Few Issues For Contemplation And Discussion

Few Issues For Contemplation And Discussion

Medical assistants will encounter ethical and bioethical issues across the lifespan. A few issues are identified for contemplation and discussion. Issues of bioethics common to every medical office are the allocation of scarce medical resources,

Infants:
In premature, deformed, or severely disabled babies, ethical issues include the decision to provide or withhold treatment. Health care professionals and parents are not always in agreement. Central to this issue, also, is the expense involved in certain treatments and deciding who pays the cost of treatment.    
Vulnerability of infants can lead to issues of negligence, abuse, or rejection. Parents are vulnerable too, for often they may not understand the ramifications of certain decisions about care of family members. Sometimes these decisions can lead to hundreds of thousands of dollars in medical expenses. Parents are also vulnerable because they may be unable to cope with the needs of the entire family.    

Children
Children who are ill-fed, housed, educated, and clothed exhibit great needs for preventive, curative, and rehabilitative health care.    
Minors with sexually transmitted diseases often seek treatment without the parents' knowledge; they can be treated without parents' consent. Treatment also must be offered without parental consent to pregnant, infected, or addicted minors. Some health care professionals consider this an ethical issue and a violation of parents' rights. Child abuse presents an ethical dilemma, especially when a child confides physical, sexual, or emotional abuse to a health care worker but does not want the information divulged. Health care professionals, as mandated reporters, must report suspected child abuse. Will the child/patient view this as a violation of confidence or suffer dire consequences as a result of the reported abuse?    

Adolescents
Adolescents as young as thirteen- to eighteen-years-old may seek abortion without parental knowledge or consent. Is this a violation of parents' right to medical information regarding their children? Or should the adolescent, fearful of parental reaction, have the right to decide? The adolescent's growing autonomy, need for independence, changing values, and desire for peer acceptance lead to a number of ethical issues that may involve the health care environment.

Adults:
Adults are increasingly faced with loss of jobs because of downsizing and layoffs. Previously with job loss, health care benefits could be lost. In August 1996, the Health Insurance Reform Act (Kassebaum-Kennedy Bill) was adopted. Among other things, this Act helps limit preexisting conditions and assures availability of individual policies for those who leave jobs voluntarily or involuntarily.    
Many low-income women do not have sufficient access to prenatal care, which has proven to be a cost-saving medical measure that is critical to the health of both mother and infant. As employers seek to reduce the cost of health insurance benefit programs, many individuals and families are finding themselves shifted from one insurance program to another, leaving them with little or no continuity of care. Also, in some managed care programs, adults may receive medical services from a number of health care professionals with whom they have no opportunity to establish an ongoing physician-patient relationship. Even with a physician's directive or a living will, a dying patient's wishes may not be followed. Technological advances in medicine have created a situation where patients may not be able to exercise a choice in the death issue even in states that may allow physician-assisted suicide.

Senior Adults:
Dementia is a common problem that is physically and financially exhausting for the caregiver, who is usually a spouse or adult child. How do caregivers cope with their own needs and the needs of dependent adults? Decisions about how and where to provide care for the senior adult pose ethical dilemmas with no easy answers. Often, the elderly may reject nursing home placement, and there may be limited funds for such long-term care. Elderly patients have the right to maintain dignity and privacy, but often their dependency on others deprives them of these basic rights. Physician-assisted suicide for terminally ill patients is a prominent issue in our society, especially when elderly patients sense a total loss of dignity. Such a decision, however, is never easily made. 

Goal Setting For Medical Assistants

Goal Setting For Medical Assistants

Discoveries prove that goal-oriented employees are more effective and assertive than colleagues with no goals or future objectives. Recognizing the value of goal planning, many employers arrange planning sessions and/or seminars to encourage goal setting as a practical application for coping with stress and the development of career objectives. If this does not happen in your work environment, seek your own seminars for goal setting. Such an activity not only "centers" you in your current employment but helps you clearly picture your future plans and hopes.

What is a goal? The dictionary definition of a goal according to Websters Collegiate Dictionary is, "the result or achievement toward which effort is directed." In order to reach a desired goal, a person must implement planning along with a sincere desire to work hard. Skill in goal setting allows the medical assistant to clarify what must be accomplished and to develop a strategic plan to successfully achieve the goal. A goal must be specific, challenging, realistic, attainable, and measurable. Specific goals are focused and have very precise boundaries. A goal that is challenging creates enthusiasm and interest in achievement. Realistic goals are practical or beneficial for the present and for future self-actualization. An attainable goal refers to the fact that the goal is possible to fulfill. Measurable goals achieve some form of progress or success. By reflecting back on the process, one is encouraged to establish additional goals.

Long-range goals are achievements that may take three to five years to accomplish. Long-range goals give direction and definition to our lives and serve to keep us "on track" so to speak. Much discipline, perseverance, determination, and hard work will be expended in accomplishing long-range goals. Some adjustment and readjustment to your goals may be necessary, however. The rewards of goal achievement include satisfaction, pride, a sense of accomplishment, and a job well done.    

Short-range goals take apart long-range goals and reassemble the required activities into smaller, more manageable time segments. The time segments may be daily, weekly, monthly, quarterly, or yearly periods.    

As a graduate and new employee, one of your long-range goals might be to become the office manager in the ambulatory care setting in which you are currently employed. You may wish to attain this goal within the next three to five years; by breaking it into three longer range goals and a series of short-range goals, you will be able to measure progress and feel a sense of accomplishment. Examples of long- and short-range goals might include:    

Long-range goal #1:    
To become proficient in all back-office clinical skills during the first year of employment!
Short-range goals necessary to achieve this goal # 1:
a) Practice accuracy and proficiency when performing tasks and skills.    
b) Practice efficiency by planning ahead for the equipment and supplies needed for each task performed.    
c) Evaluate your progress on a regular basis and identify areas that need improvement.    

Long-range goal #2:    
To add front-office administrative tasks and skills to your routine during the second year of employment.    
Short-range goals necessary to achieve this:
a) Practice accuracy and proficiency when performing all front-office tasks and skills.
b) Practice efficiency by planning ahead for the equipment and supplies needed for each task performed.    
c) Evaluate your progress on a regular basis and identify areas that need improvement.

Long-range goal #3:
To begin to focus on office management during the third year of employment.    
Short-range goals necessary to achieve this:    
a) Develop a procedures manual for all back- and front-office tasks and skills.    
b) Enroll in office management classes.    
c) Focus on team-building skills.    

By year four, you will be ready to move into the office manager position.    
Long-range and short-range goals work together to help make changes in our lives. Goals keep life interesting and give us something to strive for. We can all reach goals successfully with some planning, hard work, discipline, and dedication.

Law And Health Professional

Law And Health Professional

The law as it relates to health care has grown increasingly complex in the past decade. The agendas of federal and state governments include an investigation of quality health care, a desire to control health care costs (while hoping to assure equitable access to health care), and an interest in protecting the patient. A full discussion of health law requires several volumes; therefore, only the laws designated to protect the patient will be identified in this chapter, and emphasis will be placed on the ambulatory care setting.

For example, at the ambulatory care center of Doctors Lewis and King, a two-doctor family physician office, Dr. Lewis and Dr. King are especially careful about establishing stringent risk management procedures to protect patients from harm and the practice from potential liability. Dr. King has worked with office manager Marilyn Johnson, CMA to assemble a policy and procedures manual outlining everything from how telephone calls are answered to how patient medical records are documented and stored. Marilyn, in turn, seeks the input of the other administrative and clinical medical assistants as she frequently updates the manual. To ensure that they are providing the best care for patients while protecting themselves, four times a year the entire staff meets to review office policies, changing them as necessary or incorporating new procedures to meet new situations or legal mandates.

Being aware of the law and its implications and establishing sound practices and procedures will both safeguard patient rights and protect the health care professional.The most frequent law exercised in the ambulatory care setting is civil law, or law as it is related to individuals. Restitution awarded when a civil wrong is committed is usually monetary in nature. Criminal law addresses wrongs committed against the welfare and safety of society as a whole and punishment is usually imprisonment or a fine.

If a charge is brought against a physician as the defendant in a civil case, the goal is to reimburse the plaintiff, the person bringing charges (usually a patient), a monetary amount for suffering, pain, and any loss of wages. For example, a physician who has caused harm to a patient in the course of treatment may be sued in a civil case by the patient for the recovery of time lost from work as well as the pain and suffering that was the result of treatment.In a criminal case, charges are brought against the defendant by the state with the intent of preventing any further harm to society. For example, a physician practicing medicine without a proper license may be subject to disciplinary action from a professional association and criminal action by the courts.

Legal Public Duties And Drug Screening

Legal Public Duties And Drug Screening

Legal Public duties:

Physicians have a duty to the public to report diseases and injuries that jeopardize public health and welfare. Transmittable or contagious diseases and injuries resulting from knife or gunshot are examples and these must be reported to the appropriate authorities. This is done without the patient's consent because it is required by law. When reporting, it is important to do so properly and according to the laws in the state in which one is employed. Knowledge of which illnesses, injuries, and conditions to report, to whom to report, and the appropriate forms to submit is essential. Copies of all information must be kept for the office or clinic. Some states have laws specific to the release of information relative to mental or psychological treatment, human immunodeficiency virus testing, acquired immunodeficiency syndrome diagnosis and treatment, sexually transmitted diseases, and chemical substance abuse. Local or state health departments can provide lists of diseases and injuries to report and will also provide the appropriate forms.

Drug Screening:

States vary in the laws they have regarding the abuse of alcohol and other drugs. In general, employers are allowed to screen an employee for chemical substances if they believe the employee's work performance is being affected by the abuse. Great controversy surrounds pre-employment and random screening for drugs in the workplace. Some states allow widespread random testing of employees.
It is important that the worker's right to privacy not be violated. A tort of defamation of character could be claimed against an employer if the results of the testing become known to others. Get the patient's written consent when asked to collect a specimen for drug screening. Be certain the laboratory that performs the screening is qualified to perform the test. The possibility of liability is great if the ambulatory care setting does not have specific policies and procedures to employ in regard to specimen collection and testing. It should be carefully documented on the patient's record which medical personnel are responsible for the specimen from the time it was collected until the results are known.

The release of patients' records that pertain to chemical substance abuse is protected by federal laws under the Federal Drug Abuse Prevention, Treatment, and Rehabilitation Act. The law prohibits disclosure of information that identifies the patient as a chemi-cal substance abuser. Also, information about the patient's treatment cannot be divulged without the patient's written consent. The records can, however, be released by order of a subpoena to another health care professional during an emergency situation or if the records are to be used for research and program evaluation.

Changing societal values have contributed to an explosion of lawsuits in medical practice. Patients are more aware than ever of their rights, especially those of confidentiality and the right to privacy, consent, and records ownership. They readily seek redress when they perceive their rights to be violated. A healthy relationship between physicians and patients and between medical assistants and patients, as well as respect for the patient's rights, lowers the potential for the likelihood of a lawsuit. Knowledge of the laws that regulate medical and business practices in your state are necessary in order to be in compliance. Sources of information regarding state and federal laws can be obtained from the state medical society, the physician's liability insurance company, the state medical assistant society, the state attorney general's office, or the public library.

Maintaining Medical Records And Consent

Maintaining Medical Records And Consent

A major responsibility of the physician and the medical assistant is to maintain an accurate and up-to-date record of the patient's care. Whatever style of record is used, the credibility of the medical record will be a key factor in any litigation. All matters related to a patient's care must be charted, and these charts must be an accurate reflection of actual care rendered and charges made. An act not recorded is generally considered an act not done. Charts that are incomplete or illegible are not easily defensible. Necessary corrections should be made by drawing one line through the error and placing the correction above it with the person's initials and date. All entries should be properly signed and dated, also. Consistency in the medical records becomes a powerful defense for the physician.

1) Informed Consent:
Documentation of informed consent becomes an important part of the medical records. Every patient has a right to know and understand any procedure to be performed. The patient is to be told in language easily understood:    
a. the nature of any procedure and how it is to be performed
b. any possible risks involved as well as expected outcomes of the procedure    
c. any other methods of treatment and those risks
d. risks if no treatment is given    

It is the responsibility of the health care provider to make certain the patient understands. If an interpreter is necessary, the physician must procure one.    
Often, consent forms will be signed if there is to be a surgical or invasive procedure performed (Figure 9-5). The medical assistant may be asked to witness the patient's signature and may be expected to follow through on any of the physician's instructions or explanations but is not expected to explain the procedure to the patient. The signed consent form is kept in the medical chart and a copy is also given to the patient.    

2) Implied Consent
Two circumstances related to consent are worth mentioning at this point. Implied consent occurs when there is a life-threatening emergency or the patient is unconscious or unable to respond. The physician, by law, is allowed to give treatment without a signed consent. Implied consent occurs in more subtle ways, also. The patient who rolls up a shirt sleeve for the medical assistant to take a blood pressure reading is implying consent to the procedure by the action taken.    

3) Consent and Legal Incompetence    
Consent for treatment is not valid if the patient is legally incompetent to give consent. Legal incompetence means that a patient either is found by a court to be insane, inadequate, or to not be an adult. In such instances, consent must be obtained from a parent, a legal guardian, or the court on behalf of the patient. Consent for treatment may be given only by the natural parent or legal guardian as determined by the court for a minor child, typically defined as one under eighteen years of age or the age of majority. An emancipated minor is one considered by the courts to be an adult. Emancipated minors may be defined as persons living on their own, who are self-supporting, who may be married, or who are in the military. They can legally give consent for treatment. Consent problems may arise when providing care to minors. Consent for medical care such as treatment of sexually transmitted diseases, pregnancy, alcohol or drug abuse, abortion, or birth control pose special problems. Some states allow minors to give their consent in these special situations.

Range of Psychological Suffering In AIDS

Range of Psychological Suffering In AIDS

Health care professionals will always be called upon to care for patients who have infectious diseases, diseases not known to the medical community, or new diseases that are rare but that may become more common in the future. New diseases are likely to be seen when genetic change in causative organisms or changing modes of agriculture put human populations into contact with new pathogens. This is especially true in developing countries where populations are high, and people live in crowded conditions without proper sanitation. Even though health care professionals are prepared to respond to the medical, surgical, and psychological needs of patients, they face additional challenges when helping people with the acquired immunodeficiency syndrome AIDS, a deadly infectious disease.

One of the most important skills for medical assistants is the ability to respond to patients with special needs in an empathic way. Medical assistants will respond to the needs of patients with AIDS and individuals who test positive for the virus in an ambulatory care setting rather than a hospital or surgical center. In some measure, the ambulatory care setting removes the medical assistant from the demanding daily physical care of these individuals who can be so devastated by the ravages of AIDS. The psychological and emotional demands of the medical assistant, however, are as great, if not greater, than those placed upon health care professionals in a hospital or surgical center.

Infection with HIV causes extreme distress. The onset of symptoms is typically accompanied by the fear of developing AIDS. Distress is evident in the preoccupation with illness and patients' fears of getting cancer and other life-threatening diseases. Anxiety and depression are common. At the time of diagnosis, patients' responses may include denial, numbness, and inability to face the facts. Patients are angry at the disease, at the discrimination that often accompanies it, at the prospect of a lonely, painful death, at the lack of effective treatment, at medical staff, and at themselves. In many cases, guilt develops about past behavior and lifestyles, or about the possibility of having transmitted the disease to others. When the disease has been contracted through contaminated blood or blood products or by individuals who felt they were protected or safe from the disease, the anger may turn into rage. Sadness, hopelessness, helplessness, denial, and withdrawal are often exhibited. Some patients contemplate suicide. Because social and physical assistance are needed, a strong network of friends and family is particularly important. In the case of homosexuals and persons addicted to intravenous drugs, however, there are a large number who are estranged from their family's support system. Persons with AIDS may feel added strain if this is the first knowledge their families have of any high-risk behaviors associated with the transmission of disease. The psychological suffering leads to physical symptoms such as tension, tachycardia, agitation, insomnia, anorexia, and panic attacks. Persons who test positive for HIV often express an exaggerated sensitivity to disease and see any new symptom as bringing them closer to death.

As a medical assistant, you face the challenge of caring for persons with a life-threatening disease; you must comfort persons who face great suffering and death. You will become a source of information for patients with AIDS and their support members. You must be particularly sensitive and respectful toward individuals who are viewed as social pariahs. You will have to examine your own beliefs and lifestyle. You must be comfortable with your own sexuality and the sexuality of others whose lifestyle may differ from yours. You must replace any fear you have regarding the disease with knowledge based on medical fact, and always practice standard universal precautions As well as assisting your physician or employer in providing the best possible medical care, many nonmedical forms of assistance may be required by persons infected with HIV or AIDS. You may need to make referrals to community-based AIDS service groups, health departments, and to social workers for planning physical and financial assistance. Trained hospice volunteers or AIDS volunteers also are helpful to families and significant others, as well as to patients with AIDS.

There may be the need for patients with AIDS to obtain legal assistance and to identify their wishes and directions for care during the terminal stages of their illness. A living will or physician's directive might be encouraged. Refer to Chapter 10 for more information on physician directives. Patients who are losing mental acuity should be encouraged to appoint a legal guardian or durable power of attorney. As much as possible, be responsive to the family members or the significant others related to patients with AIDS. Answer any questions they may have regarding their fear of contracting the disease. It may be helpful to remind them that AIDS is difficult to contract, even among people at high risk for the disease. The risk of transmitting AIDS from daily contact at work, school, or at home is low. In virtually all cases, direct sexual contact or sharing of IV drug needles is the leading cause of transmission.

Risk management Torts And Medical Assistant

Risk management Torts And Medical Assistant

Some common areas of negligence may result in torts when the standard of care is not adhered to; practicing good risk management makes the medical assistant and the physician-employer less vulnerable to litigation.    

1) Protect patients from falling from an examination table, wheelchair, or stretcher.

2) Check for faulty electrocautery. Have repair done by qualified technicians.

3) Check patient identification by correctly identifying patient before performing a procedure or administering a medication.

4) Never leave a patient unattended. If you must leave, pass the responsibility for the patient's care on to another individual.

5) Be particularly watchful with patients who have special needs such as the elderly, pediatric patients, and those with physical and emotional disabilities.

6) Properly label and identify all specimens. Handle specimens properly.

7) Make certain the patient has signed a consent for surgery and other care.

8) Follow all policies and procedures established by your employer.

9) Do not misrepresent your qualifications.

10) Document fully only facts and do not alter medical records.

11) Admit any error that may have occurred.