What qualities project a professional image in an administrative medical assistant list at least two qualities?

Chapter Outline

Medical assisting came into existence as a career during the second half of the twentieth century. As recently as 1950, most physicians established their own practice when they completed their medical education and hospital training. A physician (almost always a man) usually saw patients and had no assistance, except possibly from his wife who answered the telephone and often did the billing.

The physician spent a large portion of each day making house calls. During a house call the physician would examine a patient with only the equipment he could carry in his medical bag. The physician’s office was often located in a room in his house or the first floor of a building, with the physician living in an apartment above. Patients who went to the physician’s office may or may not have had an appointment. They expected to wait to be seen.

In the first 20 years after World War II (before the increasing use of technology caused medical costs to skyrocket), a physician usually charged $2 to $5, possibly $10, for an office visit, a sum that seems small today. For some patients, however, even this small charge was more than a day’s pay. For physicians the low fee was enough because the expenses of the practice were also low. In fact, physicians rarely pressed poor patients for full payment. They always had many patients who owed them money, and it was not uncommon for patients to pay small amounts on a weekly basis for many months or even years, especially the parents of young children. Sometimes physicians would even barter by exchanging medical care for goods or services provided by the patient. For example, a patient might pay for his medical care by bringing the physician fresh produce from his farm.

In the past 60 years, the practice of medicine has changed dramatically. This, in turn, has changed the way in which physicians operate their medical practice. With the advent of government insurance programs, not only were office visits covered by insurance, but the medical office was also expected to complete and submit the insurance forms to receive payment. Physicians soon discovered that the cost of employing a person to complete these forms was offset by improved collections and cash flow. Gradually almost all insurance billing shifted to the health care provider.

Advances in medical science made many more diagnostic tests, laboratory tests, and treatments available and even necessary for good medical care. It made sense to have an assistant in the office to perform these tests and allow the physician to concentrate on seeing patients.

Even as laboratory and diagnostic testing has increased in amount and in complexity, so too have the administrative equipment and technology used in a physician’s office. Today there are computers, wireless electronic devices, printers, fax machines, photocopiers, intercoms, and voicemail systems.

Physicians send claims to a number of different insurance companies. Many insurance plans require prior approval for certain medical procedures, referrals to specialists, or surgical procedures. Insurance companies and government programs prefer electronic claims filing and often make electronic payments directly into physicians’ office accounts at banks. This creates a need not only for more staff, but also for more highly trained staff.

Physicians have also almost completely stopped making house calls. Because of this, physicians need more office space. In addition, patients with more complex needs are seen in physicians’ offices, rather than the hospital emergency department or outpatient department. Sometimes a patient must occupy an examination or treatment room for an extended period of time, such as when an individual with asthma is receiving an inhalation treatment.

Another change that has had an impact on the medical practice involves the increase in medical litigation. Since the 1970s, physicians have practiced what has come to be called “defensive medicine.” Because of the fear of a malpractice lawsuit and the high cost of malpractice insurance, physicians began to perform more laboratory and diagnostic tests to rule out even the most unlikely cause of an illness.

As services expanded, physicians employed nurses to help them in their offices. This helped ease their burden of performing procedures and caring for patients, but nurses were often unable and unwilling to assist with the administrative aspects of the practice. As a result, many physicians found a willing candidate and trained that person to assist first with administrative duties and then with both patient care and administrative duties. This evolved over time into what today is the medical assistant position.

In 1956, medical assistants from 15 states organized to form the American Association of Medical Assistants (AAMA). In 1978 the profession was recognized by the U.S. Department of Education. The AAMA and other organizations, especially the American Medical Technologists (AMT), have worked to define professional training for the medical assistant and to provide certification for medical assistants through national examinations.

Medical assistants possess or develop a number of characteristics that make them effective in their work. Although a person’s character and personality have been shaped by heredity and environment, a medical assisting student can work to enhance the traits that are important for health care delivery. Appearance and behavior are important means of projecting competence in the medical office (Figure 2-1).

The most important character traits of a competent medical assistant are dependability, honesty, and tolerance. The medical assistant is an integral part of the office practice and must arrive at work on time and not take days off, except when ill or if a family emergency arises. A medical assistant must be reliable enough to organize the day’s work and be prepared for each patient interaction.

A medical assistant projects honesty by working within his or her “scope of practice”—that is, doing only what he or she is trained to do and being comfortable in saying “I don’t know” or “I don’t know how to” when appropriate. The medical assistant must always maintain confidentiality and behave ethically. The medical assistant must recognize that a high level of trust is an important component of high-quality patient care. Tolerance or a willingness to accept the beliefs and practices of others is an important character trait. Tolerance allows the medical assistant to work effectively with co-workers and patients from a variety of religious, ethnic, and cultural backgrounds.

Putting It All into Practice

My name is Beth Ann Wilson, and I am a certified medical assistant. I attended a medical assisting training program at the community college near my home. I was the first person in my family to go to college, and my family was very proud of me. After the first year (two semesters), I received a certificate in medical assisting, and I found a job in our town at a group practice specializing in obstetrics and gynecology. My instructor encouraged me to take the CMA (AAMA) examination, and I was glad when I found out that I had passed it. I continued to take night classes so that I could get my associate’s degree. I also attend the state and local chapter meetings of the AAMA so that I can get the contact hours I need to renew my CMA (AAMA) certification.

When I started working, I spent most of my time at the front desk answering the telephone, checking patients in, and filing, but after about 8 months I began to escort patients back to the examination rooms, prepare them for examinations, perform laboratory tests, and assist during examinations. We do some specialized tests in our office, including colposcopy, and I was trained to set up for the test and assist the physicians. Janice, our office manager who is also a CMA (AAMA), has asked me to be responsible for ordering all the supplies for the office and taking inventory. She has also encouraged me to take business courses and attend seminars related to changes in insurance billing. Not too long ago, Janice told me that she is planning to cut back her hours in the spring, and she hopes that I will be able to take over some of her duties in running the practice. That will be a big challenge, but I think I am ready for it. I have a few ideas of my own, and I will be glad for an opportunity to try them out.

Certain personality traits are essential to being a successful medical assistant. A medical assistant needs to be genuinely interested in helping people. The medical assistant must be outgoing, warm and caring, and able to put the needs of others first. The ability to remain calm in challenging or difficult situations is also important.

The practice of medicine is one of the “caring professions.” Each professional in the medical office needs to have a serious interest in helping people. Although the medical assistant must know how to perform the necessary administrative activities effectively and efficiently, the first priority is the care of patients who visit the office.

The concepts of warmth and caring are discussed in more detail in Chapter 4, in the section on communication. For now, it is important to say that caring is a key personality trait. Some aspects of caring can be learned and practiced. If an individual does not have a naturally caring personality, he or she will find it much harder to learn the communication skills needed to express caring.

The ability to put the needs of others first is important. The medical assistant must not allow personal circumstances to interfere with interactions with patients, colleagues, or physicians. Remaining objective and concentrating on the situation at hand is important. The patient’s needs take precedence over the needs of the medical assistant.

The atmosphere in a medical office may change quickly from calm and orderly to rushed and somewhat disorganized. The medical assistant who can remain calm when things do not go as planned will be more successful than one who is thrown completely off balance by sudden changes in schedule or plans and who becomes emotionally unable to respond effectively.

Personal appearance influences both the feelings and the behavior of the medical assistant. It also influences the way in which the patients respond to the medical assistant. Psychologists have long recognized the importance of physical appearance. Important judgments are made within seconds of meeting a stranger on the basis of appearance and body language.

When the medical assistant calls a patient to come from the waiting room to the examination or treatment room, the patient immediately forms an impression of the quality of care the medical assistant—and the physician—are going to provide (Figure 2-2). A medical assistant who is neat, clean, and well groomed projects a sense of professionalism, authority, and competence. When medical assistants are courteous, they project respect for a person’s dignity. This is important because many patients feel awkward, especially when dressed in underwear and an examination gown. In the same way, anything that the patient experiences as negative can result in an instant feeling of doubt in the medical assistant’s ability. This may be generalized to a general feeling of doubt about all office staff. Patients often react negatively to rumpled clothing, dirty or worn shoes, unpleasant body odor, strong scent from perfume or personal products, piercings, tattoos, or an appearance that seems too “dressed up” because of jewelry, false nails, heavy makeup, and/or elaborate hairstyle.

Most medical offices require that medical assistants wear a uniform when performing clinical tasks. The uniform worn by most medical assistants consists of scrub pants with a scrub top or short-sleeved shirt; clean, white, soft-soled shoes; and a laboratory coat or jacket as needed. The top and/or jacket may be patterned, especially in a pediatric practice. Both top and bottom should fit well without being too tight. Pants should be hemmed neatly so that they do not drag on the ground (Figure 2-3). In some practices all staff wear coordinated uniforms. When performing administrative tasks, the medical assistant wears scrubs or street clothes. If street clothes are worn, they should project a businesslike appearance (Figure 2-4). Jeans, for example, are always unacceptable attire in the medical office.

Neatness and good grooming are also important for health and safety reasons. Hair carries bacteria, even if regularly washed. Medical assistants who perform clinical activities should pull their hair back and tie it, usually in a ponytail. A little bit of makeup can enhance a female medical assistant’s professional image, but too much is not appropriate for a work environment. Both female and male medical assistants should always present a businesslike appearance.

Medical assistants should maintain scrupulous personal hygiene and avoid perfume or scented personal care products. Many patients have allergies or respiratory problems that can be aggravated by perfumes, colognes, and scented hairspray or deodorants.

Nails should be kept relatively short and should not be polished. Long nails are not functional for keyboard work, patient care, or laboratory procedures. The Centers for Disease Control and Prevention (CDC) recommends that artificial nails not be worn and fingernails be kept

inch or shorter when caring for patients at high risk of acquiring infections.

Traditionally, health professionals were allowed to wear only “functional” jewelry—a wristwatch and a plain wedding band—because jewelry is not regularly washed and can become tangled in equipment. Today, most medical offices allow staff to wear small earrings that do not dangle below the earlobe and necklaces that can be tucked into the shirtfront. Wearing rings other than a wedding band is not a good idea. Rings can cut through protective gloves or scrape a patient. Also, they need to be taken off frequently for handwashing. Most medical offices do not allow visible piercings, except for the ears. It may also be a policy of the medical office that visible tattoos must be covered. Tattoos on the arms can be covered with a long-sleeved jersey worn under the scrub top or special sleeves designed specifically to cover tattoos.

Initiative is the ability to begin or follow through on a plan without being supervised. Initiative is an important quality for a medical assistant. The willingness to take initiative and perform tasks that need to be done without being specifically instructed to do so improves the functioning of the office as a whole.

Initiative, however, does not mean taking over. The office is the physician’s place of business, and the physician expects to run it. Initiative does not mean redecorating the waiting room without asking the physician. It does mean doing things that need to be done without being asked, keeping up with current issues in practice without being told, and identifying helpful educational opportunities and asking permission to attend. It also means finding useful things to do when the office is slow, such as restocking supplies, ordering supplies, and cleaning out cabinets and cupboards.

Office managers who supervise medical assisting students during externships relay that some medical assisting students do not take enough initiative. Taking appropriate initiative is an important skill to develop. While in school, students learn to wait for someone to tell them exactly what to do and how to do it. In the workplace the opposite quality is valued. A medical assistant is expected to figure out what needs to be done and how to help out—even during a practicum or externship.

When a medical assistant begins a practicum or a new position, he or she must learn when to jump in and perform a task without being asked. The task that is most comfortable for the medical assistant to perform may not be the one that shows the most initiative. Medical assisting students often work on filing during slack periods because they are comfortable with the task, but it might be more important to restock examination rooms or make telephone calls to remind patients about appointments.

Initiative is a quality that employers look for in new medical assistants. An employer may even test a new employee’s initiative by showing them how to do something, such as restocking an examination room at the end of the day, and then watching to see if the new medical assistant restocks the examination room without being told.

Managing activities, tasks, and schedules efficiently requires attention and effort first as a student and later as a professional medical assistant. This concept of time management goes beyond day-to-day use of time to include planning, setting goals, prioritizing, and analyzing the effectiveness of how time has been used.

Getting organized requires a method to keep track of personal, class, and/or work schedules. An effective schedule includes classes, work schedules, meetings, and/or other regular activities, but it can also be helpful to schedule time for specific tasks such as homework (for a student) or preparing an inventory (for a working medical assistant). There is a tendency to put off tasks that seem difficult or unappealing. Scheduling specific times to work on these types of tasks increases the likelihood of completing them so that they are done well and on time.

For class and work activities, it may be helpful to create and update a task list. In its simplest form, this is created daily as a list of tasks to be done; each task is checked off or crossed off when it is completed. Task lists do not have to be limited to a single day, and they can be prioritized with the tasks placed in order from most important to least important. In analyzing a schedule, some unimportant activities may stand out as items that can be eliminated or reduced in frequency. It may provide a psychological boost to limit the task list to tasks that can really be completed within the allotted time span.

In order to perform many tasks efficiently, it is important to have easy access to information including names, addresses, and telephone numbers of friends, classmates, or business contacts. Reference materials needed for the job or for schoolwork should also be easily accessible.

There are many tools to facilitate effective use of time, including a personal organizer, or personal planning book, or scheduling and information management software on a smartphone or computer. Address books and reference materials can also be in book or index card format or electronic format.

The willingness to adapt to change is important for medical assistants, as well as all health care workers. The pace of change within ambulatory care is fairly rapid, so it is unwise to become attached to one way of doing things. Changes in equipment, procedure, staff, and setting can occur quite frequently, but patient care needs to remain excellent. When the medical assistant approaches changes with tolerance and even enthusiasm, the office runs more smoothly. The medical assistant needs to adapt to the office setting rather than expecting the office to adapt to his or her preferences.

Finally, it is important for the medical assistant to work well with others and be a team player. Behavior that enhances patient care includes helping others, maintaining a positive attitude and not complaining, avoiding gossip, working within the established chain of command, and handling stress without losing emotional control or creating emotional scenes. Keeping perspective, accepting corrections or criticism without becoming defensive, and learning from mistakes are important. These behaviors facilitate working with others over the long term with a minimum of discord.

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