Scenario

Kayla Kemper performed her externship at Dr. Richard Tarago’s office, a general practice clinic downtown that serves lower income patients, most of whom do not have medical insurance. Some patients have a co-payment of $5 to $25; others have no co-payment, depending on their income level. Kayla’s family is quite wealthy, and working with patients whose lifestyle is very different from hers has been an eye-opening experience. On many days she wanted to leave the clinic, because she realized that a large number of patients were unable to seek medical care at the start of an illness, and when they finally came to the clinic, they were in worse condition.

Kayla is a caring person, and she saw the suffering many patients experienced daily. She found it tough to see people who had difficulty obtaining health care, yet she realized that a large number of Americans have no insurance coverage at all. Kayla discussed her feelings with the clinic manager, Elaine Mays, and expressed her concern for the patients in the clinic. Elaine asked whether Kayla would like to continue working with the patients, and Kayla admitted that she would, although it was not easy for her. Elaine then suggested that because Kayla’s background is so different from the patients, she might want to stay at the clinic as a volunteer for a few months to add to her learning experience. She accepted the offer, and after 3 months as a volunteer, Elaine hired Kayla to work in the clinical area full time. The patients consistently commented on how compassionately and considerately Kayla treated them. Kayla truly learned the meaning of giving as it relates to the medical profession. Her externship was the start of her full-time career.

While studying this chapter, think about the following questions:

New medical assistants may have difficulty putting all their skills together and using them at the same time throughout the course of a day. Medical assistants must be multitaskers and must develop a good memory. They also must be efficient workers. While in school, medical assisting students spend several days learning a specific skill, such as phlebotomy. However, during the externship and on the job, the medical assistant may need to perform a phlebotomy, chart a procedure, and check out a patient, all within a matter of minutes.

Most of the general tasks in the physician’s office are done daily, weekly, or monthly. Such tasks include preparing for the day, using the office policy manual, ordering and receiving supplies, cleaning, office budgeting, lunches and breaks, office security, travel arrangements, and ergonomics. The physician’s office is a busy environment where the medical assistant encounters new challenges each day. This chapter details the general office environment and the daily operations that the medical assistant may perform in the physician’s office. Multitasking is a critical skill that all medical assistants should strive toward; during a typical day, many duties will be carried out at one time and the medical assistant must keep track of the progress of each responsibility.

The more flexible the medical assistant, the more valuable he or she is to the physician. By learning and refining adaptation skills, medical assistants increase office efficiency, allowing the schedule to handle interruptions and emergencies. Remember that the patient is the reason the office exists and is of primary importance to the office staff. However, various tasks demand attention in the daily operation of the medical office.

The Office Policy and Procedures Manual

Virtually all businesses have some type of policy and/or procedures manual, but it is especially important in the physician’s office and other medical facilities. The manual should be easy to read, detailed, and logically organized. Besides providing administrative information, the manual also should provide procedural sheets that outline the steps of each procedure performed in the office. The manual should be a “living” document, constantly updated as technology advances and changed whenever regulations change. The manual must be reviewed annually for corrections and additions; this review must be documented as a step in the compliance with regulations established by the Occupational Safety and Health Administration (OSHA). Documentation can be a statement verifying that the manual has been reviewed; this statement should be dated and signed by the office manager or physician. One of OSHA’s most common citations for noncompliance is having a policy manual but not following the stated policy in various areas. The medical assistant must form the habit of going to the office policy manual whenever in doubt about any procedure.

Opening the Office

Employees arrive earlier than patients so that the office can be prepared for the day. Some office policies dictate that the office be readied for the next day the evening before, but for the purposes of this chapter, assume that the policy requires preparation in the morning.

Although the physician may trust the employees, office policy should demand that supervisors be proactive in preventing theft. Depending on the size of the clinic, a certain number of employees will have keys and will know the alarm codes for the facility. The best policy is to monitor this access and information strictly. When numerous keys are distributed, more employees have after-hours access to the office. By limiting this access, the physician may prevent some losses to theft. Two things in particular make the physician’s office a target: money and drugs. Usually, only a limited amount of cash is kept in the office. However, most offices keep some medications, often narcotics, which can be addictive or sold for a profit on the street. If such items are used, they must be protected, not only for safety but also to remain in compliance with the law. Even during regular office hours, the staff should practice careful methods, such as keeping back doors locked securely, so that only those authorized are able to enter the building.

Preparing for the Day Ahead

Once the employees have arrived for work, all of them should begin preparing for patients and visitors. Each employee is responsible for his or her own work space, and the staff may work as a team to prepare common areas of the office, such as the reception area. When each person understands the duties required and when they are divided up among the staff, work can be completed quickly and efficiently.

Print two copies of the day’s appointments and place one copy on the physician’s desk unless he or she chooses to view the appointments on a computer system. Use the other copy to pull medical records for the patients who will visit the office during the day if paper records are kept. If the office does not use electronic health records, keep the paper medical records in a convenient, central area so that staff members can find them easily once the patients begin to arrive. Make sure the physician has enough room in the progress notes section of the medical record to write the details of the office visit. If needed, add a new sheet of progress notes. Glance over the notes from the last visit to determine whether laboratory work or treatments were ordered and find out whether the results are available.

Patient exam rooms should be restocked with all the regular supplies used in the individual rooms. Items such as cotton balls, bandages, gauze pads, patient gowns, and drapes need to be replenished daily. The physician and patient should never be forced to wait in the examination room while the medical assistant searches for supplies. Check the restrooms to make sure adequate toilet paper, soap, and hand towels are available. If urine specimen cups and towelettes are kept in patient restrooms, make sure enough are available to last throughout the day.

Certain equipment may need to be turned on, such as computers, laboratory equipment, and copy machines. Lights should be turned on in all the examination rooms. If quality assurance tests need to be performed on any of the laboratory machines, run the tests and record the results.

Some specimens from previous days may need to be checked for results or additional testing, although many physicians today use outside laboratories. Always record test results in the patient’s medical record. The medical assistant cannot decide whether a test result is abnormal; however, if that information is clearly indicated on the lab’s report form, then act according to office policy. Some physicians only want to see the test results if they fall outside normal ranges. Most laboratories print test results so that abnormal results are emphasized; they may be printed in a different color ink or in a separate column labeled “Abnormal.” If results are abnormal, the physician may need to do follow-up work or see the patient again. As mentioned, the medical assistant cannot judge whether a test result is abnormal, but if that information is clearly indicated, the medical assistant can file the document according to office policy.  

The patient accounting system should be prepared for the day. Secure enough encounter forms for each patient in the appointment book. Stock the patient checkout area with plenty of appointment cards. If the office gives small gifts to patients, such as refrigerator magnets or coffee mugs, make sure they are available for use. Many offices place the physician’s business card just outside the receptionist’s window or in the patient reception area. Because patients often take one of the cards, this supply should also be checked.

Various specialty offices may need to prepare additional equipment; therefore, make sure everything necessary is available for the physician and staff members. The day runs smoother when the office is completely prepared for the patients. When all of these duties have been completed, the last task is to unlock the front door and begin welcoming patients to the practice.

Patient Traffic Flow

Ideally, the physician’s office is located in an area of town that is easy to find, has ample parking, and does not force the patient to do any excess walking, especially upstairs. The medical assistant is usually not involved with designing the interior of the office; however, the placement of all furniture and equipment is an important factor in the efficient flow of traffic. Patients should be able to quickly determine the location of the patient waiting room. It is helpful if one room is designated as a “sick room” so that well patients will not be stricken with an illness just from visiting the office (when space is short, a face mask may be issued to patients with symptoms of communicable disease). Good traffic flow is important so that the patients and employees can maneuver through the office easily and avoid retracing their steps. Additionally, patients should be able to locate separate parts of the office, such as the lab or check-out areas. Neither patients nor employees should be subjected to dodging furniture or tripping over equipment cords. When moving through the hallways, guide the patient along the right side and leave the left for those traveling in the opposite direction.

Visitors to the Office

Many people besides patients visit the physician’s office. Some of these individuals have appointments; others stop by at random. The office policy manual should detail the procedure to follow in dealing with such individuals. Most physicians prefer to set aside a specific time for pharmaceutical representatives (also called detail persons or drug reps). These professionals usually are quite competent and knowledgeable about various drugs, and they should be treated with respect by all members of the office staff. In the past, pharmaceutical representatives were allowed to leave memo pads, pens, and other gift items for the physicians and staff that advertised a certain drug or treatment. Many states have laws that prevent pharmaceutical companies from providing these perks. However, some states may not have passed such laws, and physicians still can receive these items. Lawmakers are more concerned about perks such as an honorarium for serving as a guest speaker than about pens and notepads. However, many lawmakers believe that physicians’ prescribing habits are directly related to pharmaceutical company perks. The company’s goal is to educate the physician about their products so that the physician can better care for patients. Some states are developing laws that require reporting of any gifts of more than $25; in most states, this does not include the free samples of the actual drugs. In general, most physicians have decided not to accept these gifts so that no question arises of any breach of ethical conduct.

Pharmaceutical representatives are not the only salespersons who may visit the physician’s office. Salespeople from office supply stores, medical equipment sellers, and others may stop by to make appointments or take orders for various items. The office manager usually can address the needs of salespeople and normally is authorized to place orders.

At times, other physicians stop by the office to see the doctor. They may not have an appointment, but the physician should be notified at once when another doctor is waiting in the reception area. If office policy allows, take the visiting physician to the doctor’s office instead of forcing him or her to wait in the patient reception area. Because doctors understand busy schedules, most do not stop by another doctor’s office without an important reason.

The physician’s family members or friends may visit the medical office. Never send family members or friends away without notifying the physician of their presence and asking whether he or she has time to speak to them.

Daily, Weekly, and Monthly Duties

Develop a list of duties that are performed daily, weekly, and monthly. Checklists are helpful when staff members want to make sure all duties are completed. The lists help the supervisors divide work evenly among staff members. Be specific on the checklist and include every task that needs to be done, even the most insignificant ones. If a staff member is struggling to finish her daily duties, other staff members should assist so that all required jobs are completed for the day. Take the initiative and work as a team; the effort may be important when supervisors choose employees to promote or terminate.

Supplies and Equipment in the Physician’s Office

The medical assistant is responsible for stocking exam rooms and making sure all supplies and equipment are available and in good working order. The following sections describe the process of ordering and receiving medical supplies and equipment.