A throat culture is done to eliminate or confirm the most common cause of strep throat. This is a group A streptococcus bacteria. A sample is taken from the back of the throat. You should aim to swab any white or yellow spots in the back of the throat. Coating on the tonsils should always be swabbed. The medical assistant must avoid touching other areas of the mouth such as inside of the cheeks or lips.
You should avoid touching the outside areas of the mouth when inserting or exiting the swab in the mouth. Always wear gloves to avoid contaminating the sample or exposing yourself to the bacteria.
Always have the patient tilt their head and open their mouths as wide as possible. Then you depress the tongue with a tongue depressor to get a clear view of the back of the throat. This can be difficult in patients with a sensitive gag reflex or in children .The sterile swab is rubbed over the tonsils and suspicious areas in the back of the throat. You remove the swab and tongue from the patient's mouth taking care not to contaminate the sample
Aim to be Accurate
Most offices will use rapid strep test so chances are the results will be available the same day the test is taken. If it is sent to the lab results will take two days to get. The swab is returned to the vial and marked with the correct identification of the patient. A second swab may be taken if a follow up culture is needed. It is important not to contaminate the swab when removing it or replacing it in the vial. It should not touch the outside of the vial.
A rapid strep test is not as accurate as the ones sent to the lab to culture. You can get a false negative if you do target the obviously inflamed part of the throat. You have to get your swap in the right place to avoid false positives. The sample can be contaminated with too much flora because the swab touched the lips and other parts of the throat and the strep could not be detected. The rapid test only tests for the common form of the strain it does not detect uncommon strains.
The most common strep bacteria known as streptococcus pyogenes and it is very contagious. It is spread by droplets when the infected patient sneezes or coughs. It is important as a health care professional you protect yourself from strep when you are doing a throat culture.
Strep can be related to other ailments like tonsillitis, kidney inflammation, and fevers that can damage the heart. Rheumatic fever can result from untreated strep infections. This condition can cause damage to the lining of the heart and problems with joints, muscle, and skin tissue. This makes it even more important for the medical assistant to become suave at the throat
These days with the advent of electronic prescriptions,the medical assistant will they are increasingly responsible for dealing with complex prescriptions issues . The dawn of the electronic prescription means more and more of the medical assistant's time will be consumed with prescription related tasks.
This will not only mean submitting prescriptions, but dealing with the problems most medical assistant did not have to deal with, in the good old days of paper prescriptions. Pharmacies will be sending back to your email all sorts of requests. Insurance companies will also send a record number of requests and even alternative prescription suggestions.
Patient's complain to you the drug is not covered.Then you will have to spend endless hours finding out what is on the patient's formulary that is covered. If the doctor is unwilling to allow the change, then you must call the patient. The patient will ask you which pharmacy near their house, charges less for the drug. The patient will expect you to check the discounted drug list of every big box store and grocery in the area to find out who will charge them the least amount of money for their prescription. If you office does not have good prescription management polices; then the wonder of electronic prescriptions will become your nightmare.
As a medical assistant doing a specialty clinical, I saw the process of taking hours to get one prescription filled or renewed ;endlessly repeat itself. This left medical assistance's behind on other duties and patient's frustrated and angry. You are-now responsible for patient drug education of a new kind This is not the kind the pharmacist gives, your patients on drug interactions.This is the kind that tells the patient how they need to take some personal responsibility for this new way of doing prescriptions via the internet.
Many patients simply will not fill prescriptions not covered by their insurance. They put themselves at risk and are inclined to take the problem out on the doctor.They do not understand that they can not wait two weeks to pick up a prescription that has been electronically sent. Many wonder why the prescriptions were not just waiting for them when they show up at the pharmacy two weeks are the prescription was sent by the doctor's office .The patient's are upset that they had to wait at the pharmacy for the prescriptions to be refilled a second time. Patient's need to understand once a prescription shows up electronically at the pharmacy that it will be filled within hours; not days or weeks.
There are many different pharmacies today with large amounts of low cost drugs available for under ten dollars. Yet, the patient whose insurance company will not cover his or her drug; is never at the pharmacy where that prescription is on the five dollar list. They call you to find out where they need to go.
Just A Plan Full of Good Policy Will Make the Medicine Go Down In A Less Stressful Way
So what is the solution? It is a well thought out office policy for dealing patient education and processing of prescription drugs. Below is my attempt at the task. My hypothetical policy will not apply to all types of practices . Most of these rewrites of current office policy should be a shared task among office staff that deal with patient prescriptions .
This office will accept prescription renewals from pharmacies via fax and phone from local pharmacies.
No prescriptions ;which are considered controlled substances or for short term drug therapy will be renewed other than by the patient coming in for an in person visit with the doctor or nurse practitioner.
This office will establish a rotating schedule of Medical Assistants to handle prescription renewals via fax or phone.
There will be a designated phone line that goes to voice mail where patients can call in prescriptions they wish to have called into a local pharmacy.
Patients will be informed on this line that all prescriptions should be called in to the local pharmacy within twenty four hours. If they call on a holiday or weekend the prescription would be called in within 24 hours of the next business day.
Patients must leave the generic or trade name of the drug, the amount taken, doctor's name, and amount of refills on the prescription on the answering machine Patients with incomplete information will not have prescriptions called in. Instead, these patients will be contacted by staff , to get the right information about the prescription.
Every working day the staff in charge of the prescription line will transcribe the recordings They should pull the charts i of the patients requesting refills. It is wise to check to see if your doctor was the original prescribed. It is really not unusual for primary care physicians to write prescriptions originally given by specialist. The doctor may need to review the chart if this situation occurs.. Some doctors will not do this ;unless the patient schedules an appointment to ask the doctor to take over their prescriptions for chronic conditions.
The Medical Assistant will fill out a patient prescription renewal form for each patient.
This form will be returned to the MA ,after physician reviews it. those drugs approved for renewal will be called into the local pharmacy by the medical assistant . This should occur within 24 hours . In cases in which the doctor wishes to review the prescription or change it , MA will call the patient and advise them or the change or review.
Patients who call for drug formularies to be reviewed because a drug is no longer covered ;need to make an in person appointment with the Medical Office Assistant to review their coverage. They must provide new copies of the formulary of covered drugs. Once a list of new covered drugs is complied it will be given to the doctor for review and an appropriate covered drug will be called in. There should be a least a week allotted for this process.
In general generic drugs will be prescribed unless not permitted by the prescribing doctor.
Patients are expected to report problems with prescriptions in a timely manner so the prescription can be changed in a reasonable amount of time.
One parent of minor patients should be in charge of renewing and monitoring their child's prescriptions. The designated parent should be noted in the chart.
In the case of elderly or disabled patients 'who do not handle their own medical affair,s should have a designated contact person for prescription related issues noted in their chart.
All patients in this practice who take prescriptions for chronic conditions will have a yearly prescription review by the doctor or nurse. They need to keep this appointment to be eligible for prescription renewal by phone or fax after the initial twelve month period.
Patient Education :
All medical assistants are expected to have a base knowledge of drugs frequently prescribed in this practice and their potential hazard of use.
The practice will have consumer drug information sheets containing basic information about common drugs or classes of drugs prescribed in this practice.
Medical Assistants will discuss with patient's information about new prescriptions.
Medical Assistants will emphasize drug interactions with herbal or over the counter drugs regardless of if the patient admits using them.
Medical Assistant will emphasize the need for medication compliance. They will discuss issues that might cause patient non compliance.
Medical Assistant can demonstrate inhalers and the use of insulin pins if the patient or their care taker requires such instruction.
Patients will be advised to report good changes and bad changes in their condition once they have started a prescription drug. They should always call the office with drug concerns.
Patients should be encouraged to read prescription inserts and ask their pharmacist questions about their medication.
Patients are to be instructed to call the office before adding other prescriptions or OTC to their drug routine. Patients not complying with this policy may lose their right to have prescriptions renewed by phone or fax.
When I started looking for articles on line about loving
your job most of them were somewhat childish. Yet, at the end of the day, the
work day that is it we should remember lessons from our youth. If you didn’t
learn them then, you are never too old. Most of us learned the lessons of youth,
but we just need to be more simplistic in our thinking to appreciate how they
can help us love our jobs.
The Bad News Past and
Present
Most of us have jobs, not careers. Many of us had careers,
but with the downsizing that happened with the recession, now we feel lucky if
we have a job. Many baby boomers at the last two decades of the 20th
century defined themselves by their careers. They were not, “company men “like
many of our grandfathers.
They felt connected and loyal to their employer and the goal
was the gold watch at retirement. Those were the days where a man’s worth to
his family and community was in many ways connected to their work be it their
employer or union. They worked long hours and spent a great deal of their time
at social functions related to work. The concept of loving their job was
foreign to them because they were grateful for work.
The company man was a product of being brought up during the
depression, the assembly line or office was a way to avoid the bread line. A
man’s worth was in his work and his ability to provide for his family.
Baby boomers had a completely different expectation of work.
We were the career generation. Women in this generation were now part of the
game. We had to up our game to prove our worth to the working world. Suddenly,
people were ashamed of not having an important sounding title or a job with
little social meaning. It was about money and meaning.
It was the narcissistic
pursuit of ridiculous amounts of personal wealth, or having a job title of
social importance. If we all could not be doctors, lawyer, and professors, then
we at least needed important title. The trash collector was now a sanitation
engineer and the sales girl at the local department store was a sales associate.
Secretaries were now distractive assistants. No normal self respecting young
girl could find filament in having children or keep house. Your self worth
required you let someone else raise your children, so that you could be a distractive
assistant. The fact of our generation was so desperate to put a great deal of
meaning into economic activities that were well, just jobs is pretty sad.
Now we have a whole generation of demoralized and anxiety
stuck workers. Women are being told to,” lean in” to their careers and make
homemade jam. Yes, there are some who do both with a flair and make to the gym
three times a week and well there are the rest of us. Now, the economic gods
have made all those lovely fulfilling careers of being an administrative
assistant (sectary), allied health professional (girl who codes insurance forms)
a necessity. Men who had good paying skill trade jobs have been reduced to
working in fast food restaurants.
Worst young people
are taking on thousand of dollars of student loan debt, to obtain the skills of
these supposed professions. These are jobs, and while technology may require a
different skill set then in our parent’s day, they do not require a twenty five
thousand dollar associate degree from some for profit career school. There are
still ways to enter these professions without being lured into a great deal of
debt, for jobs that well pay slightly above the minimum wage. They may have
growth potential, but there are ways to obtain the skills you need through
professional organizations as you go from medical assistant to practice
manager. Some people will have the drive and the love of the profession to do this,
but most will not.
Deaths, taxes, and work
Someone said that two things will always exist, death and
taxes. It should be a much longer list, but work is the definite third. We can
choose to be miserable in our work life, which means we will be pretty
miserable because we spend the majority of our adult life at work.
I’m A Big Kid Now
But what if we just decided to toss that mind set? Just toss
it. No not send the flashy guy on the TV at 3am just a 39.95 for DVDs on how to
do it. It is simple go back to your childhood. Remember, when you saw your siblings
or the neighbor kids get on the yellow bus how you envied them? Remember , how
important and how long it seemed till that day your mom dressed up in stiff new
clothes and took your picture? It was wonderful. You were now officially a big
kid. You got to go on the bus or walk to school. Kindergarten was great. There
were better toys then you had at home and you were not just forces to spend
time with the smelly kid who picked his nose because your mom said it was a
play date. You got to pick your friends, take naps, and eat cookies.
Most of us gave into the crowd, by fifth grade school was a
boring chore that no one cool really liked. Secretly, we liked a lot about
school. It gave us something to do and something to succeed at. Maybe that “A”
on a spelling test had no great life altering meaning , but we worked for that
,”A” and it got displayed the refrigerator.
So this is my secret to loving your job. Be that
kindergartner again. Understand you are a real adult now. You have real
obligations that people in your family, community, and yes company that people
are expecting you to meet. Be proud of being a provider even if it is even for you.
Love being a big kid.
Yes, you job may be boring or you may feel your doing
something of little meaning or importance. But how important was finger
painting or making macaroni necklaces?
We thought it was play; it was the adults tricking us into developing
fine motor skill, which is an important skill. Understand you are part of
something bigger and you impact your world. Sure, taking somebody’s blood
pressure and insurance information at the doctor’s office is not very exciting.
But you being a positive person who cares about the people you serve is
important.
You do not know who you will impact. You smile will make all
the difference to a patient in family practice who has been told that need to
see a specialist because they might have cancer.
There is some job it is really hard to find meaning in. Fast
food and a great deal of the whole service industry, but even in these jobs you
can make a difference. Take a shift for a co worker so they can go to their
kids school play. Have a kind word for the lonely old grumpy man that comes in
to nurse his coffee and read his paper. Your job will have as much meaning as
you give it.
In kindergarten we had a greater chance to pick on own friends.
They were not just the friends our mothers arranged for us to play with. The
lesson here is don’t play with the negative people and the office gossips;
don’t join the: I hate my job crowd in the break room. First of all, your
supervisor knows who you spend your lunch break with and they will see you as
an uncooperative malcontent. This is not the best way to get the work you want
to do and show your best work. Intentionally try to get that “A” displayed on
the refrigerator. Don’t talk about work with co workers on break or lunch. Breaks are supposed to be breaks from your
work so use them as that. You will feel less stressed and not always consumed
with the tasks at your job.
We all learned that there was life after high school. It
never seemed that way in High School every little bully or breakup seemed to
consume us. We were kids. We did not have perspective. Now we are adults and we
need to not only have perspective but define and control our perspective. Don’t
take on more than you can handle. Unless, it is part of a career move leave
work at work. Yes, many of us socialize
with our coworkers, but bitching about your boss at the after work hang out is
a buzz kill. If your co workers are your
friends, see them as friends outside of work and not coworkers. There is life
after work and you should focus on enjoying it. Monday comes very quickly.
Some of us are blessed with careers we find interesting and
fun, but most of us have jobs. We can have the same good feeling about work and
be happy at our jobs if we are intentional in our effort. We are big kids now. We
have the adult ability and perspective to define our work as meaningful, positive,
and not all consuming. If we do these things we will love our jobs.
Symbol Table for Non Verbal communication with patients (Photo credit: Wikipedia)
A patient having his blood pressure taken by a physician. (Photo credit: Wikipedia)
Medical Assistants in most practices either spend more time
with patient or a least a comparable amount of time as the physician or nurse practioner.
It is essential that the medical assistant have effective communication skills
and avoid roadblocks to communication. This can be called developing
therapeuticcommunication skill.
This applies to medical assistants throughout the practice.
Front desk and billing medical assistants also have significant amounts of
communication with patients. The attitude of the whole staff will affect the patient’s
attitude towards the practice and treatment compliance.
Sometimes when patients make appointments the medical
assistant who schedules the appointment must play detective. Is the patient
really calling to be seen for what they say? Is the patient calling to discuss
a matter that is an ongoing medical concern that could be addressed by a phone
call? Is the patient experiencing a medical event that requires a same day
appointment? Is a care giver calling for advice and is not sure if they need to
bring the patient in? This an the recent changes in managing prescriptions
electronically and in healthcare will leave the simple task of scheduling appointments
into one where you will have to have very good communication skills in order to
service the patient’s need’s and direct their call appropriately.
Those who work in billing are also going to be bombarded
with insurance questions related to the Affordable Care Act. You will be
getting patients who are not sure what preventative services is cover or who
have never had insurance before and do not understand concepts like what a
co-pay or deductible is.
You may have had additional training to deal with the
patients, but you must learn how to communicate complex insurance ideas to the
patient. Especially, patients who do not understand their bill under this new
system, might have a think their billing is being mis-managed.
What is Therapeutic Communication?
Therapeutic communication is that which expresses empathy
for the patient. It is best when discussing events that may be traumatic to the
patient, but should be used in the course of communication with the patient as
it falls in to the area of best practice.
Therapeutic communication is that which puts the patient at
ease and elicits the answers needed to provide the best patient care. It is not
medical lingo. It is translation the diagnosis, treatment protocol, and prognosis
into language the patient can understand. It is a way of managing the interview
and educational discussions with the patient that lowers their stress level. An
increased stress level in a patient can cause them to use self defense
mechanism that block clear communication and make your job as an effective
medical assistant much harder.
Things to be aware of when seeking to use Therapeutic
Communication with a Patient
We all have personal bias and prejudices that may influence
how we interact with a patient. If we believe that an older patient suffers
from dementia we may disregard their expressions of concern of discomfort. We
may believe that a patient with a questionable immigration status can not
access the practices system of care. These are not your issues. You must first
and always address patients personally and with concern. Ask and record the
elderly patient’s responses to the best of your ability.
Address them with the
same respect regardless of the appropriateness of the response. Then address
their care giver for clarification. This approach takes more time but it is the
best way to establish the most productive relationship with the patient. In
regard to a patient’s ability to pay, only inquire about such issues if the
patient asks about financial arrangements. Then refer them to the appropriate
source. Medical assistants who work in billing will have much better chance of
explaining all the options with the patient. if they have not left the exam
room feeling insulted by your inquiries about their insurance coverage status.
These are just two examples. To avoid your personal produces
and bias, simply apply the golden rule and put forth a positive attitude. This
does not mean to be Pollyanna, but to be pleasant and straightforward and to be
committed to treat every patient with the attention and respect they deserve.
Patients come with their own set of bias and prejudices.
Part of therapeutic communication is to not personalize the patients expression
of these beliefs. Again many older patients may not have had the experience of
cultural diversity that younger patients may have had. If they seem to be
uncomfortable with your race, ethinic background or sex. As a professional
medical assistant you must simply have
to over look it. Medical assistants are not the moral police. If a male elderly
patient is uncomfortable with a male medical assistant or visa versa then politely agree get one in the exam room.
You may have to ask the patient to wait longer or
reschedule, and if anger on their part erupts, use the skills you have to diffuse
the situation. Apologizing for the incontinence and giving alternatives goes a
long way. Also make sure you politely restate the patient’s request. Do not
reprimand or insult a patient for expressing negative stereotypes, simply hand
the situation and make notes about the patient’s preferences without comment on
your opinion. Difficult people need access to medical care too and their
positive interaction with you may diffuse some of their fear of cultural
diversity
The basics of therapeutic communication
This hub can only cover the generalities of therapeutic
communication. First you must be able to successfully evaluate the patient’s
mood. In the case of a routine exam with a patient that has been to the
practice the patient is probably pretty emotionally neutral or pleasant if they
have a positive relationship with the practice. They will have positive facial expressions
and open body language. Open body languets means that they will be relaxed and
their arms will not be crosses. In general they will appear open and not under
stress. They will engage in pleasantries and chit chat. These of course are the
patient’s that we find easiest to deal with. It is easy to reflect the
patient’s mood back to them. There is congruency in the communication because
the patient knows what to expect and is not expecting any surprises.
In this type of patient interaction it is best to keep the pleasantries
to a minimum to keep the patient focused at the task at hand. If the patient
seems to be in somewhat of a hurry or anxious about the length of a check up ,
it is best to restate and inquire about that concern and give them a realistic
time frame , remind the patient that the doctor might end up taking longer
because he or she is giving everyone the best attention possible.
You also will have to update patient information in a way
that may require that you ask questions that the patient feels they have
already answered. Again, simply state this is part of the task and empathizes
with them having to repeat so much information.
If something serious is found in check up, it is important
that you reflect hat you understand the patient’s concern. Again be congruent
in your Reponses. If the doctor is sending the patient for more tests be sure
to reassure the patient that the doctor is doing what is routine in the case of
an unseal finds in the routine exam. Be sure to give the patient all the
information they need including the way and the time it will take them to get
the test results. Showing genuine concern and empathy for what may be an
unexpected serious medical concern with influence the ongoing treatment of this
patient. This is what therapeutic communication tries to achieve the best
patient comfort level possible under the circumstances that will assure the
best patient compliance with testing and treatment
Patients new to the practice will have varying degrees of
anxiety. First impressions count so put your best communication skills forward.
Make it therapeutic communication from the moment you meet new patients. Empathize
with starting with a new doctor. Be honest about the length of appointments. If
you work the front area make sure you give the practice policies other than
just the privacy notice. Ask if the patient has questions or concerns about
being a new patient. If the patient is having difficulties getting records transferred
make the extra effort and offer to fax needed forms for them. The practice can
not serve the new patient’s needs without a complete medical history.
If patients have filled out long patient histories in the
waiting room, tell them in advance they may have to clarify questions they have
already answered.. Use your most effective summary skills and restatements to
get the information you need in the least amount of time. Inquire again in the
exam room about any concerns or resources the patient might need to know when
becoming a new part of your practice. Getting off on the right foot will help
you have a productive and pleasant relationship with the new patient for years
to come.
If you work with specials populations like the elderly or children
then you will need to have additional skills in order to engage in therapeutic
communication. In general you show respect for elderly patients with the
understanding that reduced vision, hearing, or cognitive issues may require you
exercise more patience. A medical assistant can not get frustrated when questions are not
understood by an elderly patient.
It helps to have some basic knowledge of child development
to speak effectively with children. Questions and statements should always be
directed toward the child first and the care giver secondly as much as possible.
Obviously, with very small children you must be able to surmise non verbal
communication of the child in addition to what their care giver is telling you.
Special practices such as oncology and hospice require knowledge
of therapeutic communication with in the context of crisis and grief. Today
cancer is not a death sentence for most but a struggle that puts huge financial,
emotional, and physical stress on the patient and all of their family. The
ability to empathize and be a support for the patient first and secondarily to
the care givers is important. The length of cancer treatment means you will be
dealing with the patients on a regular basis for an extended period of time.
Therapeutic communication that encourages absolute adherence to treatment protocols
is essential. This is especially true if for the patient the illness seems less
painful than the treatment. Understanding that patients will become
uncooperative and depressed during the course of therapy is essential, giving
moral support and showing that you understand can help resolve issues of
noncompliance.
Patients who face end of life issues and their family need
specialized forms of therapeutic communication that may require you to study
skills outside the context of normal medical assisting communication.
In the end therapeutic
communication with patients
becomes the normal way you interact with all patients. Dealing with patients in
crisis situations can take a toll on your emotional health and communications
within your personal life. Make sure that your have a support system and a
method to manage your stress as a health care provider.
