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Medical Office
26                          Communication
                                          http://evolve.elsevier.com/klieger/medicalassisting


                                          The daily functioning of a medical practice relies on good communication skills.
                          As you have learned in previous chapters, effective communication involves excellent skills not
                          only in speaking and listening but also in conveying nonverbal and written messages. Medical
                          assistants and other health professionals must use effective communication skills in such daily
                          activities as:
                           Greeting patients

                           Speaking with patients and other professionals on the telephone

                           Scheduling appointments

                           Corresponding with patients and other health professionals in writing


                          When applying effective communication skills in these areas, health professionals must meet
                          patient expectations for professionalism, as well as HIPAA regulations on how patient
                          information can be communicated or disclosed (Box 26-1).




LE A R N ING O BJECTI VES                                               11. Describe the process of placing a caller on hold when
                                                                             needed.
You will be able to do the following after completing this chapter:     12. List the seven types of information documented when taking
Key Terms                                                                    a phone message.

 1. Define, appropriately use, and spell all the Key Terms for this     13. List three types of outgoing calls that administrative medical
      chapter.                                                               assistants may make.

Greeting Patients                                                       Scheduling Appointments
 2. Describe how a warm, professional greeting affects                  14. Explain the importance for patients, medical assistants, and
      patients.                                                              physicians of managing office appointments efficiently and
                                                                             consistently.
 3. Demonstrate the correct procedure for giving patients verbal
      instructions on how to locate the medical office.                 15. Demonstrate the correct procedure for preparing and main-
                                                                             taining the office appointment book.
 4. Explain the purpose of the medical practice information
      booklet.                                                          16. List one method of blocking off, or reserving, time not to be
                                                                             used for patient scheduling.
 5. Demonstrate the correct procedure for constructing a patient
      information brochure.                                             17. Explain  the considerations      for    canceling   a   patient
                                                                             appointment.
Managing the Telephone                                                  18. List 10 abbreviations commonly used in scheduling
 6. Describe how a medical assistant's tone of voice affects                 appointments.
      telephone conversations.                                          19. Demonstrate the correct procedure for scheduling a new
 7. List 12 guidelines for telephone etiquette and explain the               patient for an office visit.
      importance of each.                                               20. List six appointment-scheduling techniques and explain the
 8. Demonstrate the correct procedure for answering a multiline              advantages and disadvantages of each.
      telephone system.                                                 21. List two special problems that can occur in scheduling
 9. Explain the considerations for screening incoming calls.                 appointments and explain what can be done to prevent
10. Explain the importance of a triage (protocol guidelines)                 each.
      manual.                                                           22. Explain the purpose of an appointment reminder.

474
                                                                            Medical Office Communication chapter 26                        475

23. Demonstrate the correct procedure for scheduling a patient
    for outpatient diagnostic testing.

Handling Mail                                                             Read the following scenario and keep it in mind as you learn about
24. Explain why it is important to sort incoming mail.                    the importance of communicating effectively in the medical office in
25. List four classifications of U.S. mail.                               this chapter.
26. List eight special services offered by the post office that can
    help medical offices track, insure, and receive delivery con-         Tara is a new medical assistant at a physician's office. Dr.
    firmation for the mail they send.                                     Vickers has hired her to answer the phone and to greet
                                                                          patients as they arrive, as well as to assist with making
27. Demonstrate the correct preparation of an envelope.
                                                                          appointments as needed. On a particularly busy day, the
Managing Written Correspondence                                           phone is ringing with two lines already on hold and a new
                                                                          patient arrives at the reception desk. Steve, the physician's
28. Explain the proper use of a letter and a memo in medical
                                                                          assistant, asks Tara to make an appointment for another
    office communication.
                                                                          patient to see Dr. Vickers as soon as possible. Since the
29. List nine guidelines for preparing effective written communi-         office makes appointments in a modified wave, Steve tells
    cation in the medical office.                                         the patient to wait to be seen because Tara has found an
30. Identify proofreader's     marks     used    to   edit   written      opening in about a half hour. In all the confusion, Tara
    correspondence.                                                       does not return to the patients who are on hold for several
31. Demonstrate the correct procedure for composing, keying,              minutes, and one of the calls is an emergency.
    and proofreading a business letter and preparing the                  Furthermore, Tara is short-tempered with the new patient
    envelope.                                                             who has arrived at the office. Tara's frustration about the
32. Demonstrate the correct procedure for composing a                     busy schedule she is expected to keep shows, and the
    memo.                                                                 new patient states that she is not sure that she has
                                                                          chosen the best physician's office for her medical care.
33. Describe the format used to prepare a manuscript based on
    clinical research performed in the office.                                What effect will Tara's frustration have on this medical
                                                                          office? How would you have handled this situation
34. List seven types of medical office reports and describe the           differently?
    purpose of each.

Patient-Centered Professionalism
35. Analyze a realistic medical office situation and apply your
    understanding of medical office communication to determine
    the best course of action.                                         GREETING PATIENTS
36. Describe the impact on patient care when medical assistants        As a medical assistant, you may serve as a receptionist. The
    have a solid understanding of communication in the medical         receptionist is the first person a patient sees in the medical
    office.
                                                                       office. Make sure the patient's first impression of you and the
                                                                       medical practice is positive. If a patient is calling for the first
                                                                       time to schedule an appointment, make sure the patient
                                                                       knows how to find the office. Procedure 26-1 shows how to
                                                                       use verbal instructions to give patients directions for locating
                                                                       the medical office.
K E Y TERM S                                                              As you recall from Chapter 24, the reception desk should
abstract                         memo
                                                                       be accessible to patients when they enter the office. In addi-
                                                                       tion, the counter height needs to be high enough to maintain
autopsy report                   modified-block format
                                                                       the confidentiality of patient information. You must keep
certified mail                   modified-wave scheduling
                                                                       several considerations in mind when greeting new patients
cluster scheduling               necropsy
                                                                       and established patients, as well as other visitors to the
consultation reports             new patients
                                                                       medical office.
discharge summary                open-hour scheduling
double booking                   operative report
emergency                        patient information brochure          New Patients
established patients             progress notes                        Patients new to the medical office (first visit or first visit to
full-block format                proofreading                          the office in 3 years) need to feel welcome. Some practices will
history and physical (H&P)       radiology report                      mail a "new patient packet" before the patient's first office
   report                        registered mail                       visit. If forms have not been sent previously, give the new
manuscript                       streaming scheduling                  patient a pen and the forms that must be completed; these
matrix                           time-specified scheduling             forms are discussed in Chapter 34. Explain the policies of the
medical practice information     transcriptionist                      medical office, or give the patient a medical practice informa-
   booklet                       wave scheduling                       tion booklet, or patient information brochure, that provides
476      Section IV Administrative Medical Assisting


  BOX 26-1

  HIPAA: the Privacy Rule and Security Rule
  The Health Insurance Portability and Accountability Act (HIPAA) of 1996 mandates that the privacy and security of patient informa-
  tion be maintained in a confidential manner. This process begins when the individual arrives for their first appointment. Patients
  must be given detailed written information concerning their privacy rights. This includes the steps the practice will take to protect
  their privacy and how the medical practice will use patients' protected health information (PHI).
      To document that the medical practice made an effort to comply with this regulation, the practice must obtain a written acknowl-
  edgment from the patient that he or she has reviewed these rights. Acknowledgment may be in the form of a signature or the
  patient's initials on the notice signifying that he or she has received the required information. If the patient declines to acknowledge
  receiving a Notice of Privacy Practices, this must be documented in the patient's chart. This documentation shows a good faith
  effort was made by the practice to inform the patient and details the reason for failure to accomplish this act and comply with the
  regulation.
      Medical practices must also post a Notice of Privacy Practices in the office, usually in the reception area. Additional copies of
  the notice should be made available if a patient requests a copy. The regulation also requires medical practices to have a written
  policy and procedure in place for determining who has access to patient medical information. For example, the policy may state
  that the receptionist may view the names of the patients coming into the office but may not view patients' records.
      To accommodate computerized information, two types of access codes (passwords) should be used. The first set would allow
  the receptionist to view the physician's schedule but would not allow the receptionist to view patient records. The second set
  would allow the physician, nurse, and medical assistant to view the patient records for the purpose of patient care. A tracking
  system that keeps detailed information of all staff members viewing a patient's medical record should be in place.
      The HIPAA regulation also addresses the issues of sign-in sheets and calling the names of patients who are sitting in the waiting
  area.
      Can a medical practice use patient sign-in sheets and call out the names of patients in the waiting room?
      Yes; the practice can do both, as long as the information disclosed is appropriately limited. The Privacy Rule allows for incidental
  disclosure as long as appropriate safeguards are in place. For example, the sign-in sheet cannot contain confidential patient infor-
  mation (e.g., reason for the visit, medical problem). It is best to change used sheets with clean ones periodically during the day.
  Calling patients by name is still the most acceptable, courteous, and respectful way to "invite" patients into the examination
  area.




this information (Box 26-2). An information booklet or bro-               BOX 26-2
chure should provide answers to nonmedical questions. Pro-
cedure 26-2 explains information necessary to construct a                 Patient Information Booklet
brochure. Figure 26-1 provides samples of various types of                The patient information booklet (or brochure) communicates
brochures used to provide information to a patient about a                policies of the practice, (e.g., payment must be made at the
medical practice.                                                         time of service). It clarifies appointment policies, office hours,
   Let patients know that when they finish reviewing the bro-             prescription refill policies, and so on. It should avoid technical
chure, you will be glad to answer any questions about the                 terminology and should be written as if the staff is speaking
medical practice. In addition, inform patients that you are               to the patient (e.g., "We want to make your medical care our
available to help them complete the forms, if necessary. Some-            number-one priority").
times patients have trouble reading or seeing, and just handing               A patient brochure, or medical practice information
them a form to be completed may be seen as uncaring. People               booklet, should answer frequently asked questions, thus
                                                                          saving staff time by limiting the need to repeat information.
unable to read are embarrassed to say so, and therefore they
                                                                          This reduces telephone calls about office policies (e.g., office
may not fill out the forms correctly. Some may not understand             hours). The booklet invites the patient to be an active partici-
the questions being asked because of medical terminology                  pant in his or her care.
used in the forms. Patients may not want to admit they need
help or may be confused.
   Helping patients with forms also saves time. Some offices
have a private area set aside to answer questions and to fill out       area"). Remember, do not address a patient by their first name
forms. This allows for minimal distractions and patient                 unless the patient has given you permission to do so. If other
privacy.                                                                patients approach the desk while you are speaking with a
                                                                        patient, stop long enough to acknowledge their presence and
                                                                        tell them you will be available shortly. This lets them know
Established Patients                                                    that they are important as well and will receive your full atten-
Personalize the greeting when returning patients come into              tion. Every patient should be made to feel that he or she has
the office (e.g., "The doctor will be with you shortly, Ms.             the full attention of the office staff and that his or her needs
Jones; please make yourself comfortable in the reception                have priority, no matter how busy the office is that day.
                                                                                           Medical Office Communication chapter 26                           477




     PROCEDURE
       26-1                Give Verbal Instructions on How to Locate the Medical Office

                           TASK: Provide verbal instructions to a caller on how to locate the medical office.

                           EQUIPMENT AND SUPPLIES
                            Telephone
                            City map
                            Pen or pencil



 SKILLS/RATIONALE

   1. Procedural Step. Address the patient or caller in a                                b. Ask the person to repeat the directions back to you if
       polite and professional manner.                                                      the location is somewhat difficult to find.
      Rationale. The tone and pitch of your voice can promote a positive                   Rationale. This provides excellent customer service and a favor-
      first impression of the office.                                                      able impression of the medical office.
   2. Procedural Step. Ask the person, "Where will you be                            5. Procedural Step. Provide the caller with the office's
       coming from?"                                                                     phone number in case the person needs to call for
      Rationale. This provides the medical assistant with a location on                  further clarification of directions en route. If time
      which to base directions. Find the location on a city map if needed. An            permits, the medical assistant may mail written
      Internet mapping service (e.g., MapQuest) may also be helpful in provid-           directions and a map to the patient before the
      ing door-to-door directions.                                                       appointment.
   3. Procedural Step. Determine the most direct route to                               Rationale. Again, this provides excellent customer service and a
       the medical office, with alternate routes if possible.                           favorable impression of the medical office. Written directions and a map
       Provide the person with major cross streets and                                  may be included in the office's informational brochure, which is often
       landmarks.                                                                       mailed to new patients.
      Rationale. Providing the most direct route will save the patient or            6. Procedural Step. Ask the caller if they have any
      caller time and will lessen the likelihood of not finding the office. Having       questions.
      alternate routes, cross streets, and landmarks available will be helpful          Rationale. Clarifies information provided and helps avoid any
      for people unfamiliar with the area. For example, "turn left on McCleary,         misunderstanding.
      take the next right onto Dearborne. Our parking lot is across the street       7. Procedural Step. Politely end the call after answering
      from the bank." Keep in mind that the person may be driving, walking,              any questions.
      or taking public transportation.                                                   Rationale. This action displays a professional approach and pro-
   4. Procedural Step. Allow the patient or caller sufficient                            vides a favorable impression of the office.
       time to write down the directions.
       a. Repeat the directions back to the person, as needed,
          with a cheerful and pleasant tone.




FIGURE 26-1 Brochures provide information to the patient
about the various services that the medical practice offers and
often answers frequently asked questions that the patient needs
to understand.
478         Section IV Administrative Medical Assisting




    PROCEDURE
      26-2                Create a Medical Practice Information Brochure

                          TASK: Create a "mock" patient information brochure for a medical practice.

                          EQUIPMENT AND SUPPLIES
                           Computer
                           Software program that allows for brochure layouts
                           Examples of local medical practice brochures and local medical office policies
                           Pen or pencil



 SKILLS/RATIONALE

 1. Procedural Step. Determine the content information                 2. Procedural Step. Write and key a short paragraph
      to include in the informational brochure to be provided              describing each of the topics to be included in the bro-
      to patients.                                                         chure. Proofread the keyed information.
      Rationale. Provides an effective means to communicate with          Rationale. The medical assistant can read the content and make
      patient's about office policies.                                    corrections as needed. A brochure should never be sent out with incor-
      Items for consideration may include:                                rect information or "typos." Remember, this may be the first interaction
         Practice's philosophy statement                                 a patient has with your office and an impression will be formed.
         Goals of the practice                                        3. Procedural Step. Determine the layout of the
         Description of the practice                                     brochure.
         Physical location of the office (address), including a          a. The layout should be visually pleasing.
          map                                                             b. Consider the placement of the office logo.
         Telephone numbers, e-mail address, web page                     c. Ensure that the name of the practice, address, and
         Office hours, day, and time                                        phone number are prominent.
         Names and credentials of staff members*                         d. Some software programs have a brochure template
         Types of services                                                  that may work for creating this booklet. If a separate
         Policy regarding appointment scheduling, no-shows,                 program is not available, any word processing program
          and cancellations                                                  can be used.
         Payment options                                              4. Procedural Step. Have the office manager or physician
         Prescription refill policy                                      approve the final draft.
         Types of insurance accepted                                     a. Make corrections as requested.
         Referral policy                                                 b. The physician has final approval.
         Release of records policy                                    5. Procedural Step. Print the brochure.
         Emergency protocols                                             This may be done at the office if the office photocopier
         Who to contact if the physician is unavailable                  can provide quality copies. Otherwise, submit the bro-
         Frequently asked questions                                      chure electronically to a printing company for profes-
         Any special needs considerations                                sional-looking brochures.
         Personal information about the physician (e.g., area
          roots, special interests, and include special training and
          board certification)

*Some offices choose not to include this information.
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