Monday, August 25, 2014

Job Burn Out and The Medical Assistant


English: Glenkens Medical Practice Rural medic...
English: Glenkens Medical Practice Rural medical practice serving the Glenkens area. (Photo credit: Wikipedia)
Job Burnout and the Medical Assistant: Coping Skills

What exactly is job burnout?

Job burnout is simply depression that is job related. You dread going into work. You feel if your job has little meaning, and it can affect your job performance and attitude towards your patience. You may even consider quitting your job, or because of depression related fatigue makes mistakes. Those around you will notice that you are not quite yourself .and You will have a low opinion of your own job performance and the practice overall. Job burn out if not dealt with can cause you to leave your job unnecessarily or be terminated.


The Stages of Job Burnout

Medical Assistants, who suffer job burnout, usually are the one’s who start out most enthusiastically. They are perfectionist who quickly becomes know as the reliable one.

Falling to far in Love with Your Work
The first stage of burnout actually in the infatuation period in which the medical assistant new to a practice lives eats and sleeps work. These medical assistant spend their down time thinking about or even staying at the practice thinking about what they can do improve their performance and move up the employment ladder. They do not know how to say no to fellow employees or the doctor. They have unrealistic expectations of themselves and others. This leads them to be put upon and then chastised by staff that has come to depend on them when they burn out.

How to avoid this
It is great to love your job. Yet, even the most enthusiastic medical assistant must achieve a life balance. Don’t take work home with you. Mentally visualize yourself shedding your job self and putting on your home self when you leave for the day. Don’t stay in your scrubs and jump on the computer to find the latest article on effective electronic prescription management.

If you are continuing your education to get a promotion at work, view that as more of a personal activity than a professional one. Use your medical assisting experience to do papers and the like, but don’t intentionally seek out experiences at work to enhance your study experience unless you are doing an internship or externship.


Work Harder to Keep Your Job Infatuation
If you have not nipped your job infatuation in the bud then you will move to the next stage. This is the stage where you are still trying to have all your emotional needs meet by your job performance. You have already set yourself unrealistic job standards and have not set boundaries with your coworkers. They now are aggravated when you do not step in to edit their documents, fill in when they want a day off, or order lunch for the office. None of these things were part of the job description. Everyone loves you at the office and this feeds your ego, but at what cost.


How to prevent this

Yes there are times when the medical assistant must go above and beyond their job description but apply the rules of common sense when you do. If you take someone else’s hours because they have a sick child at home, it is reasonable that on a day you have an early appointment they will fill in for you. If favors that you do on an individual level for co-workers are not repaid, there is a good chance that you do not have proper boundaries. Set boundaries when you do things outside the scope of your job description.

Now this can be difficult when dealing with the doctor or practice manager. If you are up to the task and performing to the task does not affect your ability to meet your job deception, then by all means accept the responsibility. If you are not politely tell the person even if they are your superiors why you can not. Tell them you are catching up on important expected work or that you do not feel you are the best person in the practice to perform that particular task. Doctors many times have little understanding your role outside of the exam room. They do not know which medical assistant is best at finding that odd medical supply. The doctor will appreciate being directed to the right person for the task even if it is not you.


The third stage of burnout is dissatisfaction with your job and negative coping. This can mean serious problems for some medical assistants. It can lead to those with past issues of substance abuse to fall off the wagon. For most it will just mean that you develop a deep resentment towards your work. You feel overwhelmed and unappreciated. It usually comes out in conflict with other staff members. You resent that they do not violate their personal boundaries to do you favors. They resent the fact that they can not longer relief on you to do tasks they find unpleasant. You must accept that you set them up to have unrealistic expectations of you as a medical assistant. Many times medical assistants in this stage will find themselves calling in sick to work more often or finding excuses to leave early for the day. Tasks may be performed poorly or mistakes made because you are distracted by your distain for your job or office politics.

If you have come to this stage of job dissatisfaction the best thing you can do to mend fences with coworkers is be honest. Tell them you set unrealistic goals for yourself and that you are frustrated. It is time for some of the favors on handling work load to be paid back till you can get yourself in order again. Talk to your practice manager and have her reiterate your job description. If your job description is not to run over to the lab for test results that were not in on time, then ask her to excuse you from the task because it unfairly became part of your job description. The practice has put a lot of time and money into training you; they do not want to lose you because you overburdened yourself. Ask the practice manager to help you learn what exactly is expected of you and how you can ask for help on tasks when you need it. Your honesty will be appreciated and fellow employees will have a better understanding of you. They will be less inclined to burden you first with request for help and will understand when a more balanced version of you as medical assistant emerges.


The last stage of burn out is one where you actually develop clinical depression related to your job and it hinders your job performance as a medical assistant. This is a dangerous situation for your mental health, professional life, and for the patients and practice you serve. In this stage you will consider just quitting your job. You will have dramatic conflicts with co-workers and possibly patients. You will be unable to complete simple tasks on schedule and everyone will notice you are not happy.  You might start sleeping, eating, or shopping excessively. You will have trouble remembering instructions from the doctor or supervising nurse. You are a risk for job performance termination at this stage of full blown burn out.
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This is the stage that if you have not done so you need to speak to your practice manager. You need to explain your frustrations with your job and seek solutions from them on how to handle those frustrations practically. You may have to apologies to co workers for events involving unprofessional behavior. If you have saved up vacation time this is now the time to take it. Don’t take the time, before you explain to your practice manager that you are really suffering burnout because you had unrealistic expectations. Do not take the time if the practice is swamped otherwise your request for time off will just be seen as one more sign of your job dissatisfaction.

Again mend fences with co-workers when you can and ask that your job description be modified if possible. Exercise after work is a good way to shake off some of the stress and depression after work. Indulge yourself in some new scrubs or move your desk, this may help you get a new outlook. Seek counseling or medication if the whole situation becomes too overwhelming. Lastly, if you can not fix the situation in your current practice look elsewhere, but do your job the best you can till you find a better job fit. Try not to leave the practice on a negative note. If you have been terminated, learn from your mistakes. Find a mentor. An older medical assistant who has worked in the field can give you the proper perspective to take to your new job.



Monday, August 11, 2014

Understanding Complete Urinalysis



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This micrograph shows calcium oxalate crystals in urine.
This micrograph shows calcium oxalate crystals in urine.
Source: By NASA/JSC [Public domain], via Wikimedia

Understanding Complete Urinalysis

We need to understand the function of the whole urinary tract system. It removes toxins and waste products from are bodies and helps keep the correct volume and fluid composition of the blood. The production of urine and the passing of urine accomplish the process. The whole urinary system is made up of the bladder, two kidneys, two ureters and a urethra.
Human urine can be made up of a great deal of different substances according to what a person consumes. Food, drink, drugs, supplements, and even substances absorbed through the skin can change the composition of urine. Most urine has urea,, ammonia, sulfates, and other common organic and inorganic substances.
A complete urinalysis looks at the visual characteristics of the urine, chemical composition, and microscopic composition.
human urine in specimen container
human urine in specimen container (Photo credit: Wikipedia)
The following is a list of the characteristics that a urinalysis looks at
Quicktest for urine
Quicktest for urine (Photo credit: Wikipedia)
Physical
Color - It varies from light yellow to amber. The presence of blood that can be seen may be a concern. Food and the level of hydration of the patient can cause color change. Certain drugs may also color urine
Odor - The stronger the ammonia scent the urine has the more likely bacteria is present.
Turbidity- Cloudy urine can indicate the presence of mucus or bacteria and be a sign of infection.
Specific Gravity- Low gravity can indicate renal failure and high can indicate kidney disease.
PH- High alkaline content can mean bacteria is present
Chemical Composition
Protein normally does not pass through the kidneys so it present indicates something abnormal but not necessarily pathological It can pregnancy or increase protein in the diet. It can also indicate inflammation or toxins are present.
Glucose- Again not usually present in urine, it can indicate diabetes.
Ketones - Indicates a breakdown of fat in the body. Some people measure ketenes to indicate that diets are working; otherwise it can be a sign of diabetes.
Urobilinogen - In small amounts it means nothing , but if it is too high it indicates liver disease.
Bilirubin -High amounts indicate gall bladder issues or liver disease.
Nitrite - It presence can indicate bacteria. If present in a sample of urine that has sat out it may not indicate an infection.
Leukocytes- There presence in urine can indicate infection especially when nitrates are present in higher levels.
Microscopic Examination
Epithelial Cells- may indicate that the sample was not a clean catch
Crystals
Bacteria- May be the source of an infection or the by product of the collection process or the storage process of the urine sample.
Yeast- May indicate diabetes , lowered immune system , or some type of fungal infection.
Interpretation of an complete urinalysis will ultimately be left to a medical doctor or nurse practitioner. Most people need to have any positive results from a home urinalysis test confirmed by their care In the case of infections a culture may need to be grown in order for the doctor to determine the best course of care for the patient. Still there are some simple interpretations we can make for even home urine tests, if we have elevated values.
There is an urgent need to follow up with a provider if blood clots are seen in the urine because it may be an indication of the presence of cancer. Still, most of the time blood in urine is an indication of less serious conditions and a there is no need to panic, but to consult your primary care provider right away.

Gram-positive bacteria, stained purple, of bot...
Gram-positive bacteria, stained purple, of both the bacillus ( rod-shaped ) and coccus (spherical) forms. A few Gram-negative bacteria are also present, stained pink. Numbered ticks are eleven (11) microns apart. (Photo credit: Wikipedia)
http://library.med.utah.edu/WebPath/TUTORIAL/URINE/URINE.html
http://www.drsperoni.com/downloads/articles/Urinalysis_Results_Interpretation.pdf

Tuesday, August 5, 2014

Dealing With Difficult Patients

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Patient Toilet
Patient Toilet (Photo credit: ConanTheLibrarian)
lightning UX 7
lightning UX 7 (Photo credit: tim caynes)
Vaccination Every Morning
Vaccination Every Morning (Photo credit: madam3181)

English: Night at the Doctors office
English: Night at the Doctors office (Photo credit: Wikipedia)
Patient: Doctor, I don't feel well and I'm not...
Patient: Doctor, I don't feel well and I'm not sure why (Photo credit: DES Daughter)
A patient having his blood pressure taken by a...
A patient having his blood pressure taken by a physician. (Photo credit: Wikipedia)

Dealing with difficult patients is something that when we train to be medical assistants gets over looked. We have course in professionalism which many assume eliminate the problem. We are not always the source of anger or misunderstanding that our patients display. If is wise to have an office policy in place that gets everyone on the same page when it comes to our approach to deal with difficult patients. I would divide most difficult patients into two groups; front office and exam room. Here I will deal with the difficult patient in the front office.

 The front office difficult patient is one who is often upset with staff about scheduling, billing, and prescription refill issues. Many times these are patients who do not understand that their insurance does not give them a totally free ride when it comes to care. When they get the bill for their portion of care they are usually convinced the office billed their insurance wrong. Sometimes they suffer from sticker shock when they see the amount of their co pay that has accumulated when they have had a condition that required numerous office visits. The patient who is suffering from medical bill sticker shock can be dealt with. First it helps to have someone doing the billing in the office that is willing to talk to patients about their financial responsibility. If a patient has a forty dollar co pay for an office visit and their treatment is going to require several follow up visits they need to be informed. It is simply best practice to collect the co pay upfront so the bill does not become exorbitant in the first place. New patients should not just be handed an office payment policy.

 They should be verbally informed that payment is expected at the time of service for their co payment. If patient’s have questions about how much of their treatment is covered by insurance, someone in the office should be willing to help them find out. Since we do not have crystal balls and can not predict how well treatment will go, we need to emphasize that it is only an estimate. Ultimately, it is the patient’s duty to deal with their financial obligations to the practice. Most patients new or established will not admit when they are in financial difficulty. They wish to keep such matters private until they are unable to pay their bills.

 Again, if your office offers financial arrangements for patients who are going to have default paying their share of the bill they should know about this policy before they need it. Discussion of a patient’s financial hardship should take place in a private setting and only staff that does the billing needs to be aware of their circumstance. The financial health of a patient should be guarded information just as their medical information is. The patient that is upset about scheduling is many times an established patient.
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They may have been in the practice when it was relatively new or had more staff. They became used to being able to have a wide variety of choices when it to seeing the doctor or nurse fractioned. They also may feel entitled to see the doctor when they want because they have been loyal to the practice. This patient needs to be told that all patients are accommodated the best way possible when they call for an appointment.

They also may need to be reminded that those with serious conditions are seen sooner then those patients who are being seen for routine matters. It helps to thank these patient’s for their patience and offer to really work to schedule them at the next most convent time for them. You will not always win this battle as some people because of social position are catered to by their hair dressers, mechanics, and other service professionals.


They simply will not understand that the doctor’s office is not in the business of catering to the busy professional schedule. In this case you may recommend a walk-in or urgent care clinic in case this patient’s will not give up their insistence on being seen immediately. This action should not be taken with out consulting the health fractioned first. You also may have the option of offering these patients the opportunity to see another doctor in the practice with a more open schedule. Patient’s that are upset about prescription issues again should receive a copy of the office policy in regard to refills.

 If they call a dedicated line for refills they need to know that you will take at least one business day to respond. If they insist on refills on a medication that has expired, they need to understand they may need to come in and see the doctor in order to have the prescription renewed. You have to stand strong on your practices policy. This is especially true in regard to controlled substances. Many states have strict regulations that must be followed when dealing with the class of drugs.

Lastly, electronic prescriptions and changes in drug formularies are issues you have little control over. You should always advise a patient to wait 24 hrs and call the pharmacy to see if an electronic prescription has been filled. You should encourage patients to put long term prescriptions on automatic refill. You can call on patient’s behalf if they have issues getting their electronic prescriptions filled, but as long as you have done it right on your end there is little you can do about the speed at which the pharmacy on the other end. Most doctors will change a prescription to something covered by the patient’s insurance, but it is the patient or their care takers job to find out what prescriptions are covered and which are not. Sometimes for medical reasons an doctor will petition the insurance company to cover a certain drug, but this is a cumbersome process and can not be done for every patient.Communication is the best way to avoid angry or frustrated patients in the front office
. You should always be respectful and honest about the things you can and can not help the patient with. Most people will calm down and do their part to solve the problem if you are clear on what you can do to help them deal with their particular issue.