Ethical Philosophies

All people operate from the foundation of one or a combination of ethical philosophies, whether or not they are aware of it. Understanding ethical philosophies and identifying which one feels most “true” helps individuals understand why they view issues as they do and why they may seem unable to understand others who have opposing viewpoints. Understanding ethical philosophies also helps a person understand why she analyzes ethical dilemmas as she does. Two of the most common types of ethical philosophies are deontological and teleological.

Deontological Philosophies

Deontological philosophies operate from the belief that all human beings are of equal worth. This type of philosophy focuses on individual behaviors, rights, and duties.According to deontological philosophies, ethical principles are absolute and exceptions are rarely, if ever, justified. Thus, some actions are considered intrinsically immoral or wrong, regardless of any good or useful consequences that might result from them. For example, a person who believes it is wrong to kill and views that doctrine in a deontological way will not tolerate exceptions to that rule. So, for example, if a person adheres to this doctrine, he may be opposed to capital punishment, military action, and abortion because each of these can be considered a mode of killing. A person with such a deontological view believes that violating the doctrine in any way will cause greater harm to humanity than any immediate harm that may be caused by adhering to it. On the other hand, some persons may use their deontological perspective to override their usual beliefs about appropriate behavior. For example, they may feel a great obligation to serve their country by joining the military, regardless of their feelings about killing others, or may feel compelled to commit a crime, such as bombing an abortion clinic.

Teleological Philosophies

Teleological philosophies focus more on the consequences of actions, rather than actions themselves. Utilitarianism is one of the most common teleological philosophies. The name of this philosophy is taken from the idea of utility or usefulness. Developed by two English philosophers, Jeremy Bentham and John Stuart Mill, this philosophy interprets the rightness or wrongness of actions according to their consequences. Similar to deontology, utilitarianism also values duty and obligation and regards all human beings of equal value. However, utilitarianism rarely views particular issues or behaviors as strictly right or wrong; rather, it allows for ambiguity, or a state of uncertainty or vagueness. This emphasis on the “shades of gray” in a particular issue steers a person to consider the consequences or end result of an action as an integral component in determining its ethical rightness. Examining the end result, then, demands that the needs of many people supersede the needs of a few, and values highly the greater good for humankind as a whole. For example, a person who adheres to utilitarianism may believe that a pregnant woman’s right to autonomy supersedes whatever rights her unborn fetus may have. For the legal system to rob the woman of her autonomy, even temporarily, may be viewed by some as a greater harm to her and to society as well, for in this country the right to self-determination (autonomy) is prized above nearly everything else.

Philosophical Divide

No one ethical philosophy is right or wrong. Each person operates from a philosophical foundation consistent with her own religious beliefs, personal values, and life experiences. Individual actions may be supported or rejected by others based on their different philosophical foundation. If two persons are operating from different ethical philosophies, they may never agree on issues as controversial as abortion or capital punishment and will probably never understand one another’s viewpoints. Sadly, without such understanding social debate commonly deteriorates into name-calling and other unproductive argumentation. Learning about ethical philosophies such as utilitarianism and deontology promotes understanding of why people tend to disagree so heatedly about some issues and may further explain why some social debates never see resolution. Regardless of the ethical philosophy used and the specific decisions made, some situations have the potential for profound, long-term consequences.

Ethical Principles

Ethical principles are rules about how people ought to behave. An understanding of these principles is necessary to understand the ethical reasoning process. Upon initial examination, ethical principles may seem simple and straightforward. However, they commonly come into conflict with one another, sometimes creating complicated situations. Some of the most common ethical principles applied to health care include:

Nonmaleficence

Nonmaleficence refers to the duty of health care providers to “do no harm.” This principle was first mentioned in the Hippocratic oath and has since been repeated in one form or another in various professional ethical codes. Few would argue the merit of such a principle. However, the reality of most forms of medical treatment is that there is always the potential for harm. Even something as simple as prescribing an antibiotic to a patient with an infection has some potential to cause harm. Although potential adverse effects of most antibiotics are minor, some could be life-threatening.

Beneficence

The principle of beneficence goes a step beyond nonmaleficence. It states that health care providers must aim to provide benefit for their clients in addition to avoiding doing harm. This principle has served to guide some of the changes that have occurred over the past century regarding the regulation of medications. Years ago, virtually anyone could sell their own version of a remedy, sometimes called “snake oil,” wherever and to whomever they wished. They could make unsubstantiated claims about its curative powers. In most cases, these “remedies” provided no benefit and, worse yet, were sometimes harmful. Since that time, laws have been enacted in the United States that require medications to be proven safe as well as beneficial before they are approved for sale. Such regulation is an example of the principle of beneficence at work.
With beneficence in mind, physicians are obligated to provide medications and treatments that have a reasonable likelihood of helping patients. As a patient faces a decision regarding possible surgery, a diagnostic procedure, or a new medication, the physician must provide information regarding potential risks and benefits. In every case, there is some element of risk, because no procedures or medications are totally risk free. In this decision-making process, the health care provider and patient strive to make a choice that minimizes potential harm (nonmaleficence) while maximizing potential benefit (beneficence).

Autonomy

The principle of autonomy refers to the right of individuals to self-determination. This principle includes the notion of freedom of choice that is so highly valued by all Americans. The right to autonomy allows people to make choices about lifestyle, work, education, and many other issues, such as religion, political affiliation, marriage, and more. Autonomy also includes the right to choose or reject forms of health care treatment. Respecting a patient’s right to autonomy means that the physician and other health care workers must enable the patient to make informed choices. For invasive and otherwise risky treatments, health care providers must, therefore, obtain consent (agreement or permission) from patients.

Distributive Justice

The principle of distributive justice comes from the broader principle of justice, which most Americans hold so dear. The principle of justice is founded on the concept of fairness. The principle of distributive justice then concerns itself with the fair allocation, or distribution, of scarce resources. This principle is especially relevant in the realm of health care, where resources are always scarce. For example, there is a chronic need for transplantable organs, which raises the difficult question of how fair decisions might be made about who receives a transplant and who does not. Furthermore, such difficult decisions must be made to maximize good (beneficence) for the greatest number of people, while minimizing harm (nonmaleficence) to all.

Paternalism

Paternalism may arise in situations where the ethical principles of autonomy and beneficence are in conflict with one another. In this setting, a dominant “paternal” role is taken by a health care provider, judge, or other person or entity who makes a decision for the good of another person, possibly against that person’s wishes. In doing so, the person’s right to autonomy is denied. For example, a parent is allowed to give consent for the medical treatment of her child who is a minor, or an adult is the surrogate decision maker for an elderly parent who has been deemed incapable of making her own decisions because of dementia.

Veracity

The principle of veracity refers to the quality of truthfulness. This simple principle is generally understood and valued by most individuals, although it is not always an easy one to follow. For example, a physician may need to find a kind but honest way to tell a patient that she has cancer, or the office manager must find a tactful way to talk with an employee about her unacceptable behavior. On the other hand, there may be times when complete honesty is not needed or even appropriate to the situation. Consider the following questions: What should a medical assistant say if a patient asks her for the results of a tissue biopsy? Knowing that such information should only be relayed by the physician, how should the medical assistant respond? What should the medical assistant say when a parent asks about the purpose of her 15-year-old daughter’s appointment with a gynecologist? Should the medical assistant’s response be any different if the parent happens to be a very good personal friend?

Fidelity

The principle of fidelity refers to faithfulness, the duty to keep reasonable promises and meet  obligations. An example of reasonable expectations includes the patient’s right to expect health care providers to respect privacy and maintain confidentiality. A patient also has the right to expect that health care providers will do what they say they will do (keep promises). For example, if a medical assistant states that a phone call will be made or a message conveyed, then the patient is reasonable in expecting that the medical assistant will carry out these tasks. However, at times patients may have unreasonable expectations. For example, a patient who expects a 100% cure rate with every treatment or medication and becomes angry when results do not meet expectations is not reasonable.

Bioethics

Biomedical ethics, or bioethics, is a specialized branch of ethics that concerns itself with human behavior within the context of modern medicine. In recent years, modern science has provided humankind with an amazing number of new treatment options. Human cloning, in vitro fertilization, stem cell research, and some forms of organ transplantation once made good topics for science fiction novels but were not considered realistic. Today, however, organ transplantation and in vitro fertilization are commonplace. Stem cell research, though still controversial, is currently underway.
Animal cloning is currently being done in a limited way. Human cloning, though not common practice, is the subject of much debate. It seems only a matter of time before some form of human cloning takes place, authorized or otherwise.

The topics of abortion and euthanasia are not new. Yet our struggle to understand and agree upon standards for human conduct are exemplified by continuous debate on both issues. In addition to these controversial topics are the more common, yet equally difficult, situations that patients and families face on a daily basis. The explosion of medical research has necessarily compounded the complexity of decision making required of patients and family members. In many situations, the “right” choice is not readily apparent, leaving everyone to agonize and, perhaps, disagree about what ought to be done in any given situation.

The number and variety of situations that confront health care providers are infinite. Therefore, it is not possible to predict them or to explain what ought to be done in each and every case. So what are health care workers to do? At worst, they can keep their heads in the sand, refusing to discuss and deal with these difficult and painful topics. Doing so tends to result in responses dictated by fear and prejudice when touchy topics arise and difficult decisions must be made, which is not helpful to anyone. A far better plan is for health care workers to become educated and prepared with information and tools that can help them navigate these difficult waters and provide better guidance to their patients. These tools include an understanding of key ethical principles, ethical philosophies, and a thoughtful plan for responding to ethical dilemmas when they arise.

Law, Morals and Ethics

Morals and ethics are terms that are sometimes used interchangeably because they are based on values regarding human conduct. However, there are some subtle differences. Morals are deeply held personal beliefs about what constitutes right or wrong behavior. Such beliefs stem from a variety of sources, including religion, family customs, culture, and past experiences. Ethics goes further than a simple pronouncement of moral judgment and involves thoughtful analysis, commonly at a philosophical level. Ethics evaluates human behavior in light of specific ethical principles and looks at the impact of such behavior on individuals and society as a whole. Stated more simply, when one is behaving ethically, one is concerned with the big picture as well as the immediate situation.

Although a behavior may be deemed unethical by some individuals, it is not necessarily illegal. Conversely, a behavior that has been designated as illegal is not necessarily considered unethical by all. All cultures have beliefs about what is considered right and wrong behavior. Actions that are considered most harmful or offensive by the majority may be designated as illegal. Individuals who commit such acts, if caught, will be subject to some form of fine or punishment.

For example, in the United States, killing another person for personal gain or other selfish reasons is considered by most people to be morally and ethically wrong. Therefore, the act of murder has been legally designated a crime. Penalties for those convicted of murder are quite severe. Yet killing another individual in self-defense or as part of a government sanctioned military action is deemed acceptable, in some cases perhaps even honorable.

However, people do not always agree about what constitutes right or wrong behavior. In such cases, there is usually not enough agreement to support legislation making such behavior illegal. For example, consensual sex between unmarried adults is legal in the United States. Some people believe this is wrong, yet others do not.When there is lack of agreement, formation of laws to prohibit such behaviors is unlikely. In some cases, rules may be enacted to regulate, rather than prohibit, specific acts. Such regulation generally specifies where, when, and by whom such acts may be performed.
For example, therapeutic abortion has been legal since the 1973 Roe v.Wade Supreme Court ruling. However, there are specific rules that regulate where such procedures may be performed and by whom. Although abortion is deemed immoral or unethical by some, such beliefs are  not sufficient to make the act illegal. An act only becomes illegal when specific action, such as the passage of a law by a governing body, makes it so.

On the other hand, some people might argue that some acts, though illegal, are not morally or ethically wrong. For example, the legal age to buy and consume alcohol varies between states and countries. An 18-year-old who buys or drinks alcohol in one place might be breaking the law, while the same person could travel a few miles over the border to a different state or country and legally commit the same act. Even so, some might argue that even though the issue of legality changed from one place to the other, the issue of morality did not. Some individuals believe that drinking alcohol is wrong regardless of the individual’s physical location or age. Others would disagree.

Patient Noncompliance

Patients who fail to comply with treatment recommendations cannot expect the treating physician to be responsible for the outcome of care. The patient’s failure to comply, called noncompliance, can compromise his health. Physicians are responsible for treating a patient once a medical chart has been established. A contract is in effect when a patient seeks and receives treatment. The physician, by agreeing to treat the patient, fulfills his portion of the contract by:

1) diagnosing and treating the patient to the best of his ability
2) being available to the patient for care and return phone calls
3) arranging for a different physician to be available in the event of the physician’s absence.

The patient is responsible for his portion of the contract in that he agrees to pay copayments, provide insurance information to the office, and comply with treatment recommendations. If a physician suggests treatment and the patient refuses that treatment, the patient’s chart should reflect that the patient has been informed of the physician’s recommendations but has decided not to comply. Patients have the right to refuse treatment, but the physician is no longer responsible for the outcome. It is reasonable for a physician to expect a patient to:

1) truthfully relate his medical history
2) follow treatment recommendations, including medication, physical therapy, and lifestyle changes
3) keep scheduled appointments
4) pay copayments or deductibles as agreed.

Either party may end the patient-physician relationship. If a physician feels that the relationship must end, the medical assistant should send a registered letter to the patient to document the severing of the physician-patient relationship.
If a physician were not to write a letter of formal discharge to the patient, but merely refused to see the patient again, the physician can be charged with abandonment and could be held responsible for the poor outcomes of the patient’s condition due to a lack of care.

Criminal Versus Civil Law

Criminal law is enacted to protect the welfare and safety of the public by determining what is legal and illegal. A person charged with a felony is brought to court and is charged by the state. If a person is accused of murder, the court record will show, for example, Thomas Jones vs. State of Illinois. Although the defendant is accused of murdering an individual, the crime is considered to be perpetrated against society or the state. Offenses that are criminal are most commonly punishable by imprisonment. Examples of criminal offenses include murder, robbery, larceny, kidnapping, rape, and arson.
Civil law, also called private law, is enacted to protect the rights of individuals, as in contract disputes, divorce, family law, inheritance law, contract law, and tort law (which covers malpractice lawsuits). Civil law is the most commonly exercised type of law in ambulatory care. The punishment for civil offenses is usually payment of a monetary award to the individual whose rights were violated. Criminal charges are brought by the state; civil claims are brought by individuals. In civil law, the dispute is considered to be between individuals and the state is not represented as the accuser in the court docket. If a physician is accused of malpractice, the court record will show, for example, Jayne A. Veins, MD vs. Marjorie Wells. The accuser is the individual patient. If found guilty, the physician owes monetary compensation to the patient, not to the state where she holds a license to practice medicine. The physician may, however, be investigated by the state if the state suspects that the physician has engaged
in criminal behavior.

Intentional Torts During Medical Assistant Job

Malpractice insurance does not cover intentional torts. An intentional tort is considered gross negligence, a form of negligence that involves an intentional act or failure to act that causes harm. Harm done to a patient by a physician or an agent that is determined intentional results in a monetary award, or damages, paid to the patient and can also result in criminal charges filed against the physician, agent, or both.
Intentional torts include:

1) Assault -- An assault is a threat or perceived threat of bodily harm to another person. An assault can involve hitting and punching or just threatening to hurt another person. This situation is easily avoided by maintaining professional decorum.
2) Battery -- Battery involves touching someone in a socially inappropriate way without her permission. The prudent medical assistant must obtain consent before touching a patient.
3) Defamation -- To cause harm to a person's reputation by providing false information in writing (libel) or by spoken word (slander) is considered a crime. The medical assistant must be careful not to talk about a physician, colleague, or patient in an unprofessional manner. If a physician's practice suffers a loss of patients due to slander, a lawsuit for defamation can be brought against the medical assistant or her employer. Writing derogatory comments in a patient's chart can be considered libel, so care should be used in describing a patient's demeanor. Gossiping about a patient can be considered slander and the patient can bring a lawsuit against the medical office. Disclosing or discussing a patient's sexual history, human immunodeficiency virus status, or drug treatment history could compromise his job, marriage, and mental health. The patient may also feel that the staff is not attentive to his needs and that the gossiping created an atmosphere in which he received substandard care.
4) False imprisonment -- Holding a patient against her will is considered false imprisonment. Hospital patients are not required to stay for treatment and are always free to leave. Forcing a patient to stay in the hospital is an imprisonment that, without due process of law, is illegal (or false). An inpatient should always be able to leave the hospital, even if it is against the recommendation of her physician. In such a situation, a patient is allowed to sign out of the hospital against medical advice (AMA). The patient indicates that she is aware that she is AMA by signing a document in which she acknowledges that the physician does not recommend that she leave the hospital but that she has decided to disregard the physician's advice.
5) Fraud -- Fraud is the intentional misrepresentation of facts for financial gain. For example, charging an insurance company for services not performed or changing dates of service to accommodate eligibility of benefits is fraud.
6) Invasion of privacy -- The public release of a patient's information without his consent is considered an invasion of the patient's privacy. If a practice wants to use pictures of a patient for an office brochure or advertisement, the office must obtain the patient's consent to use the photo. Without the patient's consent, a physician's office cannot release medical information. For example, if a physician treats a celebrity, no personal medical information can be released to the media without consent.

Lawsuit Process Against Physicians

A patient who brings a lawsuit against the physician is the plaintiff, the person who seeks monetary damages for the tort allegedly committed against him. The plaintiff will hire a lawyer to represent him in court. The accused physician is the defendant, the person who must defend or explain her actions before the court. She will also hire an attorney to defend her actions and notify the malpractice insurance carrier.

Subpoenas and Depositions

During the collection of information, the medical assistant may be issued a subpoena, which is a legal document that requires a person to appear in court or be available for deposition. A deposition is a formal gathering of information during which the individual who has received the subpoena must answer questions. It is important to remember that, while giving a deposition (also called being deposed), the individual is under oath. The medical assistant is bound by law to tell the truth. To lie or omit information in a deposition is a crime, called perjury, and is punishable by law.
Another method used to gather information is a subpoena duces tecum, which requires that the individual appear in court with specific documentation, usually the patient’s medical record.

Trial

In preparation for a trial, attorneys for the defense and the prosecution will gather necessary information. Patient medical records and depositions from witnesses are collected. Expert witnesses are contacted to give testimony during the trial and a trial date is set by the court. The lawyers from both sides choose a jury, and the trial begins. Each attorney makes opening statements and then calls witnesses. Both attorneys are given the opportunity to question the witnesses through examination and cross-examination. Both attorneys make closing statements explaining to the jury how they proved their argument. The judge will give instructions to the jury and ask them to reach a verdict based on the evidence presented. The jury deliberates or discusses what they saw and heard in the courtroom and reaches a decision. If the jury finds the defendant (physician) not guilty, the case is dismissed. If the jury finds that the physician is guilty of malpractice, a monetary settlement is awarded.

Malpractice Insurance

Most physicians have malpractice insurance out of which the settlement and legal fees are paid in the event of a malpractice lawsuit. Many states have mandatory malpractice laws that require physicians to have a minimum dollar amount of malpractice insurance. If a physician has no malpractice insurance or limited coverage, his personal assets may be seized, depending on how his practice
is structured.

Standard of Care, Consent And Malpractice

A standard of care, or the minimum safe professional conduct under specific conditions as determined by professional peer organizations, must be maintained at all times. Failure to perform to the standard of care is called negligence. If negligence results in harm to a patient, it is considered an unintentional tort and the patient can file a lawsuit against the physician or physicianfs agent, such as the medical assistant. An act of negligence can involve:
1) nonfeasance, or failure to do what a prudent person would do that results in harm to a patient.for example, failure to monitor a patient's warfarin (Coumadin) levels, which results in the patient being hospitalized for internal bleeding (also called omission)

2) malfeasance, or performance of an improper act that results in harm to a patient.for example, prescribing a medication to a patient with a known allergy, which results in the patient's death (also called commission)

3) res ipsa loquitor, a Latin phrase that means the thing speaks for itself, indicating an unintentional tort that is an obvious mistake in which negligence is clearly evident.for example, a patient with a tumor on the right leg is brought to the operating room where surgeons amputate the left leg. The negligence speaks for itself.

Consent

In addition to performing procedures in accordance with the standard of care, the medical assistant or physician must also obtain the patient's consent to perform the procedure. There are the two types of consent that may be obtained when providing care to a patient: implied and informed.

Implied Consent

Implied consent occurs when a patient consents to treatment through her actions, such as rolling up her sleeve to have her blood pressure checked. A medical assistant must never force a patient to have a procedure performed. If a patient declines a procedure, such as drawing blood or a blood pressure check, the medical assistant must note the refusal in the patient's chart. Facility policy may also require her to report the refusal of care to the physician.

Informed Consent

When a patient is scheduled to undergo invasive treatment, such as surgery, the physician must obtain informed consent, which involves a written form that is signed by the patient. The physician must ensure that the patient understands:
1) the procedure
2) why the procedure is being performed
3) who will perform the procedure
4) expected results of the procedure
5) risks of performing the procedure and of doing nothing
6) available alternative treatments and how the risks and benefits compare to those of the recommended procedure.
The medical assistant may ask the patient if he has any further questions for the physician. If she suspects that the patient does not understand the procedure, she should inform the physician immediately.

Barriers to Informed Consent

An interpreter may be required to obtain informed consent from a patient who is hearing impaired or speaks a different language than her physician. Sometimes, the physician may not be able to obtain
informed consent. In an emergency situation, a patient may be unconscious or in too much pain to comprehend the physician's explanation of care. In such a situation, where the life, health, and safety of a patient depend on the physician's quick response, the Good Samaritan law protects the physician from litigation. The Good Samaritan law extends to anyone who offers emergency help within the scope of their training and abilities, including anyone who administers CPR or first aid while waiting for emergency services personnel to arrive at the scene of an accident. If a patient regains consciousness during the course of administering first aid, the prudent rescuer should ask, May I continue? For example, lifeguards are trained not only to rescue swimmers in trouble but also to administer CPR and first aid. They are, therefore, covered under Good Samaritan laws. (Note that Good Samaritan laws vary by state but always cover aid given in good faith by a person trained to do so.)

Malpractice

Malpractice, the medical form of negligence, is proven by four criteria, commonly known as the four Ds. If the prosecution can prove that all of these criteria apply in a certain case, the physician will be found guilty of malpractice and a monetary settlement will be awarded:

1) Duty.The prosecution must prove that a patient-physician relationship existed. A medical chart can be used to show proof of a physician's duty to care for a patient.
2) Dereliction of duty.The prosecution must prove that the physician failed to meet the standard of care. In court, the prosecution can produce an equally trained physician to testify as an expert witness. Commonly, an expert witness in a malpractice case practices the same specialty as the defendant. The expert witness can testify that she would act differently than the accused physician (defendant) and that the result to the patient would be better, resulting in no damage or less damage to the patient.
3) Direct cause.The prosecution must prove that the damage suffered by the patient is a direct result of the actions of the physician.
4) Damage.The prosecution must prove that omission or commission by the physician caused the patient injury or harm.

Revoking License Of Health Professionals

Most health professions have some form of regulation to ensure the competence of their members. A license is a legal document that allows an individual to offer a set of services to the public for compensation (payment). Licensure is obtained by passing an oral and a written examination.To be eligible to take a medical physician licensing examination, an individual must:
● complete education requirements through an approved medical school.
● complete an approved residency program.
● attain an age of majority, which is a legal recognition of adulthood as defined by an individual state so that a person can enter legally binding contracts with others (something a child is not legally allowed to do).
When a person passes the licensure examination in a given state, she can obtain a license to practice medicine in another state by a process of reciprocity. Simply stated, reciprocity is one state accepting the current license of a practitioner from another state. When a physician obtains a license to practice medicine, she is able to practice within the scope of her specialty for compensation. Licenses must be renewed every two years and state dues must be paid each year. Proof of continuing education as well as proof of 5 hours of risk management training is required in all states. If the license is not renewed by the deadline, it becomes invalid, medical malpractice insurance becomes inactive, and the individual cannot practice medicine. Practicing medicine without a license by failing to renew a license but continuing to treat patients is a felony, a serious crime that usually carries a stiff penalty, such as imprisonment. The law makes no distinction between a physician who lets her license expire and a person who never went to medical school and represents herself as a physician. Each individual is committing a felony and can be punished in a court of law under the guidelines for a felony conviction.

Revoking a License

A state may revoke a physician’s license for just cause, including:
1) conviction of a crime
2) felony—murder, rape, practicing without a license, selling prescription drugs or signed prescription pads
3) fraud—billing for treatments never provided, changing dates of service, falsifying medical records.
4) unprofessional conduct
5) addiction to drugs or alcohol
6) breach of confidentiality
7) false advertising
8) unethical behaviors toward patients
9) inability to perform duties
10 fee splitting or other inappropriate billing practices.
In addition to maintaining her own licensure and continuing education, a physician is legally responsible for the actions of her employees while on the job. Because a physician is directly responsible for the actions of her medical assistant employee, a physician employer depends on credentialing of medical assistants to ensure proper training. Medical assistants can become certified through the AAMA or the AMT. Certification of a medical assistant can be a deciding factor in a physician’s choice of which candidate to hire as an employee and patient care agent.

Scope of Practice

Whether the health care provider is licensed (such as a medical doctor, chiropractor, osteopath, or registered nurse) or certified (such as a medical assistant), that professional must practice within her scope of practice, or the range of services a professional can offer, based on training, ability, and licensure. For example, a pediatrician may not fill cavities in a patient’s teeth. A dentist is not licensed to give immunizations to a patient. The medical assistant who performs medical procedures that she is untrained or unlicensed to do is putting the practice at risk for a lawsuit, or litigation. In such a suit, a patient can seek legal action against the practice or medical assistant. Such action may result in monetary compensation to the patient for harm done by the unlawful actions of the medical assistant or the physician’s failure to oversee her actions appropriately. Even if injury to the patient does not occur, the consequences may still be significant, including legal expenses, damage to the reputation of the practice, and even loss of licensure. For example, medical assistants can be trained to assist in minor office surgery but cannot perform the surgery itself. If a physician were to allow an unlicensed employee to perform an office surgery, the physician’s license would be revoked or suspended.

Legal Relationship of the Patient and Physician

A patient’s relationship with her physician is complex, not only from the standpoint of her health care but also in the many legal implications that arise from such a relationship. A person who seeks care from a licensed professional is entering a contract with that professional. Once a relationship between the patient and the physician is established, the parties have entered a contract. The contract is the agreement by the physician to provide services and the patient to pay for services, either out of her own pocket or by using a third-party payor (health insurance). Failure of either party to abide by the contract is a breach of contract. The patient must pay for services, and the physician must provide services. In addition, if the physician fails to attempt to provide continuous health care to a patient, such as by moving to another city or retiring without forwarding medical records, such an action is considered abandonment and is a form of breach of contract. Because medical care of patients must be continuous, it is the responsibility of a physician to provide care or offer an alternative, such as forwarding medical records to another physician.To enter a contract, individuals must be competent adults or emancipated minors. Minors can enjoy the same rights and responsibilities as adults, including being responsible for their own debts if declared independent by a court. Teenagers who are married or parents commonly can become emancipated minors and, therefore, enter into contracts. In such situations, responsibility to pay for services is that of the minor, not a parent or guardian.
It is the responsibility of everyone in the physician’s office to follow legal and ethical principles that safeguard a patient’s privacy and physical safety and keep a patient informed regarding her health care. The medical assistant acts as an agent of the physician by representing in actions and words the intention of the physician. Recognition of the physician’s responsibility to supervise her medical assistants is called respondeat superior. This Latin phrase translates to “let the master answer,” which means that if a medical assistant injures a patient, it is the responsibility of the physician to make restitution, or monetary compensation for the injury. Respondeat superior is a form of vicarious liability, in which the employer is responsible for the actions of an employee. For example, if a bus is in an accident, injured passengers seek restitution from the bus company, not the individual driving the bus. Although responsible for her actions as a professional, a medical assistant who accidentally injures a patient is not the liable party—the supervising physician is.

Medical Practice Act

As an agent of the physician, the medical assistant must act within the laws of the state when performing health care procedures, maintaining medical records, and disclosing personal medical information to third parties for treatment, payment, or operations. All 50 states have a Medical Practice Act, which is a statute, or law, that regulates the practice of medicine. Failure to follow her state’s Medical Practice Act can result in the medical assistant committing a tort. A tort is a wrongful act for which a patient can request compensation or other legal remedies (but does not involve a breach of contract). Harm associated with a tort commonly results in a lawsuit. Although harm caused to the patient may be unintentional, penalties can be severe and can range from suspension or revocation of a physician’s license, monetary fines, or imprisonment for more serious violations. Following legal and ethical standards of care protects the medical assistant and the physician as well as the patient.

Cultural Variables For Medical Assistant Job

Body language and verbal communication takes on different meanings depending upon the cultural norms of those involved. Medical assistants should familiarize themselves with cultural norms of the ethnic groups most commonly seen in their facility. Familiarity with this information helps them interact more knowledgeably with others and decreases the likelihood of communication mishaps.

Cultural Variations in Communication

Well-intended efforts to educate patients can sometimes be wasted energy if medical assistants unintentionally offend or confuse patients through cultural insensitivity. For example, use of direct touch, prolonged eye contact, or an overly casual greeting can be so offensive to some individuals that they cannot adequately attend to the message of the speaker. Medical assistants should strive to become culturally competent and, when unsure of how to proceed, should err on the side of addressing their patients in a more conservative, formal manner.

Cultural Competence in the Medical Office

No one has the time or resources to fully understand the variations in communication styles for every culture. However, the medical office team should meet to brainstorm about ways they could all increase their knowledge and understanding of cultures common to their patient population. For example, each member could take responsibility for choosing a culture of interest, learning about it, and then teaching coworkers about it. That person could serve as the office “expert” and a resource for coworkers. Before getting started, the team should agree on what information is most valuable to know. Clinical and administrative medical assistants may have different ideas, depending on the needs they have observed in their areas. Therefore, the team should collaborate in creating the “must-have” list of information. Then the office could distribute “cheat sheets” for each cultural group researched, which could be kept on hand as a quick reference for all office staff.

Strategies for Dealing with Difficult People

For most medical assistants, working with and helping people is the most rewarding part of the job. However, working with people can also be the most challenging part of the job. Because of pain or illness, patients do not always behave at their best. They may be upset with their lowered quality of life or feeling frustrated and angry over their lack of improvement. They sometimes seem to have unrealistic expectations of what the physician and medical science are able to offer. They may be feeling frightened, vulnerable, angry, or confused. As a result, patient behavior can sometimes be unpredictable and unpleasant.During such times, a medical assistant can become a convenient target and can find it challenging to maintain her professional demeanor. However, it is especially during such times that her degree of professionalism becomes apparent.To help during such times, a medical assistant can employ several strategies, including:

Focusing on the Patient

It is not easy to avoid taking personal offense at criticism or other negative comments from a patient. However, the medical assistant must remind herself to keep her focus on the patient’s needs, rather than on herself. By doing so, she is less likely to feel personally upset or offended by the patient’s words or behaviors. In addition, the medical assistant who tries to treat others as she would want to be treated maintains the ability to empathize with her patients. This empathy makes her less likely to react in anger and more likely to respond with compassion.

Acknowledging the Patient

All people like to feel acknowledged, and no one likes to be treated as if they were a number or an object. If patients believe they are being treated as an object rather than a person, they will be offended, angry, and frustrated. A medical assistant may be extremely busy dealing with multiple patients, ringing telephones, physicians, coworkers, and numerous other demands. However, she must never fall into the habit of viewing patients as an inconvenience. Patient care is at the heart of the profession of medical assisting. Regardless of how busy a medical assistant is, it takes no more time to look a patient in the eyes, speak in a kind voice, and smile than it does to deal with that patient in a harried, distracted manner.

Validating the Patient’s Feelings

When a patient feels upset, they do not want someone to argue with them or trivialize her feelings. Such treatment will simply further upset the patient. On the other hand, if the medical assistant responds with a calm voice and validates the patient’s feelings in a kind, empathetic manner, her response will most likely have a soothing effect that deescalates the situation. However, it can be difficult for a medical assistant to validate a patient’s feelings without implying agreement with the patient’s statement. For example, a patient complains to the medical assistant, saying, “I can’t believe that I wasted $65 on a worthless medication. You people are incompetent!” The medical assistant can simply validate the patient’s feelings by saying, “You are feeling concerned that the medication was ineffective.” Then, she can offer a temporary solution by saying, “Since you are not feeling better, you should probably speak with the physician.”

Using “I” Language

Communication with others is vital in reaching agreements, resolving conflicts, and creating a positive work environment. However, when people’s emotions rise and tempers flare, their efforts at communication may quickly deteriorate into accusations and arguments. In order to avoid such a situation, people should try to plan such conversations for a time when the persons involved are not feeling angry or upset. They should also remind themselves that the goal is to achieve a positive resolution for everyone.When attempting to address a conflict or disagreement, the medical assistant who uses “I” language, rather than “you” language, can help ensure a successful conversation that does not make the other persons involved feel as though they must defend themselves. For example, the medical assistant who is  feeling annoyed with her coworker for always returning from lunch late might yell at her as she comes in the door, “You are always late and messing up our schedule, and I’ve had it!” Doing so will probably put her coworker on the defense and start an argument. A better approach would be to wait until feelings of anger subside and then find an opportunity to have a private conversation where patients cannot overhear. She then might state something like “I’ve noticed that you’ve been taking 45 minutes for lunch lately. Because we are each supposed to take 30-minute lunches, this is affecting patient scheduling. I am feeling frustrated but do not want this to hinder our working relationship. I would like to find a solution that meets both of our needs.” Of course, there is no guarantee that the coworker will respond as desired, but he or she is much more likely to do so when he or she realizes the impact his or her behavior is having on others and when he or she does not feel that his or her personal character is being attacked.

Moving to a Solution

A medical assistant is most effective when she learns to avoid getting stuck in argumentation with patients, coworkers, or physicians. When she is in a conversation involving conflict, the medical assistant should direct the conversation toward clarifying the problem without pointing blame. Then she can begin discussing possible solutions. If an upset colleague or patient seems intent on laying blame, the medical assistant should tactfully, yet assertively, change the subject by asking a question such as “What solution to this problem do you have in mind?” In addition, the medical assistant should learn to monitor her own behavior. When she notices herself feeling upset or starting to assign blame, she should refocus her attention on finding a positive solution instead.

Setting Boundaries

While a medical assistant should always behave in a tactful, professional manner, she is not obligated to subject herself to verbal or physical abuse.Whether the aggressor is a patient, colleague, or even a physician, the strategies above should be employed. Medical assistants must sometimes set or enforce boundaries, or physical or psychological space that indicates the limit of appropriate versus inappropriate behavior. If such interventions fail to work and the behavior escalates, the medical assistant should solicit the intervention of the department or office manager. This person may have the ability to provide a fresh, unbiased perspective and also has a greater level of authority to help identify a solution to the problem. The medical assistant should report any threats of physical violence per office policy. If a patient or another person becomes physically violent, the medical assistant should immediately summon help, such as calling security or even calling the police, per office policy.

Defense Mechanisms For a Medical Assistant

Defense mechanisms are unhealthy coping strategies that people employ to protect themselves when they feel emotionally threatened. Some of the most common types of defense mechanisms include:
1) rationalization
2) compensation
3) regression
4) repression
5) displacement
6) denial
7) projection.

Rationalization

When a person makes excuses to justify inappropriate behavior, that person is making rationalizations for her behavior. For example, when an employee steals supplies from the workplace, she might rationalize such actions by stating, They don't pay me enough anyway.

Compensation

Compensation is a psychological response in which a person attempts to offset feelings of  inadequacy in one aspect of life by achieving success in another. This response is not always unhealthy, but certainly may be. For example, a parent who feels guilty for not spending time with his or her child might attempt to compensate by buying the child expensive toys.

Regression

When a person reverts to behavior associated with earlier (younger) developmental stages, he or she is exhibiting signs of regression. For example, a 12-year-old child might regress to thumb-sucking behaviors when hospitalized or when dealing with family trauma, such as death or divorce. Self-limiting regressive behaviors provide emotional protection and comfort during a time of emotional trauma. The behavior usually disappears when the emotional turmoil ends. However, prolonged periods of regression may signal serious adjustment difficulties and the need for therapy.

Repression

Repression occurs when a person eliminates from conscious thought traumatic memories or painful or conflictual thoughts or impulses that the person believes are unacceptable. For example, an adult who forgot for many years about experiencing sexual abuse as a child has repressed those memories. Yet the experience has the potential to have a lasting impact on his or her ability to form healthy relationships. A man who finds himself physically attracted to his wife's best friend and recognizes his impulse to act on these feelings as unacceptable may continually forget the woman's name.

Displacement

When a person expresses anger or another emotion at a person or object that is not the cause of those feelings, he or she is employing the defense mechanism of displacement. For example, a man who is angry at his boss goes home and vents his anger on his family by picking a fight with his wife and yelling at his children. In the workplace, this behavior sometimes manifests in coworkers mistreating one another, rather than addressing issues they have with the manager.

Denial

When a person refuses to acknowledge the validity or reality of something that is obvious to everyone else, he or she is said to be in denial; for example, a person who suffers health problems, relationship problems, and professional problems due to chronic alcoholism but refuses to acknowledge that he or she has an alcohol problem. Friends, family and coworkers are usually well aware of the problem that the individual himself or herself refuses to acknowledge. In some cases, those persons closest to the individual join in the denial. For example, the wife of an abusive alcoholic who makes excuses for her husbandfs actions is also in denial.

Projection

When a person accuses others of having certain feelings, attitudes, or behaviors that he or she has, he or she is projecting. For example, a man who projects feelings of guilt about cheating on his wife might accuse her of being unfaithful to him.

Communication Patterns During Job

To become an effective communicator, a medical assistant must understand the different communication styles. These styles include:
● passive
● passive-aggressive
● assertive
● aggressive.

Passive

People who are passive come across to others as weak and submissive.They commonly lack self-confidence and usually defer to others, while keeping their own opinions and needs to themselves. Passive patients may be too embarrassed to admit they are confused and too reluctant to ask questions or seek clarification. As a result, they might leave the office feeling frustrated with unmet needs. A passive medical assistant lacks the confidence needed to ask the physician questions and advocate for her patients when the need arises. The passive communication pattern is sometimes described as a “lose-win” pattern, which means the individual sacrifices her needs in order to defer to the needs of others. However, in reality, neither party wins.

Passive-Aggressive

People who have a passive-aggressive communication style usually present themselves in a passive manner. However, this presentation is actually an attempt to manipulate others by deferring initially but then seeking revenge or finding ways to meet their needs by undermining others. They are commonly critical and sarcastic behind the backs of those people to whom they behave passively. They seek control through indirect means, such as sabotage, procrastination, stubbornness, or feigning forgetfulness. Such behaviors may be conscious or unconscious. For example, a passive-aggressive person who is afraid to say “no” when asked to work late and close the office, might later “get revenge” by “forgetting” end-of-shift duties and leaving them for the morning shift. Also, a person who behaves nicely when talking with a supervisor might then be critical of the supervisor to
coworkers. A simple way to describe the passive-aggressive communication style is that it is a pseudo (false) lose-win style. Because the person defers her needs to the needs of others in the short-term but then seeks revenge, she ultimately undermines everyone.

Assertive

People who are assertive come across as clear, professional, and articulate. They are not afraid to share their opinion or to speak up and ask for help. Even so, they are able to keep their feelings and opinions to themselves when common sense and professionalism dictate. An assertive medical assistant understands that her priority at work is to meet the needs of her patients and her physician employers, which sometimes means that her own needs take a back seat. She is willing to listen to the opinions and ideas of others and is interested in learning and growing on a personal and professional level. A simple way to describe the assertive communication style is that it is win-win. An assertive communicator understands how to attend to the needs of others without completely sacrificing herself in the process. She is able to set appropriate limits with others when necessary and attend to her own self-care needs, while keeping her professional focus where it belongs: on the patient.

Aggressive

People who are aggressive come across to others as angry, pushy, bossy, selfish, or insensitive. They rarely hesitate to voice their opinions, regardless of the situation. They disregard the feelings and opinions of others in order to get their own needs met. A medical assistant who is aggressive is not afraid to speak up and advocate on behalf of her patients when she recognizes the need. Unfortunately, because of her insensitivity, she can miss subtle but important cues from her patients (and everyone else) and commonly ends up offending or otherwise alienating others. In defense of aggressive communicators, most of them have no idea how aggressive they are. Rather, they usually view themselves as being assertive and commonly think they are great communicators. Sadly, they are the only ones who think so. A simple way to describe the aggressive communication style is that it is win-lose. These people are so concerned with getting their own needs met that they commonly do it at the expense of others.

Verbal And NonVerbal Communication

Verbal Communication

Spoken language is a key means of communication. However, the meaning of words can change, depending on vocal pitch and inflection, word emphasis, and pauses. Therefore, the medical assistant must consistently speak clearly, enunciate carefully, use a pleasant tone of voice, and keep her mind on the messages she is conveying. She must also remember that many patients, especially the elderly, may have some degree of hearing loss. When speaking to such individuals, she should face toward them so that they can see her lips and use adequate volume without shouting.

Nonverbal Communications

When a discrepancy exists between verbal and nonverbalmessages, a listener will tend to believe the nonverbal message. Therefore, the medical assistant must pay careful attention to her body language. Body language encompasses many components, including hand gestures, mannerisms, facial expressions, posture, touch, and the use of personal space. A medical assistant in a closed stance with her arms crossed, who is looking away from the person and wearing a solemn expression, conveys disinterest or displeasure. To help patients feel welcome and at ease and to project the message of concern, caring, and openness, the medical assistant should use an open body stance, make frequent eye contact, and maintain a pleasant expression, punctuated by an occasional, genuine smile.
An important feature of body language is personal space. The study of how much personal space people prefer and how it relates to cultural and environmental factors is known as proxemics. Proxemics of people in the United States reveal a preference for public space up to 25', social space between 4' and 12', personal space from 11.2' to 4', and intimate space as 0' (direct touch) to 11.2'. People are generally reluctant to give up these barriers without a compelling reason. For example, most people are willing to stand closer than usual to a stranger in a crowded elevator or when exiting a crowded concert hall. Even so, there are commonly additional unspoken rules that dictate acceptable behavior in such situations. For example, when riding in crowded elevators, people rarely speak to one another, always face forward, and avoid making eye contact. In waiting rooms, patients rarely choose to sit directly next to a stranger if other options exist. Some may even choose to remain standing in order to maintain control over personal space. Most people do not invite others into their personal space until a degree of trust and rapport has been established. Yet the health care arena necessitates some exceptions to the rules of personal space.When a patient seeks medical care, he or she generally expects a certain amount of touching to be involved. However, because the touching is extremely personal in some cases, as with a female pelvic examination, the knowledge that such touch is necessary does not automatically make patients feel comfortable with it. Therefore, the medical assistant and other members of the health care team must treat each patient with respect and sensitivity. Most patients feel vulnerable in such situations and want to trust that all touching is  appropriate and professional. To earn and maintain such trust, the medical assistant must protect the patient's privacy and dignity. Touch can be used in an emotionally therapeutic manner to convey interest, sincerity, and empathy. Examples of such touch might include a warm, firm handshake; a pat on the arm; or gently assisting someone as they stand to their feet or get off an examination table. Many patients welcome such forms of appropriate touch and report that it helps them to feel acknowledged and cared for. However, because not all patients welcome such touch, the medical assistant must learn to read the body language of the patient and follow his or her cues. It is always best to err on the side of caution, using less, rather than more, touch when unsure. especially when dealing with the opposite sex.

Good Communication Cycle For Medical Assistant

Because a first impression is so important, a medical assistant must help ensure that each patient’s first impression of the medical office is a positive one. Good communication is one of the most essential skills for ensuring a positive first impression. Communication is a complex, continuous, multidimensional process. The message, or content, of communication includes not only what a person says but also the nonverbal and symbolic language of facial expressions, body language, and vocal inflections. Thus, a medical assistant must be sure the message she sends with her body language is congruent, or consistent, with the message she sends with her words.

Communication Cycle

Communication, or the process of sending and receiving information between two or more individuals, occurs in a cycle. The main features of the communication cycle include the referent, sender, receiver, message, channels, feedback, interpersonal variables, and environment.

Referent

The referent is what stimulates or motivates the communication. It might be an object, a sight, a sound, an idea, a sensation, or anything that prompts a person to communicate.

Message

The message is the content of the communication. It includes verbal communication through words, nonverbal communication through gestures such as head nodding, and communication through symbolism. When a person receives a message, the message also becomes a referent for that person, who in turn may respond with another message.

Sender and Receiver

The person who delivers the message is the sender. This person is responsible for the emotional tone and accuracy of the message. The sender can increase the effectiveness of the communication experience by using clear speech, simple language, and adequate volume as well as facial expressions and body language that are congruent with the spoken message. The sender should observe the person to whom he is sending the message for signs of understanding or confusion.

A receiver is the person who receives the message and decodes it, or extracts the meaning of the message. The accuracy with which the receiver understands the message depends, in part, on how well the receiver pays attention to the sender. Paying close attention involves focusing, listening, and noting verbal and nonverbal cues.
The roles of sender and receiver are fluid, meaning they change back and forth as the communication cycle continues. Compatibility, familiarity, and commonality between sender and receiver enhance their communication and understanding.

Channels

Channels are the means of conveying messages, such as vision, hearing, and touch. Such channels may incorporate facial expressions, voice volume, vocal inflection, touching a person’s shoulder, and so on. The more channels a sender uses, the more clearly he conveys the message—as long as all of the channels are consistent with the message he or she is sending.

Feedback

Feedback is the message returned by the receiver, which reflects his or her level of understanding. It also may include the receiver’s response to the original message.

Interpersonal Variables

Communication is greatly impacted by interpersonal variables, or factors that influence the receiver’s interpretation. Such factors include personal biases, education, developmental level, sociocultural background, values, beliefs, emotions, gender, health issues, roles, relationships, and prior experiences.

Environment

The communication environment is the setting in which the communication experience occurs. A number of environmental factors can interfere with the accuracy of communication, including pain, medication effects, room noise, temperature, humidity, lack of privacy, and inadequate space. In the medical office, a medical assistant is responsible for ensuring accurate communication with patients and coworkers. Therefore, she must address environmental and patient comfort issues in order to minimize distractions and maximize the patient’s ability to focus, listen, and understand.

Health Care Team Members

There are many members of a general health care team. Medical assistants should familiarize themselves with each of these specialties so they can communicate with others in an informed and effective manner.

Physicians

Physicians, or medical doctors (MDs), are qualified to diagnose and treat patients for illness and disease, prescribe medication, and perform surgery. Their education usually involves 4 years of “premed” undergraduate coursework, 4 years of medical school, and then 3 to 8 years of an internship or residency, commonly in a specialty area. Many physicians also earn board certification in their chosen specialty by passing a certification examination. Physicians must have a license in the state in which they practice medicine and must participate in continuing education for license renewal. Because medical assistants may assist with patient referrals to other physicians, they should become familiar with the many areas in which physicians specialize. Furthermore, such knowledge may be useful to medical assistants as they decide in which areas they are most interested in working.

Other Practitioners

There are some health care practitioners whose education and specialty differs from that of medical physicians. These practitioners include chiropractors, dentists, optometrists, and, in some cases, naturopathic physicians. Although these practitioners are specialists in their own right, their practice differs from that of traditional medical doctors and they may have limited authority to prescribe medications and treatments.

Nurses

Nurses are licensed professionals who are closely involved in patient care. Their practice is dictated by the state board of nursing in each state and is legally independent of physicians. However, nurses commonly work closely with physicians in the provision of patient care. Their role and duties include, but are not limited to, patient assessment, nursing care plan design, implementation of physician orders, communication of data about patient status with physicians as well as other members of the health care team, and education of patients and family members. Nursing titles and legal designations vary depending on the nurse’s education and legal credential earned. Nurses practice in a wide variety of areas in public, private, acute, long-term, and home care settings.

Physician Assistants

The role of the physician assistant (PA) was created by physicians to provide them with assistance in the evaluation, diagnosis, and treatment of patients. Historically, the first PAs were selected for their experience as medics in the military, nurses, or some other health care field. Further training was then provided by physicians in certificate programs. Currently, there are more than 130 PA programs in the United States. Some programs provide a 2-year Associate's degree; however, most are now 4-year Bachelor of Science degree programs. In addition, Master's degree programs are now available in some states. After completing their education, PAs must pass a certification examination,
which earns them the right to list the PAC (physician assistant, certified) credential after their name. PAs can work in more than 60 specialty areas. Their specific duties are determined by state law and their supervising physician. They have prescriptive authority based on this relationship. Most PAs are directly involved in patient assessment, diagnosis, and treatment in the ambulatory care setting, and some PAs are trained to assist physicians in specialty settings such as surgery.

Medical Technologists

Medical technologists (MTs) earn a Bachelor of Science degree. They are credentialed with a license or certificate to perform diagnostic testing on blood and body fluids to aid in the diagnosis of diseases and disorders. Those who pass the certification examination earn the right to list the ASCP (American Society for Clinical Pathology) credential after their name. Medical technologists work in laboratories of clinics, hospitals, or universities performing a full range of simple and complex laboratory tests. They work with and may supervise medical laboratory technicians. In the course of their work, they operate electronic equipment, computers, and precision instruments in five laboratory areas:

1) blood banking

2) chemistry

3) hematology

4) immunology

5) microbiology

Therapists

All therapists work with clients to help them regain or achieve an optimal level of function. However, their education, training, and roles vary greatly. Some of the most common types of therapists found in the health care setting are physical therapist, occupational therapist, speech therapist, and respiratory therapist.

Physical Therapist

A physical therapist (PT) earns a Master of Science degree and may earn a doctorate as well. The PT is a licensed professional and must graduate from an accredited program. Some states require continuing education for license renewal. A PT designs individual therapy programs for clients of all ages in order to restore strength, mobility, and function; decrease pain; and promote overall fitness and health. The overall goal of care is to increase the patient’s ability to function at work and at home. Physical therapy treatment methods include exercise, stretching, heat or cold application, ultrasound, electrical stimulation, and massage. PTs teach patients to use such assistive devices as wheelchairs, walkers, crutches, and prosthetics. They may specialize in a variety of areas, including pediatrics, geriatrics, sports medicine, orthopedics, cardiopulmonary rehabilitation, and aquatic therapy. They supervise and delegate tasks to physical therapy assistants (PTAs), who are also valuable members of the therapy team.

Occupational Therapist

An occupational therapist (OT) is a licensed professional who may earn the OTR (registered) credential upon passing a certification examination. A Master’s degree is required for entry into practice as an OT. OTs work with patients with a variety of disabilities from physical or natural causes. An OT designs an individual therapy program for each patient that helps him or her achieve an optimal level of function in the performance of his or her ADLs, such as bathing, dressing, and eating. OTs may also assist patients in regaining optimal function in their occupational setting. Such a program may include designing or prescribing special equipment to help a patient function at home or at work or developing computer-aided adaptive equipment and teaching a patient to use it. OTs may specialize in specific patient populations, such as pediatrics, geriatrics, or mentally handicapped patients.

Respiratory Therapist

A respiratory therapist (RT) treats patients with a variety of pulmonary disorders and works with patients of all ages. RTs also work in a variety of settings, including acute care, ambulatory care, home care, and private businesses. RT duties include helping patients experiencing breathing problems in emergency situations, setting up ventilators, and assisting in the care of patients on life support. RTs may assist physicians with diagnosis by performing pulmonary function tests (PFTs), provide oxygen therapy via various delivery devices, administer such breathing treatments as nebulizers and chest percussion therapy (CPT), teach patients to use respiratory equipment, and deliver and set up oxygen equipment in patients’ homes and teach them to use it. Their goal is to help clients achieve and maintain an optimal level of respiratory function. Educational preparation for respiratory therapists is an Associate’s degree.

Speech Therapist

A speech therapist (ST) diagnoses and treats patients with speech, voice, or language disorders. STs develop and implement individualized therapy programs based on input from and consultation with other professionals, such as physicians, nurses, and social workers. STs are uniquely qualified to evaluate patients experiencing swallowing difficulties and recommend appropriate dietary and safety modifications accordingly. Requirements to practice speech therapy include a Master’s degree in speech pathology plus 375 hours of supervised clinical practice, passing a national examination, and 9 months of postgraduate experience.

Registered Dietitian

A registered dietitian (RD) is an expert in the area of food and nutrition. An RD acts as a consultant in hospitals, long-term care facilities, HMOs, community and public health organizations, and medical centers. RDs also work in sports nutrition, food- and nutrition-related businesses, and research.They may specialize in working with pediatric, renal, and diabetic patients. A Bachelor’s degree is required for entry to practice. However, many RDs earn their Master’s or Doctorate degrees as well. After graduation, RDs must complete a supervised practice program and pass a national examination. Continuing education is required to maintain registration.

Pre-hospital Care Specialists

Some health care providers are educated and trained to provide emergency care and transport for those who experience injury or illness. Such individuals generally are employed by fire departments or ambulance companies. Examples of prehospital care specialists are emergency medical technicians and paramedics.

Emergency Medical Technicians

Emergency medical technicians (EMTs) are trained members of the emergency management services (EMS) team and assist paramedics in the stabilization and transportation of patients to the hospital. They are usually dispatched to the scene of an emergency by the 911 operator and may work with police or fire department personnel.

Paramedics

Paramedics are trained to provide emergency interventions for ill or injured patients with the goal of stabilizing them enough for transport to the hospital. They are usually dispatched to the scene of an emergency by the 911 operator and work with and supervise EMTs and, possibly, police or fire department personnel. They must know how to evaluate the scene to identify potential hazards; provide emergency, lifesaving interventions such as CPR; control bleeding; and perform other basic and advanced lifesaving skills. Paramedic programs vary in length by state and whether they are full-time or part-time. Training includes advanced cardiac life support (ACLS), pediatric advanced life support (PALS), and other emergency care courses.

Technicians

A variety of technicians work in the hospital and clinic settings to aid in the diagnosis and treatment of illness or injury. Some of these technicians include phlebotomists, radiologic technicians, and medical laboratory technicians.

Phlebotomist

Phlebotomists are trained to draw blood from patients for laboratory testing or from blood donors for blood banks. They spend time working directly with patients, taking blood, and monitoring the patient’s response. They also assist the laboratory technologists by helping prepare and process the tests. Other tasks may include updating records, preparing stains and reagents, and cleaning and sterilizing equipment. Phlebotomists work in the laboratories of hospitals clinics, and blood banks. They may be trained on the job or may complete an accredited 1-semester or 1-year program,
earning a diploma or certificate.

Radiologic Technicians

Radiologic technicians help physicians diagnose a patient’s disorder by creating images of internal organs, tissues, and bones. Common procedures include x-rays, which show bones, and fluoroscopies and sonograms, which show soft tissues by using sound, magnetic, and radio waves. Radiologic technicians analyze the images and consult with physicians about their significance. They take special precautions to protect themselves and patients from unnecessary radiation exposure. Training usually consists of an Associate’s degree in a professional technical program or a Bachelor’s degree. People with experience in another health care field may be able to complete a 1-year certification program.

Medical Laboratory Technicians

Medical laboratory technicians (MLTs) assist in the diagnosis and treatment of patients by performing tests on blood, body fluids, or tissue specimens using microscopes, computers, and complex laboratory equipment. They work under the supervision of a medical laboratory technologist (MT), pathologist, or other professional. They may specialize in one of five different areas, including chemistry, blood banking, hematology, immunology, and microbiology. Other MLT duties include equipment and records maintenance and results reporting. Most MLTs work in
laboratories of hospitals, public health organizations, universities, pharmaceutical companies, biomedical companies, or the armed forces. MLTs must complete an Associate’s degree program and pass a national certification examination.

Administrative Specialists

Administrative specialists help with such administrative duties as coding, transcription, data entry, and medical records. Two types of administrative specialists are medical coding specialist and medical transcriptionist.

Medical Coding Specialist

A medical coding specialist reads and analyzes documentation of physicians and other health care providers to gather data about diseases, injuries, and procedures and translates it into diagnostic and procedural codes.Accuracy in assigning correct codes is critically important for compliance with federal regulations and insurance reimbursement.The medical facility may also use this data for planning and marketing as well as the preparation of management reports. Medical coding specialists work in hospitals, clinics, long-term care facilities, home health agencies, dental offices, insurance companies, and government agencies. Training may be available on-the-job or through continuing education; however, an Associate’s degree is recommended. To become a certified medical coder, an individual must pass examinations offered by the American Health Information Management Association (AHIMA) and the American Academy of Professional Coders (AAPC).

Medical Transcriptionist

Medical transcriptionists work in partnership with health care providers to document patient care. They are health care professionals with expertise in medical language who translate a physician’s dictation of a patient’s medical history, diagnosis, treatment, and prognosis into written form.Transcriptionists must use common sense and sound judgment, knowing when to seek clarification and verify information in order to ensure the accuracy of the medical record, which is considered a legal document. Certification may be earned by passing an examination and is maintained through continuing education. Medical transcriptionists work in physician’s offices, hospitals, clinics, laboratories, insurance companies, government facilities, legal offices, and research centers. Some medical transcriptionists also work out of their homes as independent contractors.

Types of Medical Practices

Physicians have a number of options when choosing the type of medical practice in which they wish to participate. Choices include sole proprietorships, partnerships, and corporations. All types of medical practices are likely to employ medical assistants.

Sole Proprietorship

Historically, physicians worked as sole proprietors within their own offices. They were in charge of their practices and could operate them as they wished. Being self-employed, they enjoyed a certain level of independence and flexibility. Patients liked knowing that they could count on seeing their own doctors and appreciated the personal nature of health care. As sole proprietors, physicians were the owners of their practices and could employ whomever they wished, even other physicians. However, sole proprietorships are becoming less common as physicians these days are more aware of the disadvantages in this type of arrangement. Such disadvantages include potential liability for acts of all employees, long work hours, and being on call virtually 24 hours per day, 7 days per week.
Furthermore, physicians must bear all financial responsibility of the practice and, unless they sell them to someone else, their practices end when they retire or die. In recent years, many physicians began joining together to form associate practices. This arrangement allows them to enjoy the benefits of a sole proprietorship while sharing resources, such as office space, equipment, and employees. While associate practices help alleviate the burden of a sole proprietorship somewhat, physicians still must deal with issues of liability, long hours, and continuous on-call time.

Partnership

Because sole proprietorships and associate practices require such a substantial commitment, many physicians are finding partnerships to be more attractive. A medical partnership is created when two or more physicians create a legal agreement that specifies the rights, obligations, and responsibilities of each.There are many advantages of a partnership, including an increased potential profit because physicians share expenses and pool such resources as office space, equipment, employees, and insurance. They can also enjoy more freedom because they alternate taking calls for all patients in the practice. The main disadvantage of a partnership is the potential liability for a partner’s debts. A partnership with three or more licensed, full-time physicians is known as a group practice.

Corporation

A corporation is an artificially created body with legal and business status that is regulated by the state. The corporation exists independently of shareholders or employees and has a continuous life that does not end or change with a change in the shareholders or employees. Physicians in the corporation are usually shareholders as well as employees of the corporation. This status provides them with significant income and tax advantages, along with attractive benefit packages. Furthermore, as professional employees of the corporation, they are not liable for the acts or debts of other employees of the corporation. Therefore, their personal assets are not in jeopardy if others are involved in litigation. A health maintenance organization (HMO) is one type of a corporation in which physicians commonly practice.

Health Care Settings

Physicians and other health care practitioners provide health care to people in a variety of settings depending on their needs. Common health care settings include hospitals and long-term, subacute, home, and ambulatory care facilities.

Hospitals

Hospitals are acute care settings, in which health care professionals deliver care to patients who are experiencing sudden illness or injury. Patients may be treated in the emergency department or admitted for medical and nursing care on a 24-hour basis. Depending on the size and type of hospital, it may include a number of specialty units, such as orthopedics, medical, oncology, pediatrics, maternity, surgery, and intensive care. Hospitals may be designated as providing Level I, II, or III trauma care, depending on the types of injuries they are equipped to deal with. Some hospitals,
designated as teaching hospitals, are affiliated with medical schools. Teaching hospitals employ medical school residents, who are physicians in the process of obtaining further clinical training after internship, usually as a member of the hospital staff. These residents provide much of the physician related care in these hospitals under the supervision of licensed physicians. A growing number of hospitals have day-surgery units where uncomplicated surgeries are performed. Patients generally are admitted and discharged from such units in the same day. Hospitals are further designated as private or nonprofit. Private hospitals are commonly owned by stockholders and run by companies.

Nonprofit hospitals have a community-service focus and are generally run by a board of directors.While these hospitals may make a profit, all such monies must be reinvested in the
hospital. Physicians must possess hospital privileges in order to see patients in a hospital. Before a hospital grants such privileges, it will consider such factors as the physician’s education, licensure, experience, and prior revocation of privileges or actions against the physician’s license.

Long-Term Care

Long-term care (LTC) facilities, also known as nursing homes, provide skilled nursing care for people who are deemed medically stable yet unable to attend to activities of daily living (ADLs) without assistance. Such people are generally referred to as residents rather than patients because the LTC facility is their home. Sometimes, a person’s stay at an LTC facility may be temporary; however, it is more commonly permanent. While nurses and nurses’ aides provide care for the residents, the aim of care is to create a homelike atmosphere to the greatest extent possible, where residents have opportunities for social, physical, and creative activities.

Subacute Care

Subacute care facilities provide a level of care somewhere between that of the acute care and long-term care facilities. A patient’s stay in such a facility is usually longer than in acute care, but still temporary. The purpose of the patient’s stay is commonly rehabilitation activities with the goal of supporting the patient in regaining enough strength, mobility, and function to return home or to a semi-independent assisted-care setting.

Home Care

Home care is a setting in which individuals are able to remain in their own private homes with the help of private nurses, trained aides, chore services, and other types of assistance. Another setting that falls under the umbrella of home care is the increasingly popular adult family homes that are becoming more common in many communities, also known as assisted living facilities. The owners of such facilities are generally licensed by the state to provide housing, meals, and limited health care services to a specified number of residents. Most adult family homes accept only private-pay patients and do not provide intensive nursing care. However, they are an attractive option for people who are unable to live independently yet are not in need of LTC placement.

Ambulatory Care

The term ambulatory means “to walk or move about freely.” An ambulatory care facility is one that provides medical care to nonresidential patients who do not stay overnight. Most medical assistants work in ambulatory care settings, such as physicians’ offices and medical clinics.

Professionalism As A Certified Medical Assistant

Medical assistants are viewed as representatives of the physician and the health care organization. Therefore, they must consistently demonstrate professional behavior in all of their interactions with others.

1) Medical assistants should strive for accuracy in everything they do. When a medical assistant performs accurately, she indicates that she adheres to the standard of care and takes care in all that she does to avoid errors. Through her dedication to quality and efficiency, she will reap many rewards, including fewer errors, less need for damage control, and greater job satisfaction.

2) Courteous behavior that is polite, considerate, and helpful should be standard practice for medical assistants as they interact with patients and coworkers.

3) Being dependable means being reliable and trustworthy. These qualities are important to everyone with whom medical assistants interact.

4) Medical assistants who are adaptable and flexible will quickly earn the appreciation of their employers and coworkers.

5) Medical assistants are members of a profession in which things are continually changing. They must be willing to commit themselves to lifelong learning in order to keep up. Some ways they can do this is by attending workshops and college classes and reading professional journals.

6) A tactful person is one who demonstrates the ability to respond to others with sensitivity and courtesy to avoid causing offense. Because the medical assistant cannot take back words once they leave her mouth, it is always better to be discreet and say less, rather than more, when she is
unsure of what to say.

7) Accountability refers to a willingness to be responsible for and answer for one's actions, own up to any errors, and work positively to take any corrective measures if needed.

8)  In most work environments, and especially in health care, attitude is everything. Attitudes can be changed, but the motivation for change must come from within the individual.

9) Appearance is a critical part of the professional role. Generally, the more conservative a person's appearance is on the job, the better. Paying careful attention to appearance includes taking care with hygiene, wearing minimal makeup and jewelry, avoiding displaying tattoos, and keeping hair out of the face and eyes. Clothing should be neat and clean and conform to standards designated by the employer. Because medical assistants commonly spend long days on their feet, they should carefully select footwear and hosiery.

10) Patients look to health care providers for help, information, and guidance. Furthermore, they observe and take note of such things as lifestyle, attitude, behaviors, and habits.healthy and unhealthy. Medical assistants must be aware that they are role models and strive to be positive ones.

11) Potential barriers to professionalism include such bad habits as tobacco use, gum chewing, and vulgar language. Other barriers include being reactive rather than proactive when responding to others, bringing personal problems to work, and participating in gossip.

12) All employers agree that one of the qualities they most desire in their employees is the ability to be a team player. Professional medical assistants should recognize that the welfare of the team sometimes must take priority over personal issues, and everyone's contribution and cooperation
is essential. Medical assistants who develop the ability to be true team players will be highly appreciated and valued by everyone.

Team Playing For Medical Assistants

All employers agree that one of the qualities they most desire in their employees is the ability to be a team player. With an individual sport, such as running a marathon, a person sets individual goals, plans independently, and develops a strategy based on personal strengths and weaknesses. The person relies only on herself to accomplish the task, arrives at the finish line alone, and takes personal credit for the accomplishment.With a team sport such as soccer, goals are shared by the entire team, and the game plan is communicated and agreed upon between players.

On the field, players pass the ball to each other and lend support when and where it is needed. Everyone contributes to the process, and nobody performs alone. Personal sacrifices are made for the good of the team with the goal of achieving a team victory. Credit for the results, regardless of the final score, is shared by everyone on the team. Even players who may not particularly like one another understand that the welfare of the team comes before personal issues. They learn to work together effectively putting personal feelings aside—and as a result develop a measure of respect for one another.

Similarly in the health care setting, such goals as providing top-quality patient care and creating a profitable medical practice are shared by the entire team. Effective communication is critical to the process and members of the team lend one another support when it is needed. Nobody performs in isolation. Everyone’s contribution and cooperation is essential. On occasion, personal sacrifices are made for the good of the team so that the goals can be achieved. Although it is preferable, it is not mandatory for all employees to like one another. Even so, they must develop the ability to work together in a cooperative and respectful manner. Medical assistants who develop the ability to be true team players will be highly appreciated and valued by everyone.