2. Therapeutic Communication differs from
normal communication in that it introduces
an element of EMPATHY into what can be
a traumatic experience for the patient.
It imparts a feeling of comfort in the
face of even the most horrific news
about the patient’s prognosis.
The patient is made to feel validated
and respected.
Showing Empathy

3. Personal preferences, biases and prejudices will enter into many
physician-patient relationship.
BIAS – a slant toward a particular belief.
PREJUDICE – an opinion or judgment that is formed before the facts are
known.
Common biases and prejudices in today’s society include:
1. A preference for Western style medicine
2. Choosing physicians according to gender
3. Prejudice related to a person’s sexual preference
4. Discrimination based on race or religion
5. Hostile attitudes toward people with different value system than one’s own
6. A belief that people who cannot afford healthcare should receive less care
than someone who can pay for full services.

5. The Sender
The sender begins the
communication cycle by encoding
or creating the message to be sent.
Before creating the message, the
sender must observe the receiver
to determine the complexity of the
words to be used within the
message, the receiver’s ability to
interpret the message, and the best
channel by which to send the
message.

6. The Message
The message is the content being
communicated. The message must
be clearly understood by the
receiver.
Four modes of communication:
•Speaking
•Listening
•Gestures or body language
•Writing
These modes or channels are affected by our physical
and mental development; our culture; our education and
life experiences; our impressions from models and
mentors, and in general by how we feel and accept
ourselves as individuals.

7. The Receiver
The receiver is the recipient of the
sender’s message. The receiver
must decode, or interpret, the
meaning of the message.
The primary sensory skill used in
verbal communication is listening.
The receiver must be aware that
not only the spoken words, but the
tone and pitch of the voice and the
speed at which the words are
spoken carry meaning and must be
evaluated.

8. The Feedback
Feedback takes the place after the
receiver has decoded the message sent
by the sender.
Feedback is the receiver’s way of
ensuring that the message that is
understood is the same message that
was sent.
Feedback also provides an opportunity
for the receiver to clarify any
misunderstanding regarding the original
message and to ask for additional
information.

9. Active Listening
Active listening involves a “third ear,” that is, being
aware of what the patient is not saying or picking up
on hints to the real message by observing body
language. The health care professional should have
three listening goals:
1. To improve listening skills sufficiently so that
patients are heard accurately.
2. To listen to either what is not being said or for
information transmitted only by hints.
3. To determine how accurately the message has
been received.

10. VERBAL COMMUNICATION
Verbal communication takes place when the
message is spoken.
One must keep in mind that unless the words
have meaning, and unless the sender and the
receiver apply the same meaning to the spoken
words, verbal communication may be
misunderstood.
To have any meaning, the spoken word must
be understood by all parties of the
communication.

11. VERBAL COMMUNICATION
The Five Cs of Communication
Complete. The message must be
complete, with all the necessary
information given. The medical assistant
cannot expect the patient to be compliant
if the instructions are not given and
understood.
Clear. The information given in the
message must also be clear.

12. VERBAL COMMUNICATION
The Five Cs of Communication
Concise. A concise message is one that
does not include unnecessary
information. It should be brief and to the
point. Avoid technical terms that may not
be understood by the patient.
Courteous. Courtesy is important in all
aspects of communication. It only takes a
moment to acknowledge a patient with a
smile or by name. Likewise, be courteous
to colleagues in the office.

13. VERBAL COMMUNICATION
The Five Cs of Communication
Cohesive. A cohesive message is
organized and logical in its progression. It
doesn’t rumble nor jump from one subject
to another. The patient should be able to
follow the message easily.
The medical assistant should always
allow time to summarize detailed
messages and use responding skills to
verify that the patient fully understands
the message.

14. VERBAL COMMUNICATION
When communicating within health professions,
keep in mind the following:
1. Good communication skills are necessary in
establishing rapport with patients.
2. Patients feel respected and validated when called by
their full name.
3. Patients should be encouraged to verbalize their
feelings.
4. Patients should b given technical information in a
manner that they can understand.
5. Patients should be allowed to make practical
application to their personal health needs.

15. NON VERBAL
COMMUNICATION
Non-verbal communication, often referred to
as body language, includes the unconscious
body movements, gestures and facial
expressions that accompany speech.
The study of body language is known as
kinesics.
Body language can communicate more than spoken words.

16. NON VERBAL
COMMUNICATION
Facial Expression. This is considered as one
of the most important and observed non-verbal
communication. Each facet or aspect of
anatomy of the face sends a non-verbal
message.
Often expressions of joy and happiness or
sorrow and grief are reflected through the eyes.
The anatomy of the eyes does not change, but
the movement of the structures surrounding the
eyes enhance or magnify the message being
communicated.
Cultural influences affect customs and different
forms of facial expressions.

17. NON VERBAL
COMMUNICATION
Territoriality. This is the distance at which we
comfortable with others while communicating.
Some examples of comfortable personal space
for U.S. culture are as follows:
• Intimate: touching to 6 inches
• Personal: 1 ½ to 4 feet
• Social: 4 to 12 feet
• Public: 12 to 15 feet
As with facial expression, territoriality or
personal space is handled differently by various
cultures.

18. NON VERBAL
COMMUNICATION
Posture. Posture relates to the position of the
body or parts of the body. It is the manner in
which we carry ourselves, or pose in situations.
Those who study kinesics believe that a posture
involves at least half the body, and that the
position can last for nearly five minutes.

19. NON VERBAL
COMMUNICATION
Position. The physical stance of two
individuals, while communicating is a key factor
while communicating with the patient.
When speaking with a patient, the physician or
medical assistant will want to maintain a close
but comfortable position, enabling observation
of all clues being sent, bother verbal and non-
verbal.
Positive posture and position encourage
therapeutic communication.

20. NON VERBAL
COMMUNICATION
Gestures and Mannerisms. Most of us use
gestures and mannerisms when we “talk” with
our hands.
This form of body language may be useful in
enhancing the spoken word by emphasizing
ideas, thus creating and holding the attention of
others.

21. NON VERBAL
COMMUNICATION
Touch. This is a powerful tool that
communicates what cannot be expressed in
words.
The touch that communicates caring, sincerity,
understanding, and reassurance is usually
welcomes and considered to be a therapeutic
response.
However, not all patients are comfortable with
touch. Whenever a patient is not comfortable
with touch, ask permission and create as safe
and reassuring an environment as possible.

22. Congruence is an abstract term that applies to
similarity in objects.
When applied to therapeutic communication,
congruence, or congruency in therapeutic
communication, it simply means that there had
to be agreement between verbal and non-verbal
communication in order to the message to be
successfully delivered to the patient.
Shaking your head NO while saying YES is an
example of what congruency is NOT, and is
sends a mixed message.

23. It is also important to remember that most non-
verbal messages are sent in groups of various
forms of body languages:
• Clustering – the grouping of non-verbal
messages into statements or conclusions.
• Masking – an attempt to conceal or repress the
true feeling or message.
• Perception – the conscious awareness of one’s
own feelings and the feelings of others.

25. ESTABLISHING CROSS-
CULTURAL
COMMUNICATION
Patient trust must first be established before
any cross-cultural communication can begin.
The following are some steps to building
trust:
• Risk/Trust: Promise no more than you
can deliver. Be honest, and carefully and
thoroughly explain procedures and
policies. Answer all questions truthfully
and honestly.
• Empathy: The ability to accept another’s
private world as f it were yours. IT
communicates identification with and
understanding of another’s situation. It
states, “I’m available to walk this road with
you.”

26. ESTABLISHING CROSS-
CULTURAL
COMMUNICATION
• Respect: Respect values another person
and considers her or him as a special
individual. It is important to respect a
patient’s personal space, to provide
privacy, and to use his or her full name
and title when appropriate.
• Genuineness: This means being real and
honest with others. The health care
professional must be able to communicate
honestly with others, while being careful
not to blame or condemn.

27. ESTABLISHING CROSS-
CULTURAL
COMMUNICATION
• Active Listening. Active listening
involves verbal and non-verbal clues that
send the message you are completely
involved in the communication.
Maintain an open, relaxed posture to
establish an non-threatening environment
for the patient.
Listen carefully to the words the patient
uses to describe problems, and use those
terms rather than medical terminology
when discussing symptoms.

28. Cultural Brokering
Cultural brokering is “the act of bridging
linking, or mediating between groups or
persons through the process of reducing
conflict or producing change.”
A cultural broker serves as a go-between,
or one who advocates on behalf of
another individual or group within he
health care community.

29. Maslow’s Hierarchy of
Needs Maslow is considered the founder of
Abraham
humanistic psychology and is most well known
for his hierarchy of needs.
Abraham Maslow Maslow’s Hierarchy of Needs

30. Maslow’s Hierarchy of
Needs PHYSIOLOGIC OR SURVIVAL NEEDS.
First Level:
These needs include food, water, and air to breath-
homeostasis for the body.
Maslow’s Hierarchy of Needs

31. Maslow’s Hierarchy of
Needs
Second Level: SAFETY AND STABILITY
These needs include safety, security (stability) and
protection. Everyone has a desire to be free from
fear and anxiety. Safety needs also include the need
for structure, law and order, and limits.
Maslow’s Hierarchy of Needs

32. Maslow’s Hierarchy of
Needs SOCIAL DESIRE (Belonging and love
Third Level:
needs).
This third level involves both giving and receiving
affection.
Maslow’s Hierarchy of Needs

33. Maslow’s Hierarchy of
Needs
Fourth Level: SELF ESTEEM (Prestige and
esteem needs.
These needs come from a basic need for a stable,
healthy self-respect for ourselves and others.
Maslow’s Hierarchy of Needs

34. Maslow’s Hierarchy of
Needs SELF REALIZATION (Actualization)
Fifth Level:
In this level, we at our peak, doing what truly fits us.
It is an achievement of potential.
Maslow’s Hierarchy of Needs

36. At times a patient may need to be referred
to a community resource. This could be as
simple as arranging with Meals on Wheels
to deliver daily hot meals, or as complex
as arranging for skilled nursing facilities or
hospice care.

37. Technology-mediated communication and
a greater reliance on cyberspace
technology will greatly affect
communication in the twenty-first century.
Examples of new technologies in medical
offices:
• Interactive videoconferencing
• Clinical e-mail
• Automated routing units
• Instant messaging
• Paging systems
• Physician digital assistants

38. Roadblocks close communication and
prevent quality care of the total person.
The following are examples:
• Reassuring clichés
• Moralizing/ lecturing
• Requiring explanations
• Ridiculing/shaming
• Defending/contradicting
• Shifting Subjects
• Criticizing
• Threatening
Being sensitive to patients’ unique
personalities and needs enable the
health care professional to avoid these
roadblocks to communication.

39. Defense mechanisms are defined as
behavior that is used to protect the ego
from guilt, anxiety, or loss of esteem.
It is the body’s way of seeking relief
from uncomfortable or painful reality.
Defense mechanisms are difficult to
analyze without knowledge of the motive
behind the behavior.

40. Regression – An attempt to withdraw
from an unpleasant circumstance by
retreating to an earlier, more secure
stage of life.
Use of a security blanket by an adult or
child when faced with something that
disrupts his or her life is an example of
regression.
Denial – Refusal to accept painful
information that is readily apparent to
others. It is often the first stage of an
emotional response after a traumatic
event.

41. Repression - Similar to denial, but it is
a totally unconscious reaction, in which
case the person seems to experience
temporary amnesia.
It is the mind’s way of defending itself
from mental trauma by forgetting or
wiping things out of the conscious
memory.
Projection – Attributing unacceptable
desires, impulse and thoughts falsely to
others to avoid acknowledging they are
actually the person’s own experiences.

42. Sublimation – The channeling of a
socially unacceptable behavior into a
socially acceptable behavior.
An overly aggressive person directed to
play football to relieve his aggression is
an example o sublimation.
Displacement – The unconscious
transfer of unacceptable emotions,
thoughts, or feelings from one’s self to a
more acceptable external substitute.
Compensation – A conscious or
unconscious overemphasizing of a
characteristic to offset a real or
imagined deficiency.

43. Rationalization – The mind’s way of
making unacceptable behavior or
events acceptable by devising a rational
reason.
The purpose of rationalization is to
avoid embarrassment or guilt, or to
avoid obeying a directive.
Undoing – An action designed to make
amends or to cancel out inappropriate
behavior.
Showering the abused with gifts to
compensate for unacceptable actions
that took place in the past is an
example.

45. Interview Techniques. All health
professionals must be adept at interview
techniques – knowing how to encourage the
best communication between them and the
patient.
Early in the interview, the patient must feel
comfortable enough to risk being honest with
the health professional. The health
professional must build an atmosphere of trust
by showing concern for the patient.
Always be honest and genuine in your
responses to the patient. Be sympathetic and
empathic and create an environment that is
devoid of hypocrisy.

46. It is important to listen with a “third” ear. Listen
to what the patient is not saying but is apt to
exhibit through non-verbal communication.
Closed Questions – those that can be
answered by “yes” or “no.”
Open-Ended Questions – Probing questions
that encourage therapeutic communication
because the patient is required to verbalize
more information.
Indirect Statements – Statements that will
elicit a response from a patient without the
patient feeling being questioned.

47. Telephone Techniques. Communication over
the telephone requires understanding on the
part of each communicator.
When communicating over the telephone,
listen with full attention to make certain that t
he message se and received is correct.
Observe all the techniques for effective face-to
face communication even when the
communication is over the telephone because
you cannot see the person with whom you are
speaking.

48. Consider the following, for example, when
closing an appointment over the telephone:
1. Use the patient’s name if it can be done
without announcing the name to persons
in the reception area.
2. Confirm the date and time of the
appointment.
3. Identify the physician if there is more
than one physician in the office.
4. Give any specific instructions that may
be necessary.
5. Say good-bye.