentrate
•Avoid distractions
•Take notes
Strategies
•Use reflections
open ended questions statements to repeat
back what you heard
ex. “Mr. Wellness, you
were saying that the new medication is making you
vomit.”
•Use paraphrasing
use your own words to restate what you heard
ex. “it sounds as if you are saying you do not want to
take the medication anymore”.
•Use open ended questions to gain further information
(activity…open vs closed ended questions)
Ex. “Can you describe the type of pain?”
•Closed ended questions are necessary for times when
specific information is required.
Ex. “Are you in pain right now?”
•Summarize
organize the information they have communicated
and check back for accuracy
•Listen with an accepting attitude.
•Use encouraging words that will invite them to continue
on.
"Mmm, hmm" "I see." "Right." “ Uh, huh."
"Tell me more."
"Sounds like you have some ideas on this."
"I'm interested in what you have to say."
"Let's talk about it."
•Use nonverbal actions to show you are listening.
relaxed posture
head-nodding
facial expression
relaxed body expression
eye contact
•Use Silence
is natural and sometimes appropriate in
conversations
NEGATIVE IMPACTs
ON COMMUNICATION
Giving an opinion
Offering false reassurances
Being defensive
Showing approval or disapproval
Stereotyping
Asking why
Changing the subject inappropriately
Things to avoid while being an active listener
•Do not interrupt.
•Do not interrogate. Limit the number of questions
you ask so that you are "drilling" them.
•Do not try to think of your response in your own
head while you are listening.
•Do not change the subject.
•Avoid phrases like:
"Are you sure."
"You shouldn't feel that way."
"Its not that bad."
“You're making something out of nothing."
"Sleep on it. You'll feel better tomorrow."
•Do not be judgmental … allow speaker to feel that
they can communicate questions and ideas.
NON-VERBAL COMMUNICATION
What is the message for each?
NON-VERBAL COMMUNICATION
Includes:
1. Appearance
2. Kinesics or body movement
Facial expressions
Gestures
Eye movement
3. Facial expressions
4.Posture & gait
5. Tone of voice
6. Touch
Can create positive or negative feelings, Watch for
nonverbal cues that show how the patient feels about being
touched, Maintain proper personal space, position, & posture
7. Eye contact
8. Proxemics (personal space)
Larger when talking to a stranger
Becomes smaller the better you know someone
Typically larger between two men than between two
women
Differs from culture to culture
How are these a reflection of professionalism ?????
Give an example of how non-verbal clues
create misperceptions ?????
NON-VERBAL COMMUNICATION
may vary with culture
Handout…
What is the message for each?
TIPS FOR MAKING SURE PATIENTS WITH LOW
HEALTH LITERACY (patients' ability to understand their
disease and how to manage their care) …GET THE
APPROPRIATE MEDICAL INFO
1. Look for patients who need help:
A patient can read and write with average skill and
still not understand the language you use.
2. Avoid jargon:
many well-intentioned physicians make the mistake of
using technical terms, then trying to define them.
(also remember most Americans read at an 8th grade
level)
3. Use the “teach back” method:
 Avoid asking patients, "Do you understand?"
most will say they do even when they are
confused.
 Joanne Schwartzberg, MD, director of the AMA's
department of geriatric health, suggested saying,
"I want to make sure I did a good job teaching you.
Tell me how you are going to do this when you get
home.“
Ask them to repeat your instructions in their
own words .
4. Avoid unnecessary details:
…yet be specific when necessary.
Address one problem or issue at a time, or on separate
meetings
5. Use pictures:
Illustrations often convey instructions better than words.
(Sample pictogram s on next slide)
6. Enlist the aid of a family member or friend or
translator
Positive messages come from:
· Attentiveness: Maintaining eye contact, looking relaxed,
facing the speaker,
nodding the head to show understanding without
interrupting.
· Voice and Facial Expression: Clear, strong voice volume,
relaxed face with
smile when appropriate, and minimal frowning.
· Movement and Position: Don’t stand stiffly in one spot,
sit down or move
around with a relaxed stance, and use movement as an
energizer.
Silence: As a sign of effective listening, use silence
after asking a question
so people can think of their responses; don’t be
afraid of silence.
HAZARDOUS SUBSTANCE SYMBOLS
Dynamics of
Care in Society
Written Communication
for
Health Care Professionals
42
Written communication
“practical writing”… for a specific purpose,
ex:
 Reports
 Business letters
 Interoffice memos
 Manuals
 Forms
 Applications
 Chart documentation
“Practical Writing” Types
 Narrative writing…tells what happened, paragraph
form,
 Descriptive writing…details of person, object, event
 Informative writing…giving directions, explaining
how to, answering questions, making something
easier to understand, use bullets or steps,
 Persuasive writing..giving an opinion or stating a
point of view and supporting it with reasons in order
to persuade the reader to accept or possibly take
action on it
Recording and Reporting
 Record patient information completely &
precisely
 Record information only in secure &
appropriate locations
 Record any action you take concerning a
patient (“if it is not documented…it didn’t
happen”)
 Just the facts…
 Minimize medical jargon (if for a patient)
Drafting hints…
 Get started… get comfortable, be concise, have logical
transitions of thought
 Outline ideas… organize before you write
* brainstorm
* group similar ideas together
* find unifying themes
* have a beginning, middle, end
 Revising…check for…
* clarity
* sentence & paragraph structure
 Proofreading… refinement…check for…
* grammar, punctuation, spelling
* final touches
Tips for… “Well & Clearly Written”
- create an outline to clarify and order your concepts
- write a really bad first draft with no rewriting
- rewrite, read out loud, rewrite, read again and rewrite
- have colleagues comment on your draft
- trust feedback from reviewers and rewrite again
- let it sit, return for a fresh read out loud,
and finalize
Ideas for Learning to Write Better
• Read examples you like and also review your colleague’s
draft papers and edit them.
• Take course in essay writing - good analysis, clear
arguments and exposition, and convincing conclusions.
• Write for broad audiences too - if you can capture them,
you can capture professionals
• Read your writing out loud and then edit!
For Research Assistance…
UCLA Library
under services menu tab choose
references & research help
MEDICAL
DOCUMENTATION
Purposes of documentation in HC
1. Communication among the health care team
2. Assessment (vital signs, hx, symptoms…)
3. Quality Assurance (competence & quality of care)
4. Reimbursement (verification for insurances…)
5. Legal Record (admission of evidence)
6. Education (use for training)
7. Research: Useful Data Gained From Patient
Records
 Examples:
Nurse updates patient’s record with new info from
patient
Doctor sees nurse’s note & orders speech therapy consult
to eval swallowing ability
Pharmacist views medical history before filling
prescription
Discharge planner evaluates occupational therapist’s
notes on progress in independence with ADL’s
Advantages of Computerized Documentation
 Ease of access to data
Multiple users simultaneously
 Different locations
 Various devices
 Easy storage & retrieval; faster recording of data
 Nearly unlimited file space
 Easy back-up for security
 Easy to add or attach info
 Improved legibility

Safe Computer Recordkeeping
1. Don’t share passwords/computer signature
2. Don’t leave logged-on terminal unattended
3. Follow protocol for correcting errors
4. Allow only authorized personnel to create, change, or
delete files
5. Back up records regularly
6. Don’t leave patient info displayed on monitor in view of
others
7. Keep running log of electronic copies made of files
8. Never use unencrypted email to send protected health info
9. Follow confidentiality procedures for sensitive material
What you’ll find in the medical record…
Admission sheet – general demographic info, insurance
info…
Graphic sheet – for vital signs…
Physician’s orders – for medications, instructions,
procedures…
Progress notes – on patient’s progress, new or changing
info from each of the members of the health care team
Medical history and exam –
Allergies, Immunizations, Childhood diseases
Current & past medications
Previous illnesses, Surgeries, Hospitalizations
Family medical history
Reports – test results, lab results, consultations…
Psycho-Social History
Marital status
Occupation
Education
Hobbies
Diet
Alcohol & tobacco use
Sexual history
Miscellaneous – correspondence, AD, organ donor…
Good Medical Documentation Tips
1.It is accurate (ex. Correct spelling, Errors
marked through, labeled with “error,” initialed,
& dated…)
2.It is complete (ex. All supporting information
– lab results …)
3.It is concise (ex. Only relevant information)
4.It is legible
5.It is organized (ex. Most recent information
first, date stamped…)
Progress Notes --- 3 Types
1. SOAP notes
Subjective data
Statements from patient describing condition
Symptoms experienced
Objective data
Data that provider can measure, see, feel, or smell
Test results
Vital signs
Assessment
Patient’s diagnosis
Possible disorders to be ruled out
Plan
Description of what should be done
Diagnostic tests
Treatments
Follow-up
2. Charting by exception
•
•
•
•
•
•
•
•
•
Covers only significant or abnormal findings
Decreased charting time
Greater emphasis on significant data
Easy retrieval of significant data
Timely bedside charting
Standardized assessment
Greater interdisciplinary communication
Better tracking of important patient responses
More cost effective
3. Narrative
 Paragraph format
 Includes:
Contact with patient
What was done for patient
Outcomes
 Can be time-consuming to write & difficult to
read
 It is the oldest & least structured type
Handout…
PROPER TELEPHONE COMMUNICATION
ANSWERING….
1. ANSWER PROMPTLY
2. IDENTIFY SELF
3. FIND OUT WHO IS CALLING
4.SPEAK COURTEOUSLY, CLEARLY & PLEASANTLY
5. USE DISCRETION IN RELEASING INFORMATION,
REMEMBER CONFIDENTIALITY
6. END CALL GRACEFULLY
Handout… SCREENING….
1. DON’T OFFEND CALLER
2. ASK WHO IS CALLING, NATURE OF
BUSINESS OR EMERGENCY
3. ANSWER QUESTIONS TACTFULLY
4.ASK IF MESSAGE CAN BE LEFT
5. PLACE ON HOLD AND GET GUIDANCE, HELP
IF NEEDED
Handout…
TAKING A MESSAGE….
1. OBTAIN TIME, DATE, NAME OF CALLER ,
PURPOSE OF CALL
2. TAKE NOTES, REPEAT INFO BACK TO CALLER
FOR ACCURACY
3. USE MESSAGE FORMS & FOLLOW THOUGH
WITH PASSING MESSAGE TO CORRECT
RECIPIENT.
Handout…
HANDLING COMPLAINTS….
1. STAY CALM
2. GATHER INFO
3. BE SYMPATHETIC
4.OFFER TO FIND OUT
WHAT CAN BE DONE
5. END CALL ON PLEASANT
NOTE