Therapeutic communication and diverse patient care

To provide high-quality patient care, we must communicate effectively with the patient and provide a warm, caring environment. Positive reactions and interactions with the patient are vital. A medical assistant must always remember that each patient is an individual with certain anxieties. These anxieties often cause people to act and react in different ways; therefore, effective verbal and nonverbal communication with each patient is essential.

Healthcare professionals accept the responsibility of developing helping relationships with their patients. The interpersonal nature of the patient-medical assistant relationship means that the focus should be on the patient’s needs. A medical assistant can bring out either a positive or a negative response simply by the way they treat and interact with patients. You are usually the first person the patient communicates with; therefore, you play a vital role in therapeutic patient interactions.

Another important aspect of communicating with patients is an awareness of self-boundaries. When working in healthcare, it is important to develop a solid professional relationship with patients. By establishing realistic self-boundaries, that relationship can be protected. It is important to keep the focus on the patient. When you work with patients who are seen frequently, it is easy to think of them as friends. With a friend, you are likely to share personal information that is not appropriate to share with a patient. Patients may feel that they cannot share important health-related information because you are their friend, and it would be embarrassing to share that information with a friend. Self-boundaries can also be thought of as professional boundaries. You need to treat patients with respect and keep the relationship professional. Be friendly to patients and always keep the focus on the patient.

Diverse patient groups

Most healthcare facilities have a diverse patient population. The diversity could be based on race, age, culture, religion, or physical qualities, such as being deaf or hard of hearing. Whatever the origin of the diversity, practicing respectful patient care is extremely important. Empathy is the key to creating a caring, therapeutic environment. Empathy is different from sympathy. Sympathy is feeling sorry for the patient from an emotional distance, centered on the caregiver’s own reaction: “I feel so sorry for you.” A medical assistant who is empathetic respects the patient’s individuality and attempts to see the person’s health problem through their eyes, and responds in a way that helps the patient cope. The medical assistant also recognizes the effect of all holistic factors on the patient’s well-being. Empathetic sensitivity to diversity requires you to examine your own values, beliefs, and actions; you cannot treat all patients with care and respect until you first recognize and evaluate personal biases. We think and act a certain way for many reasons. The first step in understanding the process is to evaluate your individual value system. Why do you have certain attitudes or beliefs about the worth of individuals or things?

Many factors influence the development of a value system. Value systems begin as learned beliefs and behaviors. Families and cultural influences shape the way we respond to a diverse society. Other factors that influence reactions include socioeconomic and educational backgrounds. To develop therapeutic relationships, you must recognize your own value system to determine whether it could affect how you interact with patients. Preconceived ideas about people because of their race, religion, income level, ethnic origin, sexual orientation, or gender can act as barriers to the development of a therapeutic relationship. You cannot treat your patients empathetically unless you can connect with them in some way. Personal biases or prejudices are huge barriers to developing therapeutic relationships.

Regardless of the type of healthcare facility you work in, you will care for a wide variety of patients. The medical assistant should take the initiative to learn about the cultures represented in the healthcare practice. Some points to consider about diverse groups include the following. Keep in mind that these are general tendencies, not fixed rules - confirm each patient’s individual preference rather than assuming it from their background:

• Patients of Asian backgrounds may have been raised in a culture that considers it extremely rude to establish eye contact. Americans view an unwillingness to establish eye contact as a sign of distrust or embarrassment; however, for people from Japan or China, lack of eye contact may be a way of demonstrating respect.
• Personal space may be an issue for patients from diverse backgrounds. If uncomfortable with touch or lack of personal space, attempt to accommodate the patient as much as possible during the office visit.
• Research has shown that older people face unique communication problems in the healthcare environment. The healthcare facility should have tools available to help patients with hearing or vision issues. When caring for an aging individual, it is important to focus patient teaching and information on the patient rather than the family member who may be present.
• Patients may use their religious beliefs and values to understand and cope with their health problems. However, using religion to guide healthcare decisions may result in a conflict with the provider’s recommendations. Healthcare workers may need to find a balance between respect for a patient’s beliefs and the delivery of high-quality care. The medical assistant should notify the provider of the patient’s wishes, document them accurately in the health record, and respect the patient’s autonomy rather than argue or pass judgment.

Environmental and socioeconomic stressors

Social determinants of health (SDOH) are the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect their health. The Healthy People 2030 framework groups these conditions into five domains: economic stability, education access and quality, health care access and quality, neighborhood and built environment, and social and community context. Stressors such as low income or job loss, food insecurity, unstable housing, lack of transportation, unsafe neighborhoods, and discrimination can make it difficult for patients to keep appointments, afford medications, or follow a care plan, and chronic stress itself can harm a patient’s health over time. As a medical assistant, you may ask screening questions about these stressors as your office directs, listen to patients without judgment, and connect them with resources such as a social worker, community programs, or transportation help.

Patients with disabilities, developmental delays, or chronic illness

A disability or long-term illness can bring grief over lost abilities, fear, frustration, anger, depression, and a sense of lost independence. When caring for a patient with a disability or chronic illness, speak directly to the patient rather than to an accompanying companion, ask before helping, allow extra time for the visit, focus on what the patient can do, and watch for signs of depression to report to the provider. When caring for a patient with a developmental delay, explain things at the patient’s level of understanding, using simple words and demonstrations, while still treating the patient as an adult and involving caregivers as the patient wishes.