1. The Healthcare Industry
Chapter 2
Chapter 2
The Healthcare Industry
Chapter 2 provides an overview of the history of medicine, featuring many of the major men and women who contributed to the industry.
Additionally, the chapter covers the healthcare industry itself, describing the facilities and healthcare workers that medical assistants will come into contact with during their career in healthcare.

2. While Studying This Chapter, think about the following questions:
What recent events could be included as ground-breaking discoveries in medicine? Why is continuing medical research so important to the healthcare industry? How can the individual medical assistant contribute to the progress of medicine in today’s world? What is the value in gaining an overview of the entire healthcare industry as one begins a career in medical assisting?
Ask these questions to the class and discuss their answers together.

3. Introduction
Medicine and medical technology grow at amazingly rapid rates.
The medical assistant will be expected to always remain open to learning and growing within the field.
This chapter will examine:
the history of medicine
national organizations associated with the healthcare industry
various types of healthcare facilities
types of medical practices
different healthcare professionals we encounter in medicine
Discuss the importance of continuing education, and that a career in the medical field means one of lifelong learning.
Discuss the requirements for continuing education for the CMA credential and the suggestions for continuing education for the RMA credential.

4. Medical Language and Mythology
Much of our medical terminology comes from Greek and Roman mythology. Terms have also been borrowed from Arabic, Anglo-Saxon, German, and biblical sources. Atlas bore the heavens on his shoulders, and this name has been given to the first cervical vertebrae. Achilles’ heel is a term used to indicate a weakness of some sort, and this is rooted in Greek mythology. Aesculapius, the son of Apollo, was revered as the god of medicine. The early Greeks worshiped his healing powers and built temples in his honor.
Refer to the student’s study of medical terminology and why is it critical to the medical assistant.

5. Aesculapius
The staff of Aesculapius depicts a serpent encircling a staff and signifies the art of healing. This icon has been adopted by the American Medical Association as the symbol of medicine. The snake may have originally been a worm, but in the Middle Ages, it was considered a snake and that is the interpretation that has survived to the present day. The snake is supposedly shedding its skin, representing birth and renewal, while the staff is a symbol of authority befitting the God of Medicine, Aesculapius.
Discuss the possible origins of this symbol.

6. Caduceus
The caduceus, a mythological staff belonging to Hermes, depicts a staff encircled by two serpents, with wings at the top. The staff was considered to have magical powers. Today it is the icon for the U.S. Army Medical Corps. Several stories exist regarding this symbol. One suggests that Hermes saw two serpents involved in mortal combat. He separated them with his wand and brought peace between them, and the serpents entwined on the staff; the wings that represented Hermes became known as a symbol of peace.
Several stories exist regarding this symbol.

7. Medicine in Ancient Times
The use of drugs, surgery, and other treatments dates back as far as 5000 BC. Moses offered a group of rules related to health to the Hebrews around 1205 BC. He was an advocate of public health and is considered the first public health officer.
Discuss the role of a public health officer today.

8. Hippocrates - The Father of Medicine
Wrote the Hippocratic Oath, which is administered to medical school graduates even today.
View of medicine was based on scientific evidence.
Credited with taking some of the mysticism out of medicine.
Argued that illness was not a result of demon possession.
Believed the body had the capacity to heal itself.
Provide students with a copy of the Hippocratic Oath and read it aloud in class, discussing its pertinence with today’s medicine, and how the situations that are contained in the document relate to issues that medical personnel face today.

9. Galen - Prince of Physicians
Wrote more than 500 treatises on medically related subjects.
Much of his information was inaccurate because it was based on the dissection of apes and pigs instead of the human body.
Teachings were considered truthful and valid until human dissections began and physicians could see exactly what was inside the human body.
Believed that medicine was not to be practiced for profit. He was a champion of medical ethics.
Discuss whether the early dissections may have led to some evolution theory.
Discuss what medicine would be like today if it were not practiced for profit.
Believe it…or not?
Few people challenged Hippocrates and Galen in their teachings because the two were so well respected. Experimentation in medicine was not done during these times.

10. Early Development of Medical Education
The invention of the printing press played a major role in the exchange of medical information and ideas, because books and papers could be distributed faster and on a wider scale. The printing press was critical not only for medicine, but for all endeavours. Information is passed from place to place much faster now with the Internet, but books are still used much more frequently than computers for study and scholastic purposes. This could change as technology advances and more individuals grow up with computers, producing a more computer-literate society.

11. Medical Academies and Societies
In the seventeenth century, academies or societies were established in Europe that consisted of small groups of men who met to discuss areas of mutual interest. This contributed to the free exchange of medical and scientific ideas. Even early medical pioneers saw the value in coming together to discuss trends, discoveries, and exchange of information. One of the first of these organizations was the Royal Society of London, which was formed in The Medical Act of 1858 in Great Britain established a statutory body, the General Medical Council, which controlled admission to the medical register and had authority over medical education and examinations.
Stress the importance of joining medical assistant societies and being active in their efforts and events.

12. Medical Academies and Societies
Johns Hopkins University Medical School became the leader in medical education in the United States. The school partnered with Johns Hopkins Hospital, which exposed students to actual patients during their medical training. This made Johns Hopkins the best option for medical training, and the school remains a leader in medical education today. Johns Hopkins took part in a television series produced by ABC that was made from over 1500 hours of footage shot at the hospital. Actual doctors and patients participated in the unscripted series.

13. Quality in Medical Education
Abraham Flexner studied various medical schools and determined which ones offered the highest quality education. His “Flexner Report” was one of the earliest examples of the accreditation process. As a result of the publication of his report, many schools that were low ranking closed, many schools were improved, and others emerged as leaders in medical education of the day.
Early in the medical industry, the value of accreditation was evident. Medical assisting schools are accredited, usually by CAAHEP or ABHES. Medical schools are still subject to the accreditation process, as are hospitals and other medical facilities.

14. Early Medical Pioneers
Andreas Vesalius was the Father of Modern Anatomy. He published a book detailing the structure of the human body that conflicted with the earlier teachings of Galen. This led to his persecution by his colleagues.
Discuss the reasons that individuals with new ideas might be persecuted.
Discuss the difficulties faced by those practicing early medicine.
Illustration courtesy of National Library of Medicine, Bethesda, MD.

15. Early Medical Pioneers
Gabriele Fallopius described and named many parts of human anatomy, including the fallopian tubes in the female. Was a student of Vesalius and he also named the vagina and placenta. William Harvey discovered that the heart acts as a muscular pump, moving blood throughout the body. He also suggested that blood circulation is a continuous cycle. England considered Harvey its “medical Shakespeare.”

16. Early Medical Pioneers
Anton van Leeuwenhoek discovered the magnification process and was the first to observe bacteria and protozoa through a lens. He ground over 400 lenses throughout his lifetime, some no larger than a pinhead. Marcello Malpighi was a proponent of using the microscope and was instrumental in making microscope study a prerequisite in medicine. He also described the pulmonary and capillary system, one of the most important discoveries in scientific history. He is considered the first histologist.

17. Scientific Advances in the Eighteenth and Nineteenth Centuries
John Hunter is known as the Founder of Scientific Surgery. He presented surgical procedures based on sound pathologic evidence. He was the first to introduce artificial feeding into the stomach through a tube. He studied venereal diseases and pioneered tissue transfer. He was also an army surgeon and an expert in gunshot wounds and tissue transfer. He also classified teeth in a scientific manner. Edward Jenner is best known for giving the first vaccination. He studied smallpox and cowpox, and as a result of Jenner’s work, smallpox has been eradicated from the world. Think of all the diseases for which we now have vaccinations. Jenner is directly responsible for the discovery of the vaccination process. He was one of John Hunter’s students. Smallpox was a pandemic at the time.

18. Scientific Advances in the Eighteenth and Nineteenth Centuries
Leopold Auenbrugger developed the use of percussion in diagnosis. Rene Laennec developed the stethoscope, which began as a rolled paper, allowing him to hear sounds inside the body.
Discuss how the use of percussion and sound helps physicians in diagnosis.

19. Scientific Advances in the Eighteenth and Nineteenth Centuries
Ignaz Philipp Semmelweis has been called the Savior of Mothers because of his work fighting puerperal fever. Semmelweis felt an incredible guilt that so many deaths were caused by the physicians themselves. He realized that disinfecting and washing hands when moving from one patient to another would reduce the spread of germs. Unfortunately, he died from puerperal fever himself, having been infected by a cut on his finger during an autopsy. Louis Pasteur is one of the most famous contributors to medicine. He is best known for developing pasteurization, a method of destroying microorganisms. He continued his work in the world of bacteria, certain that bacteria were the key to infectious diseases. The last 7 years of his life were devoted to the Pasteur Institute, which still exists in France today.
Discuss the stresses, such as guilt or helplessness, that physicians may feel as they go about treating their patients.

20. Scientific Advances in the Eighteenth and Nineteenth Centuries
Joseph Lister is considered the Father of Sterile Surgery, because he realized that Pasteur’s beliefs about bacteria were correct and that microorganisms must be kept out of wounds and surgical sites. One of the highlights of Lister’s life was meeting Pasteur. Pasteur’s studies and discoveries allowed Lister to advance medicine in the area of sterile technique. Robert Koch developed Koch’s Postulates, which are rules that must be in place before an organism can be accepted as the causative agent in a disease. He developed tools that are used in laboratories, such as the culture plate, and he discovered that diseases could be transmitted by food and water.
Discuss Koch’s Postulates:
The microorganism must be found in abundance in all organisms suffering from the disease, but not in healthy organisms (the second part was later discarded).
The microorganism must be isolated from a diseased organism and grown in pure culture.
The cultured microorganism should cause disease when introduced into a healthy organism.
The microorganism must be reisolated from the inoculated, diseased experimental host and identified as being identical to the original specific causative agent.

21. Scientific Advances in the Eighteenth and Nineteenth Centuries
Paul Ehrlich is best remembered for his Formula 606, which was designed to fight syphilis. This drug was the first that was injected into the body to destroy a specific organism. Crawford Williamson Long was the first to use an anesthetic agent. He discovered that medical students who were under the influence of ether did not seem to feel pain, and he later successfully used ether as an anesthetic agent during surgery.

22. Scientific Advances in the Eighteenth and Nineteenth Centuries
Wilhelm Konrad Roentgen discovered x-rays in 1895 and was awarded the Nobel Prize in Physics in Marie and Pierre Curie discovered radium in 1898 and were awarded the Nobel Prize in Physics in 1902.
Discuss how these discoveries changed medicine.

23. Nineteenth-Century Women in Medicine
Florence Nightingale was the founder of nursing, known as the “Lady with the Lamp” because of her efforts in caring for wounded soldiers. She founded the Nightingale School and Home for Nurses, which was the beginning of nursing education. Clara Barton was the founder of the American Red Cross, an agency established originally to keep more accurate records of men missing, wounded, and killed in combat. She first established the Bureau of Records. Later the American Red Cross emerged as a vital organization, and it remains so today.
Discuss the reasons that the physicians may have treated nurses poorly during Florence Nightingale’s time.

24. Nineteenth-Century Women in Medicine
Elizabeth Blackwell was the first female medical doctor in the United States. She also established the New York Infirmary for Indigent Women and Children, which was the first hospital staffed entirely by women.
Discuss the innate traits that females usually have that make them successful in the medical industry.
Lillian Wald was instrumental in establishing the world’s first public school nursing system.

25. Nineteenth-Century Women in Medicine
Margaret Sanger was a proponent of birth control for women at a time when it was illegal to import or distribute any device designed to prevent pregnancy or induce abortion. She was imprisoned for her work in establishing the first American birth control clinic. The research she advocated into hormonal contraception eventually led to the development of the birth control pill. She was named honorary chairperson of the Planned Parenthood Federation of America when it was formed in 1941.
Discuss the reasons that birth control might have been illegal in these earlier times. Discuss the reasons that researchers might be willing to go to prison when their work is either illegal or morally unacceptable.

26. Twenty-First Century Medicine
Walter Reed proved yellow fever could be transmitted by a mosquito bite.
Sir Frederick Banting and Charles Best isolated insulin for use in treating diabetics.
Discuss how these discoveries have impacted medicine.
Sir Alexander Fleming discovered penicillin accidentally as he was researching.

27. Twenty-First Century Medicine
Helen Taussig, Alfred Blalock, and Vivien Thomas developed the lifesaving Blalock-Taussig procedure for blue babies.
Research and discuss other “accidental” medical discoveries. Research the story of Vivien Thomas and discuss the influence of racism and how it hindered medical progress.

28. Twenty-First Century Medicine
Jonas Salk and Albert Sabin developed an injectable vaccination against polio.
Discuss other important medical discoveries not mentioned in the chapter.
Werner Forssmann developed the cardiac catheterization technique

29. Twenty-First Century Medicine
Christian Barnard performed the first human heart transplant.
Elisabeth Kübler-Ross pioneered the understanding of the grief process. Elisabeth Kübler-Ross wrote more than 20 books on the subject of death, dying, and living well when faced with terminal illness.

30. Twenty-First Century Medicine
Dr. David Ho is one of the most brilliant minds working on the AIDS crisis today. He is the Scientific Director and Chief Executive Officer of the Aaron Diamond AIDS Research Center in New York. Dr. Ho still does his calculations in Chinese. He was Time Magazine’s “Man of the Year” in 1996.
Dr. Eve Slater is the former Assistant Secretary for Health in the Department of Health and Human Services. She currently serves on numerous boards for aggressive medical research organizations. Dr. Slater was the first female Vice President of Corporate Public Affairs for the Merck Research Laboratory and the first female chief of residents at the Massachusetts General Hospital.

31. Twenty-First Century Medicine
Dr. C. Everett Koop is a dedicated, colorful man who continues to contribute to medicine. He is a former Surgeon General of the United States. Dr. Koop is a strong antismoking proponent and supported the right to life. He also was one of the few early Governmental figures who supported AIDS information – so much so that he mailed information about the disease to every household in America. He also supported sex education in public schools, which eventually included information on condoms as a preventative for HIV transmission.
Dr. Marcia Angell is the former editor-in-chief of the New England Journal of Medicine, a leading publication widely read and regarded by physicians. Dr. Angell teaches in Harvard Medical School’s Division of Medical Ethics.

32. Twenty-First Century Medicine
Dr. Anthony Fauci was the fifth most cited scientist during the years 1981 to1994. He is the Director of the National Institute of Allergy and Infectious Diseases at NIH, where his career has spanned over 40 years. Dr. Fauci received the Presidential Medal of Freedom at the White House in June of He has written more than 1,100 scientific publications and several textbooks.
Dr. Antonia Novello is New York State’s Health Commissioner and was the first Hispanic and first woman to be appointed Surgeon General of the United States. Dr. Novello was once the honorary chairperson of the National Youth Summit for Mothers Against Drunk Driving. She devoted much of her career to issues surrounding underage drinking and smoking.

33. The National View of Health Care
The World Health Organization (WHO)
Specialized agency of the United Nations
Promotes cooperation among nations to control and eliminate diseases worldwide
Created and maintains the ICD coding system to classify diseases and conditions
Instrumental in discussions of ethical and moral implications of medical issues
Discuss the purposes of the WHO.

34. The National View of Health Care
Department of Health and Human Services (DHHS)
Principal U.S. agency for providing essential human services
Consists of more than 300 programs
Oversees Medicare and Medicaid programs
DHHS programs include:
Medical and social science research
Immunization services
Financial assistance for low-income families
Child support enforcement services
Improvement of infant and maternal health
Child and elder abuse prevention services
Assistance programs for elderly Americans

35. The National View of Health Care
United States Army Medical Research Institute of Infectious Diseases (USAMRIID)
Conducts research programs in national defense and infectious diseases that benefit everyone
Works extensively with WHO and CDC
Researches four biosafety levels of diseases with varying degrees of biohazard potential
Discuss the four biosafety levels of diseases.

36. The National View of Health Care
Centers for Disease Control and Prevention (CDC)
Principal U.S. agency concerned with health and safety of people throughout the world
Clearinghouse for health information and statistics
Researches the origin and occurrence of diseases
Develops methods for disease control and prevention
National Institutes of Health
Division of the Department of Health and Human Services
Thousands of research projects are underway at any given time
Furnishes biomedical information to healthcare professions
Research and discuss the types of cases that the CDC handles.

37. Types of Healthcare Facilities
Hospitals
Classified according to type of care and services they provide and their ownership.
Some hospitals are for profit, and some are nonprofit.
Nonprofit organizations may make money, but the money must be reinvested back into the facility.
Acute care hospitals are equipped to handle the most severe emergencies.
Sub acute care hospitals offer less extensive patient care.
Specialty, teaching, and community hospitals also exist in the healthcare arena.
Private hospitals are usually run by a corporation.
Numerous departments within the hospitals carry out a wide variety of functions.
Credentialing involves determining if an individual should have staff privileges.
Hospitals go through an accreditation process, often conducted by JCAHO.
Standards or indicators are used to determine compliance with regulations.
Discuss the hospitals in the local area, the type of each, and the services that they offer.

38. Types of Healthcare Facilities
Ambulatory Care
Physician’s offices may be single practice, partnerships, group practices, or multispecialty clinics.
Other ambulatory care centers include:
Occupational health centers
Sleep centers
Physical therapy centers
Urgent care centers
Freestanding surgical centers
Dialysis centers
Skilled nursing facilities
Assisted living facilities
Independent retirement communities
Discuss the type of healthcare facilities in which students would like to become employed.

39. Types of Healthcare Facilities
Other Healthcare Facilities
Physician office laboratories
Diagnostic laboratories
Home health agencies
Medical suppliers
Rehabilitation facilities
Discuss the other healthcare facilities available in the local area.

40. Medical Practices Sole Proprietorship Partnership Corporation
An individual holds exclusive right and title to all aspects of the medical practice.
Partnership
Two or more physicians associated in a medical practice.
Corporation
A legal and business status independent of its shareholders or employees.
Discuss the advantages and disadvantages of each type of medical practice.

41. Healthcare Professionals
The Title of Doctor
Doctors of Medicine
Doctors of Osteopathy
Hospitalists
Doctors of Chiropractic
Dentists
Optometrists
Podiatrists
Other Doctorates
Discuss the differences between each type of doctor.

42. Licensed or Certified Professionals
Licensed Medical Professionals
Respiratory therapists
Physician assistants
Occupational therapists
Nurse practitioners
Cardiovascular technologists
Nurse anesthetists
Diagnostic medical sonographers or technologists
Registered nurses
Licensed practical/vocational nurses
Radiology technicians
Medical technologists
Paramedics
Medical laboratory technicians
Emergency medical technicians
Physical therapists
Registered dieticians
Discuss the function and duties of each professional.

43. Closing Comments
This is an exciting time to enter the healthcare industry. Medical assisting is a versatile career field that offers incredible opportunities to new graduates and seasoned professionals.
Ask students to talk about their goals for their career in medicine.

44. Summary of Scenario
Points to Reinforce: Medical research in developing new techniques, procedures, and medicines is critical. Medical research allows us to discover new diseases or new information about current diseases.
Reinforce both points and discuss the summary of the scenario.