Navy reflects the philosophy of the Navy Medical Department regarding contact point interactions.
Some of the most frequent complaints received by the Bureau of Medicine and Surgery [now known as Commander, Naval Medical Command] are those pertaining to the lack of courtesy, tact, and sympathetic regard for patients and their families exhibited by Medical Department personnel at initial points of contact within Navy Medical facilities. These points of initial patient contact, which include central appointment desks, telephones, patient affairs offices, emergency rooms, pharmacies, laboratories, records offices, information desks, walk-in and specialty clinics, and gate guards, are critical in conveying to the entering patient the sense that Navy Medicine is there to help them. The personnel, both military and civilian, who man these critical areas are responsible for ensuring that the assistance that they provide is truly reflective of the spirit of caring for which the Navy Medical Department must stand.
No matter how excellent and expert the care in the facility may be, an early impression of nonchalance, disregard, rudeness, or neglect of the needs of patients reflects poorly on its efforts and achievements. Our personnel must be constantly on their guard to refrain from off-hand remarks or jokes in the presence of patients or their families. We must insist that our personnel in all patient areas are professional in their attitudes. What may be commonplace to us may be to a patient frightening or subject to misinterpretation.
By example and precept, we must insist that, in dealing with our beneficiaries, no complaint is ever too trivial not to deserve the best response of which we are capable. . . .
As mentioned earlier in this chapter, a distinguishing aspect of therapeutic communication is its application to long-term communication interactions. Therapeutic communication may be defined as the face-to-face process of interacting that focuses on advancing the physical and emotional well-being of a patient. This kind of communication has three general purposes: collecting information to determine illness, assessing and modifying behavior, and providing health education. In the process of using therapeutic communication, we attempt to learn as much as we can about the patient in relation to the illness. To accomplish this, both the sender and the receiver must be consciously aware of the confidentiality of the information disclosed and received during this process. The health care provider must always have a therapeutic reason for invading the patients privacy.
When used to collect information, therapeutic communication requires a great deal of sensitivity and expertise in using interviewing skills. To ensure the identification and clarification of thoughts and feelings, the interview must include observing behavior, listening, giving and receiving verbal and nonverbal responses, and interpreting and recording data.
Observation of behavior is simply the recognition of any sign the body makes when responding to a need. The quivering, excited tone of voice you hear when a mother rushes into the emergency room after her child has swallowed bleach is communicating fear and anxiety.
Listening is probably one of the most difficult skills to master. It requires the health care provider to maintain an open mind, eliminate both internal and external noise and distractions, and channel attention to all verbal and nonverbal messages. Listening involves the ability to recognize pitch and tone of voice, evaluate vocabulary and choice of words, and recognize hesitancy or intensity of speech as part of the total communication attempt. The patient crying aloud for help after a fall is communicating a need for assistance, which is different from the way you might sound in communicating a need for assistance in requesting help to transcribe a physicians order.
The ability to recognize and interpret nonverbal responses depends upon consistent development of observation skills. As you continue to mature in your role and responsibilities as a member of the health care team, both your clinical knowledge and understanding of human behavior will also grow. Your growth in both knowledge and understanding will contribute to your ability to recognize and interpret many kinds of nonverbal communication. Your sensitivity in listening with your eyes will become as refined as, if not better than, listening with your ears.
The effectiveness of an interview is influenced by both the amount of information and degree