Thursday, November 20, 2014

Helping Our Patients Follow Up With the Right Eye Care Professionals.

English: Dilated pupils after an optometrist appointment. (Photo credit: Wikipedia)

Conventional surgery to treat glaucoma makes a new opening in the meshwork. This new opening helps fluid to leave the eye and lowers intraocular pressure. Description: Conventional surgery to treat glaucoma makes a new opening in the meshwork. This new opening helps fluid to leave the eye and lowers intraocular pressure. Credit: National Eye Institute, National Institutes of Health Ref#: EDA11 (Photo credit: Wikipedia)

That's the name for this thing that you look through so the optometrist can tune the settings for your eyeglass prescription. (Photo credit: Wikipedia)

"Slit lamp examination of Eyes in an Ophthalmology Clinic" (Photo credit: Wikipedia)

The Optometrist (Photo credit: Wikipedia)

When it comes to eye health it is important to know which eye care practitioners can provide you the best care. Many of our patients may be referred to an optometrist or ophthalmologist for follow up care after they have been in our office for minor eye injuries, unexplained eye inflammation, or have been newly diagnosed with diabetes. In the case diabetes the patient will be referred to have their eyes screened for signs of glaucoma. Glaucoma is a common eye condition in patients with uncontrolled or poorly controlled blood sugar. Some patients may be referred to an eye specialist to determine if the headaches they experience are a result of pressure from various eye conditions.

Many times eye doctors both optometrist and ophthalmologist will refer patients to our practice to be screened for high blood pressure, diabetes, or even neurological conditions. This is because eye exams can be the place that Symtoms of many conditions first appear.

An eye specialist many times will consult family physicians about a patient’s eye problem if they suspect a medication is responsible for a decline in vision. Blurred vision is a very common side effect of many of the drugs people take for heart conditions, arthritis pain, or even erectile dysfunction drugs. It is good as a allied health professional to help our patients understand the difference between optometrist and ophthalmologist.

Optometrist is the primary care givers for our eyes. If we have ever needed glasses or contacts we have been evaluated by an optometrist at least once. Optometrist diagnoses complex eye conditions such as glaucoma, cataracts, and retinal issues. In some states they even treat they these conditions. Optometrist also follow the eye health of people with underlie health conditions that may effect their eye health such as diabetes and hypertension.

They can prescribe certain medications for eye conditions and provide low vision rehabilitation. They also can remove foreign objects from the eye.

An ophthalmologist is a medical doctor. Many are eye surgeons. They provide comprehensive service that covers the services provided by optometrist. The difference is that those seeking regular exams for glasses or contacts from an ophthalmologist many times have been diagnosed with a significant eye condition not traditionally treated by the optometrist.

Ophthalmologist treat disease related to the cornea and conditions that effect the exterior of the eye such as sclera, conjunctiva, and tumors. They tend to deal with any disorder that affects the optic nerve in any way. This includes optic nerve damage related to brain tumors, MS, or any condition causing intraocular pressure.

Ophthalmologists are frequently surgeons today. They do surgery ranging from common Lasik procedures to complex retinal reattachments. They provide a range of cosmetic as well as vision restoring procedures. Many ophthalmologists may specialize in areas related to neurology or pediatric eye care. Some devote their careers to the research of serious eye conditions.

Sometimes care is based on insurance coverage and not necessarily the seriousness of the eye condition. If you have vision insurance your first choice for any eye problems will be an optometrist. If you have no eye coverage you may opt to see an ophthalmologist because they are medical doctors and many times their services will be covered, but their testing may not be. If you can afford to pay out of pocket it is best to see an optometrist first. This is for several reasons. Costs are greatly reduces and optometrist can treat a great deal of conditions such like glaucoma and retinal diseases

When optometrist fined your condition out of the scope of expertise then they will referral you to an ophthalmologist. Eye injuries and conditions creating a sudden loss of vision should be evaluated in the emergency room. Any follow up care will probably be referred to an appropriate provider.

Sunday, November 16, 2014

The Role of the Medical Assistant in Risk Management In the Medical Office

We tend to focus on treatment plans for patient's and the role of the medical assistant in helping the doctor implement his course of action. Yet, how we treat our patient's as consumers may be just as important as how we treat their medical issues.

Why risk management matters?

Risk management in the medical office is about policies in the office that promote the daily use of best practices.. These practices are the one’s that assure the safety of staff and patients; in the daily operation of the medical office.

Best practices for a group or individual physicians are there make sure they are complying with legal standard and ethical standards of the profession. Standard compliance limits the chance of legal liability for the physician. Individual medical malpractice suits can be reduced by office having policies that provide checks and balances in patient care to prevent mistakes. Patient policy should also address patient concerns in a timely manner. This prevents minor issues with patient’s becoming major issues that could result loss of patients or lawsuits.

Policies and Prodecures for a Successful Medical Practice

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The change from paper charts to electronic health records is an opportunity for staff to commit to accuracy on a new level.

Source: Wikimedia Commons- NARA

The Devil is In the Details

Minor mistakes in the diagnosis and treatment of patients can lead to law suits. The office manager can not correct mistakes made by the physician in individual patient care , but correct medical record management can reduce errors. Most physicians make decisions based on a review of charts as well as direct patient examination. Poor data gathering on test results, allergies, or past care can result in serious mistakes in patient care. New laws involving patient privacy and patient care require practices update their practices involving patient records. These should mean that medical assistants and all staff involved in adding data or correcting data in patient’s records; should be committed to accuracy.

It is important to know how happy your patient's are with your practice. Using common sense in patient communication can reduce the legal risk your medical office faces.

Breaking Up is Hard to Do

Some practice risk management is straight forward. Placing signs in waiting areas when floors are wet or simply moping when the practice is closed can reduce this simple type of risk. Patient termination is a bit more complicated.

Practices terminate patient care for a number of reasons. Sometimes it is that the patient has been disruptive or refused to comply with care plans. Many times patients are terminated because the physician can not provide the scope of care needed; and the patient has been unwilling to use referrals from the physician. Sometimes the patient has failed to pay their part of bills for services or keep scheduled appointments.

Most states have laws to cover the ways physicians can terminate the patient physician relationship. You must a have policy in place to comply with these laws. You should provide written notice of termination to the patient within the guidelines. It is also good for a practice to publish notices to existing patients the reasons that the relationship may be terminated. These way patients can be aware if they are acting in ways that may cause them to be dropped from the practice.

Having clear policies for patient scheduling decreases missed appointments and having to charge patients for no shows. Letting patients know the payment options and policies for a practice can reduce the need for practices to dismiss their patients due to unpaid bills. If a referral is made for continuing care the appointment should be made from the current physician’s office. Good communication practices reduce the number of patients who are dismissed for disruptive behavior. Good bed side manner and customer service do a lot to keep patients from becoming frustrated and disruptive.

The practices and policies I have outlined above will reduce the risk of the need to terminate patient relationship. They will also reduce the risk of liability over all for the practice. People are less likely to sue practices where they felt they were treated with respect; they are less likely to leave practice if they fell valued as patients. This is true even if a patient feels a mistake in their health care may have occurred. People are less likely to be disruptive in waiting areas if they are seen in a timely manner. Most patients want to pay their bills on time. They simply need to have their questions answered and payment arrangements made they can manage. The golden rule is still the best way to reduce the liability of the practice overall

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Thursday, November 6, 2014

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.

Friday, October 31, 2014

Undertanding The Patient With Anxiety Issues

Panic attack (Photo credit: Wikipedia)

English: This chart shows the lifetime prevalence of anxiety disorders found in the Epidemiological Catchment Area Study. Data from: L. N. Robins and D. A. Regier, Eds. Psychiatric Disorders in America: The Epidemiologic Catchment Area Study. New York, NY: The Free Press. (Photo credit: Wikipedia)

English: Signs & Symptoms of Anxiety (Photo credit: Wikipedia)

English: An anxious person (Photo credit: Wikipedia)

Millions of Americans need help to deal with anxiety related health problems. If your patient reports anxiety to you when you take a medical history then you should report it to the doctor. Screenings for anxiety and depression are now part of routine check ups. What really is anxiety? Many people are anxious when they come to see the doctor for any reason. If a patient’s blood pressure is high and it is not part of their medical history to have hypertension there is a good chance anxiety is the cause. Taking the blood pressure again after the patient has settled in the exam room sometimes solves this issue. Having a base understanding of anxiety is good for any Medical Assistant to help them understand this common patient issue.

Anxiety is a natural emotion that all humans experience. It is both a physiological state and a psychological state. It is a state of reaction to a perceived threat real or imaginary causes people stress on all levels of experiences: cognitive, physical, and emotional. It determines that way we act in situations that generally trigger fear. Many people suffer from a generalized state of anxiety unable to understand what triggered it. It can manifest itself in panic attacks or just a state of constant worry and depression.

Anxiety is not always a non rational response to one's environment. It can be a normal reaction to everyday stress and the uneasiness can push us to complete tasks that it would be our natural inclination to avoid. A student feeling mild anxiety over an upcoming test might be inclined to study.

A student feeling severe anxiety about a test may be so paralyzed by fear that they cannot take a test at all. The measure or good motivational anxiety and pathological anxiety are a very personal thing. No one suffering panic attacks is experiencing motivational anxiety , but a child anxious to pass a test may be motivated to put up the videogame and study by a little anxiety.

There are different types of anxiety disorders. One type is a spiritual anxiety called existential anxiety. This tends to be the type of disorder freshman in college experience when they learn to think critically and realize that life is more complicated than it appears. They are no longer sure of the safe guards’ of meaning and purpose in life that they grew up with. This can be seen as a positive anxiety as it motivates people to define their own purpose in life and pick their own spiritual path.

Older people may again question the meaning of their lives in middle age. Again, a little anxiety is a good motivation to reevaluate the purpose of your life. This type of anxiety is best addressed by spiritual advisors and life coaches. It is part of the growth of spiritual and emotional maturity to realize that the decision you make in life determine your purpose and meaning

There are situational events that will trigger anxiety to some degree in almost all people. Most people will experience anxiety before a test. Still, for most people this is motivation that causes them to adopt positive actions to pass the test. It becomes pathological anxiety when it causes a person to be so consumed by fear they cannot take the test. This is also true; when it comes to stranger anxiety and social anxiety. If a person is wary of strangers and avoids walking in dark streets for fear of getting mugged, then most would agree that is rational anxiety. If a person refuses to leave their house for fear of meeting any stranger on the street, it becomes a mental health issue

Most people do not suffer from an anxiety disorder to the point they will not leave the house. More likely people seek treatment for anxiety disorders when they suffer from panic attacks. They become flushed, sweat, and shake. Some people experience chest pain and think they are having some sort of coronary attack. Many people report feeling they are 'dying" during a panic attack. Many people will head to the emergency room when they have their first panic attack.

Many people do not know what triggers a panic attack. They will generally develop a fear of the environment that triggered the first panic attack. If you had a panic attack driving to the mall you would then probably not want to drive to the mall. Still the underlying cause of the panic attack; most likely had nothing to do with driving to the mall. Behavioral therapy helps people find the true triggers for their anxiety and helps them see their fears in a rational light. The goal of behavioral therapy is to give practical ways to behaving that stave off a panic attack.

There are other mental health disorders associated with anxiety. Post traumatic stress syndrome is one where the experience of a traumatic event keeps promoting a reaction of depression, anger, and anxiety long after the traumatic event has passed. It is usually a combination of medication and therapy that help people with this type of anxiety.

Obsessive compulsive disorder can also be seen as an anxiety disorder. People channel their anxiety into obsessive behaviors in order to feel in control of their environment. Unfortunately ,the obsessive and compulsive behaviors of these individuals become as source of increased anxiety of which the individual has no control. Again, medication with therapy is the approach most medical professional use to deal with OCD.

In the general category of anxiety there are a number of disorders that can affect the individual. The following are all considered anxiety disorders; Generalized Anxiety Disorder, Panic Disorder, Agoraphobia, Social Phobia, Obsessive Compulsive Disorder, Specific Phobia, Post-Traumatic Stress Disorder, and Acute Stress Disorder.

Many anxiety disorders are more common in women than men. Conditions like Post Traumatic stress however, will affect a significant amount of males who have served in the military, as opposed to a male just in the general population.

There appears to be biochemical and genetic factors that lead to anxiety disorders. Most people can find some relief from symptoms in cognitive / behavioral therapy and medication. Some people suffering from a generalized state of anxiety unable to identify a true trigger will opt to control symptoms with just medication.

The fast paced nature of life in the world today probably means we will be seeing an increase in individuals with some sort of anxiety disorder. Relaxation techniques and stress relieving exercises and family time can help most people deal with the anxiety of everyday life. People should avoid using recreational drugs and alcohol to self treat anxiety symptoms as an issue with substance abuse could develop.

If your patient is anxious to the point it affects their every day work and family relations they seek out professional help.

Thursday, October 23, 2014

Understanding Steriods in Patient Treatments

Various anabolic steroids. Author: Wikidudeman...

(Photo credit: Wikipedia)

Generic structure of the steroids, numbered (Photo credit: Wikipedia)

Steroids are prescribed for numerous conditions including in high does to treat conditions like cancers(in conjunction with chemotherapy and for most autoimmune disorders Steroids are used in small does and most people will find themselves starting at a higher dose and , “stepping down” to a lower dose. Depending on the condition you are being treated for you will find yourself stopping them completely or staying on a maintained dose.
It is amazing how many conditions are treated with steroids. Lupus, rheumatic fever, severe asthma, and even organ transplant patients will find themselves using steroids. It also is administered in many different forms. There are steroid creams for skin conditions, sprays, shots, and pills.
Steroids act on the body by decreasing inflammation. Dexmethsone is a common steroid prescribed for pain. However predisolone may also be used to treat pain. The use of steroids in palliative care in the elderly has become wide spread. Steroid can interact with mineral absorption and cause elderly patients to be more inclined to weakening in bones and joints. The benefits of treatment for chronic pain of steroids as a whole is something doctors will consider if you are prescribe steroids for strictly pain control.
The degree of side effects you can expect from steroid usage is really dependent on dose. These are the most common side effects and some solutions to them
• Heartburn – Steroids like aspirin can upset your stomach. It helps to take steroid with a meal and possibly with milk.
• Mood Swinging-Most people fell anxious and more emotional on steroids. Try not to take yourself too seriously if you find yourself feeling this way. Avoid emotionally stressful situations if you can during your steroid therapy
• Insomnia- Steroids can give you an adrenal rush so avoid taking you medicine right before bed. It is ideal to take you doses as early as possible to avoid this side effect
• Weight gain- Steroids tend to make you retain water and have a huge appetite. Your weight will eventually return to normal after therapy has stopped. If you eat more doing treatment tries to stick with fruits, nuts, and other healthy snacks.
• Increase in Acne: Many people find the acne they had outgrown in adolescence returning with steroid use. Home remedies and over the counter acne treatments should minimize this side effect.

Some of the more serious side effects are only likely to occur with long term treatment. Vision problems like glaucoma or cataracts can occur during treatment. Any changes in your vision when receiving steroid treatment should be reported to your doctor. Blood pressure and blood sugar increase in people being treated with steroid therapy. The doctor may need to adjust the dosage of any high blood pressure medicine you now take to keep you hypertension under control. The same is true if you are a diabetic, the doctor may adjust your insulin.
Steroids lowers your immune system .To be on the safe side avoid contact with people you know are ill. It is also good to avoid people who have recently been vaccinated and to no be vaccinated you during steroid treatment.

People on long term steroids can develop some odd problems that the doctor will be looking for. Call your doctor if you develop a swollen face. This is known as,”Cushing syndrome “and your doctor will want to know about it. Your doctor also will monitor you for weaker bones and muscles that can occur as a result of long term steroid use.

Buttock injections are a common way for patients to recieve steriods.

Sunday, October 12, 2014

Are You Showing A Professional Attitude At Work?

What Constitutes A Professional Attitude In An Allied Health Professional ?

Patients come to us stressed and uncomfortable, even if they are not at thier best to do our best we need to keep a professional attitutude.

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It is not enough to have the appearance of a professional , but you must have the right attitude to be an effective professional.

Source: Morguefile

No Patient Likes Being At The Doctor or Dentist

The first quality an allied health professional has to have is a professional attitude. This means the ability to not be influence by the negative attitude of the patient or their family. Many times as an allied health professional you will be facing a situation where the caregiver and the patient are stressed. It does not mean that every patient or caretaker that you encounter is in crisis, but simply dealing with medical issues and medical bureaucracy can put even the cheeriest individuals into a dour mood.

Dental Assisting is part of the allied health professions. When was the last time you woke up saying,” I have been looking forward to visiting the dentist all week;” on the day you have a dental appointment. You are not in crisis, but you would no doubt rather be somewhere else. You might find yourself grumpy and less inclined to be corporative. You patients are experiencing the same thing.

Patient's tend to be stressed just by walking into the medical office. Being positive and friendly can help set them at ease.

Source: By Bill Branson (photographer) [Public domain or Public domain], via Wikimedia Commons

It may not be a crisis but patient's are anxious !

If you are employed as a medical assistant or dental assistant in an urgent care facility the situation is more crises oriented. Patients are usually stressed by pain bad enough to visit the urgent care office. Caretakers are worried. Both have had their normal routine, weekend, or workday interrupted. In these setting it is important to show positive attitude and not take any bad behavior on the part of the patient personally, this is especially true when getting long patient histories.

Patients are obviously anxious to see the doctor; they do not necessarily remember when they had their tonsils out when they were a small child. Take answers as you get them. Medication lists are more important you may just have to encourage them to remember the dosages and exact names. If they need to call home to find out from someone there who can look at the bottles encourage them to do so.

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Activities like putting on a skimpy hospital gown may violate some cultural norms for some patients.

Source: Morguefile

When there is high patient drama

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When patients are seriously ill the stress level rises for the patient , family, and professional staff that care for them.

Source: Morquefile

Communicating Past Obstacles: Dealing with Diversity

Other aspects of a professional attitude include the ability communicate. Since you deal with different cultural populations this means you may have to learn something about the different cultures that you come in contact with. In some cultures there are huge divides put between men and women. A male patient may be unwilling to undress for an exam while you are in the room or even see them in an examination gown. In these cases you must be flexible. If the patient is there for a checkup there is no reason that they have to remove more than restrictive clothing. Also if you patient history asks about things of a very personal nature you may have to get a same sexed assistant to take the history. Do act negatively to request from patients who want to preserve and practice their cultural identity. Keep a positive attitude and be flexible.

There are obviously thing that you should know before you become an allied health professional like the practice standards at the organization that you work for. It part of basic ethical behavior to adapt to these standards and uphold them. If they conflict with your personal beliefs say around reproductive rights or other social issues you must reconcile your behavior to the practice standards. If you can not do this you need to seek employment elsewhere. It is a given that you uphold privacy standards and always protect patient confidentiality.

Communication can be difficult with non English speaking patients. Here again do not get anxious or frustrated. Do the best you can. Many times the patient or caregiver will speak a little English or broken English. Do not make assumptions but get the best amount of information you can and ask for help. If someone else in the office or a translator from a social organization is available use them. Remember if it is taking extra time to get the right information or give information the patient needs you are doing your job. Schedules in medical offices get backed up all the time. Doctors get called away on emergencies or find more complex medical issues when doing exams and get of schedule. You need to be able to go with the flow, while being as dependable as possible.

The difficulty of communication can also happen with the disabled. If you know a disabled patient is coming in make preparations beforehand. If you do not know sign language has a note pad available to be able to write notes back and forth. Do not address personal questions about the patient to the caregiver unless absolutely necessary. It is extremely rude and patients find it dehumanizing. This rule also applies to the elderly again patience and flexibility are professional attitude you will need when dealing with diverse patient populations.

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Diverse Patient Populations

Self Care Prevents Burnout

Remember your job is stressful and you may not always be at your best. If you were up all night with a sick kid, you may not be on top of your game. Your personal life should never really affect your professional life but in truth it does. If you normally work through your breaks and lunch hour to catch up on paper work, don’t do it on days you are stressed and if you never ask for help do so. Taking the pressure off yourself will help you maintain a professional attitude on ‘bad days”
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