Looking at Prescription Drug Addiction in Our Patients

Prescription (Photo credit: Wikipedia)

Drug companies use direct-to-prescriber advertising in an effort to convince prescribers to dispense as written with brand-name products rather than generic drugs. (Photo credit: Wikipedia)

Anyone who pays any attention to the news knows that in general populace addiction to prescription drugs is seen by some experts as being at a record high. Many folks feel like they can hide their addiction because no one really questions you're going to the pharmacy to get just what the doctor order. Prescription drug use and abuse does not have the same stigma for the abusers as 'street drugs."


Many people feel sorry for the prescription drug addict, because the doctor gave them the drugs and the addiction is viewed as some unfortunate medical accident. We seem to overlook the fact' like all addicts, prescription drug addicts lie, steal, and cheat to keep themselves in the prescription drugs they are addicted to.

English: A graphic map showing the rates of accidental prescription drug overdose deaths for the state of Ohio by counties for the years 2004 to 2008. Information obtained from here and here. (Photo credit: Wikipedia)

All medical assistants should has a basic understanding of how prescription pain drugs pose a threat to the patient’s health. Yes, physicals and nurse practitioners prescribe drugs, but medical assistant take medical histories and obtain medical records. You may be the first person to notice that a new patient has be doctor hopping or has gotten multiple prescriptions for different kinds of pain drugs. T

These are red flags in a patient’s medical record. Many times addicted patients return again and again to their primary care physicians with complaints of headaches or back pain that no apparent cause can be found. Many times if these patients are referred to specialists or for further testing, they put up a great deal of resistance. They will balk at the suggestion of physical therapy for pain related to an injury. They want pills and many times will even suggest to the doctor the kind of narcotic that works best for them. You as a medical assistant may be the first to notice this type of behavior.

A busy doctor may be just too busy to notice these types of behavior. It might be helpful to tell the doctor you think a patient might be engaging in drug seeking behavior,  Be sure to back you suspicions with information from the patient’s chart. 

When retrieving records for new patients , be sure the prescriptions the patient’s says they are on, match the patient’s record. Many times the patients forget to tell you about the prescription for pain killers from the dentist. They are bold enough to complain of back pain and get another prescription from you. Many times pain killer addicts use multiple pharmacies;so it may take a little extra work for you to get an accurate picture of what drugs your patient is really taking.

.Those who are addicted to Vicodin, Zanax, or Oxycontin tend to miss a lot of time at work. Many sit at home in a stupor  making up ailments to gain more access to the prescriptions they are addicted to. I am not sure we will actually know how much property damage or death is caused by drivers addicted to prescription drugs. Only those who appear seriously impaired would probably be tested by authorities at an accident scene . Someone impaired on Vicoden does not reek of alcohol.

There is a public awareness of the problem of teens getting high out of their parent's medicine cabinet. Those five  pain pills that are a couple of years old patient’s  have left over in their  medicine cabinet; are not the real problem. The 20 pills  a teen takes regularly out of the  mom’s hundred Vicoden is the source of serious teen addiction..  Patients may deceive health care providers with complaints that they have a chronic pain condition. Over use of painkillers leads to the painkillers not being effective anyway. The dose must be upped on many drugs for them to work for patient pain.

States are now using computers to track the distribution of  controlled substances from pharmacies. Still an addict will not hesitate to cross state lines to bypass these types of obstacles. Even older patients are at risk for pain killer abuse. That sweet Mrs. Jones may have several active prescriptions at pharmacies in Florida as well at the corner drug store.  

Ask about any prescriptions that might have been obtained by the patient on vacation or when wintering outside of your own state.

There are alternative methods of treating people with chronic pain. Acupuncture, bio feedback and just losing a few extra pounds have brought pain relief to thousands of patients. Still there is no magic cure for chronic pain and certainly no magic pills.. We must make sure our  patients understand that just because it came from doctor does not mean prescriptions are a real cure all for chronic pain.

We need to discuss prescription drug addition with teens because once they are addicted from raiding mom’s medicine,t the next level of addiction will have them forging prescriptions or ordering mail order prescriptions off the internet. The cost of most of the addictive drugs is not as draining on our teen wallets as the street drugs. Most teens will not get caught popping a pill at the water fountain in the hall at school. We need to examine our own attitude to the popping a pill for every small ailment. It is better to show your patients healthy ways to deal with pain, Doctors and supporting staff need to show patients  the ultimate solution to pain management does not come in the form of a pill.

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Managing Electronic Prescriptions

English: Novamoxin Prescription Drug - Amoxicillin Trihydrate (H-6) 500 mg Français : comprimés de trihydrate d'amoxicilline 500 mg (Photo credit: Wikipedia)

Pharmacy Rx symbol (Photo credit: Wikipedia)

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.

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Therapeutic Communication

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 therapeutic communication 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.

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Is Medical Assisting the Career for You?

s Ashley Cameron blows soap bubbles for a local child while assisting with a medical civic action program held at Delap High School (Photo credit: Wikipedia)

Medical Assisting and Certifications

If you are looking for a career that offers the ability to develop ongoing skills and job security; then you may want to consider medical assisting. The medical assistant today works in a variety of setting and has a variety of skill sets.There are the traditional medical assistant roles in family practice and general practice doctor's office.

This is a great setting if you enjoy diversity in your work day and having an ongoing relationship with patients that spans the years. You will have the opportunity to learn a variety of clinical skills when you assist the doctor with various exams. In smaller practices, you may have the opportunity to be involved with front office activities like setting appointments and billing. Many larger practices have very defined roles for their medical assistants.

Opportunities in General or Specialty Practices
There are all sorts of opportunities to specialize in medical assisting. You can work for a number of different specialists. Some medical assisting specialties like working in an ophthalmologist office are recognized as specialized professions. If you work in an orthopedic or urgent care facility you have the opportunity to learn skills like limited radiology.

Each specialty has number specialized tasks those medical assistants in that practice i are expected to learn. The more skills the specialty requires; the more opportunities the medical assistant has to expand their skills and career opportunities. In general medical assisting in a specialty practice pays higher wages then medical assisting in a more general clinical setting.

Patient simulator in the Clinical Skills and Clinical Simulation Center. (Photo credit: Wikipedia)

Training in Accredited Programs

Many entry level positions in medical assisting start out about $20.000 a year, but pay tends to increase relatively quickly as skills and positions advance. Many medical assistants will have salaries in the$40,000 a year range. Many states do not require any special training for becoming a medical assistant, but technological and medical advances make it highly unlikely that you will find positions in medical assisting without any formal training.

The majority of career schools offer training in medical assisting. There are a variety of diploma programs and associate degrees programs. Associate degree programs are suggested for students who want to go into other areas of health care. It is a good associate degree for someone who wants to go on to get a bachelor's degree in related to practice management.

Most programs include courses both administrative and clinical skills. These include courses such as Anatomy, Physiology, Medical Transcription, Medical Billing and Medical Coding. Clinical courses teach vitals, phlebotomy, assisting in common exams, limited radiography, basic laboratory and specimen preparation skills. All programs require a clinical ex-tern to give medical assistant students job ready skills when they leave the program. You should only consider programs that will prepare you to take certification exams.

Types of Certification
The two most common certifications are Certified Medical Assistant (CMA) or Registered Medical Assistant (RMA). For new medical assistants they require that you complete a training program that is accrued by either the Accrediting Bureau of Health Education Schools (ABHES) or the Commission on Accreditation of Allied Health Programs (CAAHEP).

There are a few online programs that will prepare students to sit for either the CMA or RMA exams. The programs can be much focused. They are a good choice for students who get some clinical experience in their current employment such as CNA's or patient techs. For the student with no clinical experience it can be difficult to obtain skills needed in the clinical classes because you are limited to learning this skill by simulation. You will be dependent on learning clinical skills in the extern part of your training.

Unless , you extern in a practice that give you very diverse experience you will find yourself shorted on the ability to master some of these clinical skills. Most local community colleges and career colleges offer medical assisting courses that include hands on clinical training. Most students new to the medical profession will want to get their training in this type of setting.

The job outlook is good for those entering the career of medical assisting. The ageing baby boomer population will be providing specialties that provide management of conditions common in old age plenty of new patients. The implementation of Obamacare will mean that more people will be accessing the medical system and the need for family and general practices will increase. There should be no shortage of interesting practices for medical assists entering the profession in the foreseeable future. 

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