Physicians may choose whom to serve, but may not refuse a patient on the basis of race, color, religion, national origin, or any other illegal discrimination. It is unethical for physicians to deny treatment to HIV-infected individuals on that basis alone if they are qualified to treat the patient's condition. Once a physician takes a case, the patient cannot be neglected nor refused treatment unless official notice is given from the physician to withdraw from the case. Patients have the right to know their diagnoses, the nature and purpose of their treatment, and to have enough information to be able to make an informed choice about their treatment protocol. Physicians should inform families of a patient's death and not delegate that responsibility to others. Physicians should expose incompetent, corrupt, dishonest, and unethical conduct by other physicians to the disciplinary board. It is unethical for any physician to treat patients while under the influence of alcohol, controlled substances, or any other chemical that impairs the physician's ability.
Physicians who know they are HIV positive should refrain from any activity that would risk the transmission of the virus to others. Any activity that might be regarded as a "conflict of interest" (for example, a physician holding stock in a pharmaceutical company and prescribing medications only from that company) should be avoided. Financial interests are not to influence physicians in prescribing medications, devices, or appliances.
It is the responsibility of physicians and their employees to report all cases of suspected child abuse, to protect and care for the abused, and to treat the abuser (if known) as a victim also. This is not an easy task. Abuse is not easy to witness. While there are very specific laws regarding suspected child abuse, and in most states medical assistants are mandated to report abuse, the laws are vague or nonexistent in elderly and spousal abuse. However, whatever form the abuse takes, it is best to treat all forms of abuse in the same manner by providing a safe environment for those abused and seeking treatment for the abuser and the abused.
Bioethical Dilemmas
Guidelines for bioethical issues are even harder to define than are guidelines for ethics, because each of the bioethical issues calls upon us to make decisions that directly affect a person's life. In some instances, the bioethical issue requires a choice about who lives and requires a definition of the quality of life. Such dilemmas are difficult, if not impossible, to approach from a neutral point of view even though medical assistants should strive not to place their moral values upon patients or coworkers.
Allocation of Scarce Medical Resources
The issue faced daily by health care workers is the allocation of scarce medical resources. Even with the government's attempts at health care reform, medical resources still will not be available to everyone. When the receptionist determines who receives the only available appointment in a day, when patients are turned away because they have no insurance or financial resources to pay for services, when Medicare/Medicaid patients are denied services because of low return from state and federal insurance programs, scarce medical resources are being allocated.
Professional Rights and Responsibilities
Torts And Medical Assistants
A tort is a wrongful act that results in injury to one person by another. Medical assistants may commit a tort that may result in litigation. If it can be proven that the injury resulted from the medical assistant (or other health care professional) not meeting the standard of care governing their respective professions, then litigation is a possibility. If, however, the medical assistant (or other health care professional) commits a wrongful act but the patient suffers no injury or harm, then no tort exists. If, for example, the medical assistant changes a wound dressing, breaks sterile technique, and the patient suffers a severely infected wound, the medical assistant has committed a tort and can be held liable, and legal action can be taken. On the other hand, if the medical assistant changes a wound dressing, breaks sterile technique, and the patient's wound does not become infected, no harm has been suffered, and a tort does not exist. If a medical assistant fails to report to the physician a negative result on a blood test that causes the physician to fail to make an early diagnosis of a disease, the assistant's omission of an act has caused a breach in the standard of care.
There are two major classifications of torts, intentional and negligent. Intentional torts are deliberate acts of violation of another's rights. Negligent torts are not deliberate and are the result of omission and commission of an act. Malpractice is the unintentional tort of professional negligence; that is, a professional either failed to act in a reasonable and prudent manner and caused harm to the patient or did what a reasonable and prudent person would not have done and caused harm to a patient.
There are two Latin terms that can be used to describe aspects of negligence. These are known as doctrines. Res ipsa loquitur, or "the thing speaks for itself," is the term used in cases that involve situations such as a nick made in the bladder when the surgeon is performing a hysterectomy. The negligence is obvious. The other doctrine, respondeat superior, "let the master answer," expresses that physicians are responsible for their employees' actions. If a medical assistant violates the standard of care, therein lies the basis for a suit of medical malpractice. For example, the medical assistant used the incorrect solution to clean the patient's wound and the patient sustained injuries to the wound. The physician-employer can be sued under the doctrine of respondeat superior because the physician-employer is responsible for the acts of employees committed in the scope of their employment. The medical assistant also can be sued because individuals are responsible for their own actions.
Value of the Computer to Medical Office
Today's ambulatory care setting is typically a fast-paced environment where medical assistants must complete a variety of administrative and clinical tasks thoroughly and conscientiously. The myriad paperwork that goes hand-in-hand with patient care is a critical if time-consuming responsibility; the use of computers and computerized systems can reduce the time involved in many routine office procedures and, when used properly, will streamline repetitive tasks, giving the medical assistant more opportunity for creative problem solving and office management.
Once medical assistants become familiar with computer operations and software applications, they will find more and more uses for the computer in the ambulatory care setting. Below we describe some potential functions of the computer.
While the computerization of an ambulatory care setting may seem like a daunting process, the task is made more manageable if problems are anticipated beforehand. While computerization can simplify cumbersome tasks, and ultimately lead to greater productivity, initially staff members may experience some frustration until they become proficient in the use and language of computers.
Scheduling
Appointment scheduling
Follow-up scheduling
Patient recall lists
Patient reminders
Word processing
Articles
Consultation reports
Correspondence
Labels and addressing
Medical transcription
Memos
Thank you letters
Welcome-to-practice letters
Clinical
Access to national data banks
CME (continuing medical education) programs
Drug interaction and allergy checks
Medical records
Patient education brochures
Prescription writing
Protocols, diagnosis, and treatment
Research
Retrieving medical research from on-line sites
Treatment plans
Accounting
Accounts payable
Cash report
Cash register
Charge slips
Check writing
Cross-posting in multiphysician practices
Daily log
Deposit slip
General ledger
Income and expense statement
Monthly statements to patients
Payroll
Profit and loss statements
Retirement plan accounting
W-2 forms
Billing, collecting, and insurance
Accounts receivable
Aging accounts receivable
Billing forms
Collection letters
Electronic transmission of claims
Insurance claim processing
Patient billing
Practice management
Employee vacation and sick-time records
Hospital lists and charges
Inventories and drug supplies
Ordering drugs and supplies
Patient profiles by age, diagnosis, and so on
Practice profiles by diagnosis, procedure, service
Production reports by physicians
Referrals