Medical assistants routinely deal with patients in a variety of encounters, and patients respond to medical care differently, depending on their developmental stage, their psychological well-being, and the nature of their health status. This section discusses the principles of psychology and human behavior that are most pertinent to medical assistants in their dealings with patients. Psychological Theories Psychiatrists, psychologists, and other researchers have developed a range of theories to explain human thought, emotion, and behavior. While the medical assistant is not required to know the details of these theories, a broad understanding of the approaches taken by researchers will allow them to be more informed about the entire medical field and human behavior in general. Psychoanalytical Theory Developed by Austrian physician Sigmund Freud in the early 1900s, this theory was founded largely upon Freud’s research into and thinking about the unconscious mind and the structure and development of 'personality.' According to Freud, an individual’s personality is composed of the id, the ego, and the superego, which are explained here. - id: the collection of basic drives and impulses that arises from our preoccupation with and concerns about survival, preservation, and the procreation of life; this component is largely buried in an individual’s subconscious. - ego: the aspect of an individual’s personality that, in a way, sits above the id, in the realm of awareness, and is comprised of perception, cognition, and action. Through the ego, an individual most directly interacts with other individuals and his or her environment. - superego: the part of 'personality' that functions, again as in the relationship between the id and the ego, above the ego. It arises from elements outside the individual, in the realm of family relationships, societal values, social mores, and the like. It is in the realm of the superego that a person’s moral standards and conscience reside.
Psychotherapy, based on Freud’s ideas about personality, involves what is sometimes called 'talk therapy,' in which a psychoanalyst guides a patient in probing conversation and free association aimed at uncovering aspects of the patient’s personality buried in the subconscious. Behaviorism Behaviorism largely arose out of criticism of Freud’s approach in analyzing personality. Theorists John B. Watson in the 1920s and later B. F. Skinner in the 1950s, among others, developed the idea that observable behavior, rather the subconscious, was the more important aspect of personality to explore. A person’s response to external conditions was the core to understanding what underlay his or her behavior. From these theories came behavior therapy, or behavior modification, which was popularized in the 1950s and 1960s. Rather than uncovering unconscious motivations, thoughts, and feelings, this approach concerned itself with modifying behavior that could be observed and then changing that behavior. Humanistic Psychology Humanistic psychology developed as a means to understand and analyze the whole person, not just the components of personality that psychoanalytical theory employed and not just the more scientifically observable aspects of behavior that behavioral theory employed. It focused less on pathology and more on efforts toward growth. One of the main theorists—Abraham Maslow—established what he described as a hierarchy of human needs. This 'pyramid' approach explained how the most basic physiological human needs, such as the need for food and shelter, must be met before more advanced requirements— security, social interaction, self-esteem, and self-actualization—could be achieved. Cognitivism Developed by a range of researchers, including those from the information sciences field, in the latter part of the twentieth century, cognitive psychology focuses on how an individual learns and processes information. It is particularly concerned with these questions as they help to shape a person’s behavioral patterns. Cognitive therapy, with its focus on cognition, is a popular style of treatment style for certain disorders, such as depression and anxiety. The patient is encouraged to explore and uncover errors in their thinking that arise from 'irrational beliefs.' Such irrationality can exist in thinking that is outside the realm of possibility. For instance, a student may feel that the only way to achieve self-worth is through attaining the highest grades in his or her class in every subject studied; while this goal may be attainable in some cases and at some times, it is not truly sustainable. Uncovering such cognitive errors helps an individual adapt to more realistic expectations and adjust their behavior and emotional responses to events accordingly. Terminally Ill Patients and the Process of Grieving Severely and terminally ill patients—and their loved ones—face a set of emotions and psychological challenges not typical of other patients. Specialized research and treatment have been developed to assist those individuals. Elizabeth Kübler-Ross’s Five Stages of Grief Elizabeth Kübler-Ross, a Swiss-born psychiatrist who lived and worked for much of her life in the United States, developed a model that described the pattern that dying patients go through in dealing with their impending death. Known as the five stages of grief, they are: - Denial: Behavior in this stage is characterized by a refusal to accept the severity of illness and the fact that death is inescapable. Denial at this stage is a natural defense mechanism, as the patient is not emotionally equipped or ready to face the idea of their own death. - Anger: This stage is characterized by feelings of anger and outrage, often directed outwardly at loved ones, caregivers, and medical professionals encountered during treatment. - Bargaining: In this stage, individuals are often given to expressions of desperate hope that the grave situation they face will reverse itself. Behaviors can include seeking drastic alternative treatments, for instance, or promising to change behavior patterns that are thought to have brought on the condition. - Depression: At this stage, individuals begin to face the reality of their own death. In doing so, typical signs of depression, such as withdrawal and crying, are normal. - Acceptance: This final stage completes the emotional journey of the previous stage: As the individual faces reality, he or she comes to accept his or her situation and start to 'let go.' Patients become less emotionally wrought and more accepting of their situation. Terminally ill patients do not always undergo these stages in the same order or, of course, in exactly the same way. Also, the stages have come to be applied not just to terminally ill patients, but to individuals who have suffered the loss of a loved one or who have undergone any type of serious trauma and loss, such as a grave illness that results in incapacitation or a massive change in lifestyle. The medical assistant may be required to deal with terminally ill patients and their loved ones. It is useful, therefore, that they understand these patterns of behavior associated with grief and respond appropriately. For instance, understanding that a patient’s anger about his or her illness may be directed outwardly at healthcare professionals should help the medical assistant react calmly, without becoming defensive or angry. Hospice Care Largely because of Kübler-Ross’s work, as well as the English physician Cecily Saunders, the hospice care movement developed. Hospice is a method of attending to the needs of terminally ill patients that treats the whole patient, not just the physical illness. Treatment and care administered under hospice programs are based on the acceptance of the terminal nature of a patient’s illness and therefore are focused on easing the effects of the illness, including not just physical symptoms such as pain, but the emotional and psychological aspects as well. This method of care, frequently delivered by trained volunteers in community-based organizations and agencies, applies not just to patient but to loved ones and caregivers, to help reduce the emotional and practical stress involved in taking care of a dying patient. The medical assistant will often be asked to give terminally patients and their loved ones information about hospice care and to help contacting the community organizations that offer such services. Defense Mechanisms Defense mechanisms are strategies individuals use to avoid difficult or painful feelings. They are means to submerge upsetting emotions into an individual’s subconscious. There are a range of defense mechanisms patients use to deal with their illnesses and health conditions. Here are some of the most common. - denial: A complete rejection of a difficult fact or feeling, this strategy was previously discussed as one of the five stages of grief. This refusal to accept one’s circumstances can indeed apply to patients who are less than terminally ill. - suppression: While not completely in denial, a patient may push a fact or feeling to back of their conscious thought, thereby allowing them to escape uncomfortable feelings. - projection: In this strategy, a person experiencing difficult or negative feelings or thoughts may accuse others of thinking or feeling the way they do, protecting or insulating an individual from his or her own negative thoughts and feelings. - rationalization: A person uses this strategy when he or she makes excuses to justify inappropriate behavior. For example, when an employee takes a 45-minute lunch break, but puts only 30 minutes for lunch on his or her time card, he or she might rationalize this indiscretion by saying, 'They don’t pay me enough anyway.' - intellectualization: This strategy is a more intellectual form of rationalization. For instance, a patient, angry at insurance company’s refusal to cover a specific treatment because he or she forgot to get a referral or put a claim in on time, may try to blame the entire health insurance industry or the heathcare policy of the country. Medical assistants will be able to improve their interactions with patients if they are aware of these types of defense mechanisms. However, their primary role is to engage with patients in a calm and compassionate way, not try to diagnose psychological or emotional problems.
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