medical office management 2 2

Lecture Notes

Assisting with physical examinations is one of the medical assistant’s most important roles. In addition to their administrative responsibilities, medical assistants may also interact with patients directly by helping with physical examinations, diagnostic tests, and even treatments in some cases. When assisting with physical examinations, your duties may include taking vital signs, preparing or administering medications, getting specimens ready for the lab, or educating patients, as well as other tasks.

However, it’s not all about the medicine. A very important aspect of your job will be to develop a positive rapport with patients, working to make them feel safe and secure, and also to let them know that their information is private. Remember, most people are very anxious when visiting the doctor, so it will be your job to put them at ease before the doctor sees them!

Because you’ll be working in health care with a wide variety of diseases and illnesses, it’s important for you to become familiar with the different medical specialty areas. This starts with a strong knowledge of medical terminology and a complete understanding of the anatomy of each major area of the body. A medical assistant is one of the few roles that has the ability to work across both administrative office functions and clinical duties. When you have a complete understanding of body systems and the diseases, illnesses, and treatments that go along with those systems, you become more valuable to the office team. Additionally, it will make you more marketable to move into different specialty area offices if you wish!

Assisting with Physical Examinations

As your textbook discusses, one of the key responsibilities of medical assistants is to assist physicians with the patient’s physical exam. This includes ensuring that exam rooms are clean and prepared for the next patient, including supplying any special instruments that may be required.

When assisting with physical examinations, it may be your job to ensure that the patient is comfortable and that the patient’s privacy is maintained. This includes the following:

• Setting the room temperature at a comfortable level for the particular season
• Knocking before entering the room
• Offering the patient a blanket or sheet
• Explaining how to wear the gown, if applicable
• Reviewing where the patient can leave his or her clothes
• Keeping the door closed when the patient is in the exam room
• Properly draping the patient for the exam

Before the physician can assess the patient for the reason for the visit, a past medical history must be obtained. A patient’s medical history may be one of the most important elements in accurately diagnosing patients. Providing information on the patient’s medical history assists the physician with diagnosing the patient’s current condition and understanding any underlying diseases and disorders.

To effectively gather information, those staff members responsible for collecting the patient history must

• Possess excellent communication skills
• Make the patient feel comfortable and secure
• Maintain good eye contact with the patient
• Be aware of nonverbal cues from the patient
• Avoid medical jargon
• Understand when to use open-ended versus closed-ended questions

A complete medical history includes information on all of the following:

• Present illness
• Past medical history
• Family history
• Work history
• Psychosocial history
• Review of systems

During the physical examination, a physician will use specific techniques to assess the various body systems. These include

• Inspection
• Palpation
• Percussion
• Auscultation

Assisting with Medical Specialties

Now, let’s take a look at different body systems and diseases and disorders that healthcare professionals may encounter with patients.

Allergies and Skin Disorders

Many patients present with skin problems because the skin can be affected by so many different factors, including allergies, infections, immune disorders, and reactions to medications.

Common skin disorders include

• Acne
• Eczema (atopic dermatitis)
• Allergic contact dermatitis
• Hives (urticaria)
• Angioedema
• Neoplasms

Cardiovascular System

The cardiovascular system is made up of both the heart and the circulatory system (i.e., the arteries, veins, and capillaries). The cardiovascular system carries blood, oxygen, and nutrients throughout the body.

Cardiovascular diseases include a wide range of diseases that affect the heart and/or the vascular system. Common cardiovascular diseases and conditions include

• Arrhythmias
• Heart attack (myocardial infarction)
• Congestive heart failure (CHF)
• Coronary artery disease (CAD)
• Vascular disease
• Stroke

Signs and symptoms of cardiovascular disease can include

• Fatigue
• Dizziness or lightheadedness
• Irregular or fast heart beat
• Chest pain or discomfort
• Difficulty breathing
• Nausea

A heart attack is also called a myocardial infarction (MI). Warning signs of a heart attack can include

• Chest pain
• Pain that radiates to the shoulder, jaw, back, or arm
• Nausea
• Lightheadedness
• Cold sweats
• Heartburn
• Shortness of breath
• Weakness
• Irregular heartbeats

Women having heart attacks often experience very different symptoms from those men do, so it’s important for the office staff to be aware of the symptoms of heart attack in women and for their patients to be aware of these symptoms as well.

Because women sometimes don’t get the same crushing chest pain that radiates down the arm, they don’t realize that they’re having a heart attack. Many women miss these “silent symptoms.”

Heart attack symptoms in women include

• Chest pain that’s more like a “fullness” or squeezing that occurs anywhere in the chest, and not just on the left side
• Pain in the neck or jaw
• Severe abdominal pain
• Shortness of breath, especially when they haven’t been moving or doing anything
• Sweating as if they were in a stressful situation
• Exhaustion, even for simple things like walking across the room
• Flulike symptoms

Endocrinology

Endocrinology is the study of the endocrine system. The endocrine system is made up of hormones and glands that tell our bodies to do different things. The endocrine system affects almost every function of our body.

The endocrine system helps to regulate the following:

• Mood
• Growth
• Development
• Metabolism
• Tissue function
• Sexual function
• Reproduction

Some common endocrine system disorders include

• Diabetes
• Obesity
• Osteoporosis
• Thyroid cancer
• Addison’s disease
• Cushing’s syndrome
• Graves’ disease
• Menopause
• Hypo- and hyperthyroidism
• Hyperglycemia

Gastrointestinal System

The gastrointestinal, or GI, system is made up of the stomach and the intestines. The GI tract is one long, continuous tube that starts at the mouth and ends at the anus, where waste is expelled from the body after digestion.

Common disorders of the GI tract include

• Reflux
• Peptic ulcers
• Gallstones
• Lactose intolerance
• Diverticulitis
• Inflammatory bowel disease (IBD)
• Celiac disease
• Constipation

Musculoskeletal System

The musculoskeletal system is made up of the muscles, bones, and joints. The musculoskeletal system

• Protects the internal organs
• Supports the body
• Provides for range of motion

The musculoskeletal system includes

• Bones
• Cartilage
• Muscles
• Ligaments
• Tendons

Some common diseases of the musculoskeletal system include

• Arthritis
• Gout
• Fibromyalgia
• Osteoarthritis
• Tendinitis
• Rheumatoid arthritis

Nervous System

The nervous system is made of up the brain, spinal cord, and nerves. The brain controls all of the body functions, while the nerves relay the messages from the brain via the spinal cord and then back to the brain.

Some common disorders of the nervous system include

• Headaches
• Brain tumors
• Cerebral palsy
• Epilepsy
• Meningitis
• Encephalitis
• Alzheimer’s disease
• Cerebral aneurysm
• Multiple sclerosis
• Parkinson’s disease
• Stroke

Reproductive System

The male and female reproductive systems comprise organs, glands, and tissues that work together so that people can reproduce. The reproductive system is composed of the following:

• External genitalia
• Internal genitalia
• Gonads
• Fluids
• Hormones

Both the male and female reproductive systems can be affected by various cancers and also infertility. Additionally, sexually transmitted diseases such as HIV, herpes, and syphilis can affect both males and females.

The most commonly spread sexually transmitted disease is HPV, or human papilloma virus. Almost all sexually active men and women get HPV. According to the CDC, currently around 79 million Americans are infected with HPV.

There are many different types of HPV. In some cases, those infected will never experience symptoms and may live their entire life not knowing they have the STD. In other cases, people may experience genital warts and even cancer.

The female reproductive system is divided into the outer reproductive system and the inner reproductive system. The outer reproductive system includes the labia minora and majora, Bartholin’s glands, and clitoris. The inner female reproductive system is made up of the vagina, uterus, fallopian tubes, and ovaries.

The function of the female reproductive system is to produce the ova that can be fertilized by the sperm. The female reproductive system also produces hormones to regulate the system.

Some common female reproductive diseases and disorders include

• Pelvic inflammatory disease (PID)
• Endometriosis
• Prolapsed uterus

The male reproductive system is made up of the penis and the testicles. The testicles are where the sperm, the male reproductive cell, are produced.

Some common male reproductive diseases and disorders include

• Benign prostatic hypertrophy (BPH)
• Hypospadias
• Varicocele
• Cryptorchidism

Urinary System

The function of the urinary system is to remove urine from the body. Urine is made up of waste and extra fluid that’s not needed by the body.

The urinary system includes

• Kidneys
• Ureters
• Bladder
• Urethra

The urinary system helps to

• Eliminate waste from the body
• Make red blood cells
• Filter waste from blood
• Stabilize electrolytes in the body

Urinary tract infection (UTI) is probably one of the most well-known disorders of the urinary system. However, other issues affecting the urinary system include

• Urinary incontinence
• Hematuria
• Kidney failure
• Kidney stones
• End-stage renal disease

The Eyes and Ears

The eyes are the organs of vision. When you look in the mirror, you can see the following parts of the eye:

• Pupil: The dark part of the eye
• Iris: The colored part of the eye
• Sclera: The “whites” of the eye
• Cornea: The clear “dome” over the eye

A layer called the conjunctiva covers most of the eye, but it’s difficult to see because it’s a thin, clear layer.

The eye works by projecting light through the pupil to the lens at the back of the eye. The retina converts this information into electrical impulses, which are then carried to the brain by the optic nerves.

A variety of eye diseases and disorders are possible, ranging from visual problems such as nearsighted and farsightedness to more serious conditions such as cataracts and retinal detachment.

Some additional eye diseases and disorders include

• Stye
• Conjunctivitis
• Glaucoma
• Diabetic retinopathy
• Macular degeneration

Many eye diseases may not present with symptoms, so it’s important to stress to patients to have regular eye checkups to identify those issues that may not be readily identifiable.

The ears are the organs of hearing and also help maintain balance. The ear has three parts:

• Internal ear
• Middle ear
• External ear

Each of those parts serves important functions for helping us hear. Sound travels from the pinna of the outer ear (the curved, cartilaginous portion of the ear) into the external auditory canal, which houses the eardrum.

From the eardrum, the sound vibrations rattle the small bones within the inner ear. These three small bones are the malleus, incus, and stapes.

In the inner ear, the cochlea receives the sound vibrations from the ear bones and transforms them into nerve impulses that are sent to the brain to tell us what we’re hearing.

Disorders and disease of the ear range from minor issues such as earaches to more complicated and serious issues such as ruptured eardrums or even tumors. Some other issues with the ears include

• Otitis media
• Swimmer’s ear
• Meniere’s disease
• Tinnitus
• Mastoiditis
• Acoustic neuroma

Assisting with Life Span Specialties

The phrase “life span specialties” may be a new one to you. Life span is defined as the functions of a person across the entire time that they are alive. You may also call this a lifetime. Therefore, life span specialties deal with specific areas of a patient’s life at specific points in time across the entire span of life.

Does this seem confusing? Well, think of it this way: when a patient is a baby, she may see a pediatrician. When that patient ages and is in the later years of her life, she may see a geriatrician. These two different specialties—pediatrics and geriatrics—are both considered “life span specialties” because they deal with patients at specific points in the span of their life.

In this lesson, you’ll learn about pediatrics and geriatrics. Pediatrics deals with patients from birth through adolescence. Many people think that pediatricians only deal with small children. However, many pediatricians see a patient through childhood, which may be categorized as old as ages 18 or 21, in some cases. In pediatrics, children’s bodies are smaller, which means you may be working with smaller equipment than you’re accustomed to. Additionally, normal body rates and lab readings and values as well as medicine dosages are different, so be sure that you’re using the right values when working with pediatric patients. Lastly, you need to remember that pediatric patients haven’t reached the age of consent, which means that not only will you be dealing with the patient, but you’ll also be dealing with the parents. Juggling a young patient as well as dealing with the barrage of patient questions from the parents can be tricky, but it’s something you’ll learn to do easily as you spend time observing others and working with these types of patients.

In geriatrics, you’ll be working with patients who are entering the end stages of their life. Unlike in pediatrics, there’s no firm set age range for a patient to see a geriatrician. Instead, the patient’s diseases, illnesses, and treatment needs will determine if a patient needs to see a geriatric specialist. Geriatricians are specialized in recognizing diseases that occur in older adults versus those issues that are happening as a normal part of the aging process. Additionally, they’re experienced in understanding how mild symptoms, such as a fever, can cause major issues in an older patient versus a younger patient. When you’re working with older patients, you’ll need to remember to adjust your patient education methods to meet their needs. For example, some older patients have auditory and visual issues. You may need to speak slower and louder or use a brochure with larger text for easier reading.

Working with both pediatric and geriatric patients requires a great deal of understanding and patience. Remember, these are both life span specialty areas that have patients who may have issues fully comprehending their diseases and treatments, so be sure to maintain a flexibility in your work style to adjust to handling different patient’s needs.

Pediatrics

Assisting in a pediatrics office differs from assisting in an office that deals mainly with adults. Equipment and tools may be smaller to compensate for the smaller body parts. Normal ranges for test results may vary for children versus adults. Additionally, as you can imagine, communicating with children is very different from communicating with an adult in a medical office.

When communicating with pediatric patients, you’ll need to be

• Patient
• Unintimidating
• Soothing
• Calm
• Aware of your facial expressions and movements

Babies grow and change quickly. Therefore, infant visits will include a great deal of measuring and tracking of growth so that abnormalities can be identified.

Baby visits are divided into well-baby visits and sick-baby visits. In many pediatric offices, the waiting rooms are even divided so that the well babies and children aren’t in the same area as those who are sick. Well babies are seen to track growth and milestones. The following will be performed at each well-baby visit:

• Full physical exam
• Measurement of growth (height and weight)
• Measurement of head circumference
• Check for attainment of developmental milestones

Well visits will continue every couple of months for babies until they’re 2 years of age. At age 3, the child should be seen every year through age 18.

Adolescence is the period from the onset of puberty to adulthood. Dealing with adolescent patients can be tricky because this is a time of a great deal of change and transition—physically, mentally, and emotionally. This is a time of self-discovery, which can be both liberating and confusing.

Puberty is the period of physical change during adolescence when boys and girls go through the process of reaching sexual maturity for reproduction. Both boys and girls may experience growth spurts. For girls, this is a time that their breasts start to grow and they get their periods. For boys, their voices will start to change and they’ll start to grow more body hair.

Adolescence is a period of rapid intellectual development. At the start of adolescence, many children are unable to understand the consequences of their actions, which may result in poor decision making and erratic actions. That’s why many preteens and teenagers live very much “in the moment” and don’t consider what will happen to them later. It isn’t until later in adolescence that they’re capable of fully understanding consequences and develop the ability for complex problem solving.

Adolescence is also a time of emotional development. During adolescence, many parents are confused because one minute the adolescent will be fiercely independent and then in the blink of an eye will be looking to the parents for guidance and direction. Adolescents are often moody, hypersensitive, and self-conscious.

Social development during this time is very important. Teens will start to push away from their family and prefer friends’ opinions and companionship. It’s also during this time that adolescents will become sexually interested in others and begin to form romantic relationships.

Because of all the changes going on, adolescents may find this time confusing and overwhelming. This confusion and sometimes peer pressure may result in the emergence of medical issues, including

• Anxiety
• Depression
• Eating disorders
• Drug abuse
• Alcohol abuse

Geriatrics

At the other end of the life span specialty spectrum is geriatrics. Geriatrics is the branch of medicine that deals with diagnosing and treating the elderly. A physician who specializes in the field of geriatrics is called a geriatrician. Because elderly patients often have issues that can’t be cured, the focus of a geriatrician is often on helping elderly patients deal with their medical conditions and improving their quality of life.

As people age, their bodies change. The medications that a person could take when he or she was younger may no longer be safe at more advanced ages. Elderly patients will often need dosage adjustments and may be at risk for drug interaction issues. Also, the immune system weakens with age, so the elderly have a higher risk of dying from infections or conditions that wouldn’t affect people in younger age brackets.

The following issues are common among elderly adults:

• Impaired balance
• Dementia
• Depression
• Alzheimer’s disease
• Parkinson’s disease
• Osteoarthritis

The following are a number of tips for assisting physicians with elderly patients. When working with elderly patients:

• Try to schedule appointments earlier in the day. Most elderly patients tire easily, so you want to see them when they’re at their freshest.
• Don’t rush them through the appointment. They’ll probably need more time with the physician than younger patients.
• Be aware of your nonverbal communication cues, especially eye contact.
• Maintaining eye contact will help elderly patients become more comfortable with you.
• Sit at eye level with the patient. This allows elderly patients who have hearing issues to read your lips. Additionally, it reduces distractions, which can be an issue for some elderly patients.
• Speak slowly. These patients often learn at a slower rate at this point in their lives. So, talking to them slowly and clearly may help them better understand what you’re saying.
• Write down important instructions. Memory loss and confusion is an issue for many elderly patients, so having exactly what they’re supposed to do written down will help them when they get home.