Navy reflects the philosophy of the Navy Medical Department regarding contact point interactions. “Some   of   the   most   frequent   com- plaints  received  by  the  Bureau  of  Medicine and Surgery [now known as Commander, Naval  Medical  Command]  are  those  per- taining  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  in- itial patient contact, which include central appointment   desks,   telephones,   patient affairs   offices,   emergency   rooms,   phar- macies,  laboratories,  records  offices,  in- formation   desks,   walk-in   and   specialty clinics, and gate guards, are critical in con- veying 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  pro- vide   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 impres- sion 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 person- nel 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 in- sist  that,  in  dealing  with  our  beneficiaries, no  complaint  is  ever  too  trivial  not  to deserve the best response of which we are capable.  .  .  .” THERAPEUTIC   COMMUNICATIONS As  mentioned  earlier  in  this  chapter,  a  dis- tinguishing aspect of therapeutic communication is its application to long-term communication in- teractions.  Therapeutic  communication  may  be defined as the face-to-face process of interacting that focuses on advancing the physical and emo- tional  well-being  of  a  patient.  This  kind  of communication  has  three  general  purposes:  col- lecting  information  to  determine  illness,  assess- ing  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  con- fidentiality  of  the  information  disclosed  and received during this process. The health care pro- vider must always have a therapeutic reason for invading  the  patient’s  privacy. When used to collect information, therapeutic communication  requires  a  great  deal  of  sensitivity and expertise in using interviewing skills. To en- sure  the  identification  and  clarification  of thoughts  and  feelings,  the  interview  must  include observing behavior, listening, giving and receiv- ing  verbal  and  nonverbal  responses,  and  inter- preting  and  recording  data. Observation of behavior is simply the recogni- tion 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  com- municating  fear  and  anxiety. Listening is probably one of the most difficult skills to master. It requires the health care pro- vider 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 physi- cian’s   order. The ability to recognize and interpret nonver- bal responses depends upon consistent develop- ment  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 nonver- bal 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 5-6