1. Medicine and Medical Assisting
Chapter 1:
Medicine and Medical Assisting

2. Copyright © 2016 Wolters Kluwer • All Rights Reserved
Learning Outcomes
Cognitive Domain
Note: AAMA/CAAHEP 2015 Standards are italicized.
1. Spell and define the key terms
2. Summarize a brief history of modern medicine
3. Explain the system of health care in the United States
4. Discuss the typical medical office
5. List medical specialties a medical assistant
may encounter
6. List settings in which medical assistants may be employed
7. List the duties of a medical assistant
Copyright © 2016 Wolters Kluwer • All Rights Reserved

3. Learning Outcomes (cont'd.)
8. Describe the desired characteristics of a medical assistant
9. Differentiate between scope of practice and standards of care for medical assistants
10. Compare and contrast provider and medical assistant roles in terms of standard of care
11. Recognize the role of patient advocacy in the
practice of medical assisting
12. Define a patient-centered medical home
13. Define the principles of self-boundaries
14. Differentiate between adaptive and nonadaptive coping mechanisms
15. Identify members of the health care team
16. Explain the pathways of education for medical assistants

4. Learning Outcomes (cont'd.)
17. Discuss the importance of program accreditation
18. Name and describe the two nationally recognized accrediting agencies for medical assisting education programs
19. Explain the benefits and avenues of certification for the medical assistant
20. Discuss licensure and certification as it applies to health care providers
21. List the benefits of membership in a professional organization
22. Identify the effect personal ethics may have on professional performance

5. Learning Outcomes (cont'd.)
Psychomotor Domain
Note: AAMA/CAAHEP 2015 Standards are italicized.
1. Locate a state’s legal scope of practice for medical assistants
2. Perform within scope of practice
3. Practice within the standard of care for a medical assistant
4. Develop a plan for separation of personal and professional ethics
5. Respond to issues of confidentiality

6. Learning Outcomes (cont'd.)
Affective Domain
Note: AAMA/CAAHEP 2015 Standards are italicized.
1. Demonstrate awareness of the consequences of not working within the legal scope of practice
2. Apply ethical behaviors, including honesty and
integrity in performance of medical assisting practice
3. Recognize the impact personal ethics and morals may have on the delivery of health care
4. Demonstrate the principles of self-boundaries

7. Learning Outcomes (cont'd.)
ABHES Competencies
1. Comprehend the current employment outlook for the medical assistant
2. Compare and contrast the allied health professions and understand their relation to medical assisting
3. Understand medical assistant credentialing requirements and the process to obtain the credential. Comprehend the importance of credentialing
4. Have knowledge of the general responsibilities of the medical assistant
5. Define scope of practice for the medical assistant, and comprehend the conditions for practice within the state that the medical assistant is employed

8. Learning Outcomes (cont'd.)
6. Demonstrate professionalism by:
a. Exhibiting dependability, punctuality, and a positive work ethic
b. Exhibiting a positive attitude and a sense of responsibility
c. Maintaining confidentiality at all times
d. Being cognizant of ethical boundaries
e. Exhibiting initiative
f. Adapting to change
g. Expressing a responsible attitude
h. Being courteous and diplomatic
i. Conducting work within scope of education, training, and ability

9. Learning Outcomes (cont'd.)
7. Comply with federal, state, and local health laws and regulations
8. Analyze the effect of hereditary, cultural, and environmental influences

10. Introduction
The need for the multiskilled health professional will continue to grow within the foreseeable future, and you are now a part of this exciting career direction.
multiskilled health professional: an individual with versatile training in the health care field
You have selected a fascinating and challenging career, one of the fastest growing specialties in the medical field.
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11. History of Medicine
Greatest advances in 20th century in general health, comfort, and well-being of patients
In 21st century, continued advancement in cancer research, human genome project, and eradication of many diseases
Chances are good that the next great medical discovery will result from stem cell and cord blood research
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12. Modern Medical History
Begins with Renaissance — about 1400 AD
Runs through first half of 20th century
Notable contributors
Andreas Vesalius, 1500s: “Father of Modern Anatomy”
Anton von Leeuwenhoek, 1660s: invented microscope
Rene Laennec, 1816: invented stethoscope
John Hunter, 1700s: “Father of scientific surgery”
Edward Jenner, late 1700s: smallpox vaccine
Benjamin Rush, 1800s: founder of modern psychiatry
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13. Modern Medical History (cont’d.)
Strides in the Prevention of Disease Transmission
Louis Pasteur, mid 1880s: “Father of Bacteriology and Preventive Medicine”; pasteurization began
Ignaz Semmelweis, mid 1880s: encouraged handwashing to prevent childbed fever
Joseph Lister, mid 1880s: infection prevention
Sir Alexander Fleming, 1928: discovered penicillin
Possibilities in Surgery
Crawford Long, 1842: anesthesia invented
C. Walton Lillehei, 1952: first successful open-heart surgery
John Gibbon, 1953: invented first heart-lung machine
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14. Modern Medical History (cont’d.)
Women in Medicine
Florence Nightingale, 1800s: founds nursing
Elizabeth Blackwell, 1800s: first woman to graduate medical school in the United States
Clara Barton, 1869: establishes American Red Cross
Marie Curie, ~1903: discovers polonium and radium
Important Discoveries
Wilhelm Roentgen, 1895: discovers x-rays
Jonas Edward Salk and Albert Sabin, 1950s: discover vaccines for polio
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15. How was penicillin discovered?
Checkpoint Question
How was penicillin discovered?
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16. Checkpoint Answer
Sir Alexander Fleming saw areas clear of microorganism growth surrounding the mold gathering on the unwashed Petri dishes in his lab. He was able to extract the prototype for the first antibiotic.
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17. Recent Medical History
1980s — advances in radiology
Computed tomography (CT)
Magnetic resonance imaging (MRI)
Positron emission tomography (PET)
Cloning
Human genome
Throughout the next three decades, public health protection improved and advancements continued.
New discoveries will continue to expand the parameters of medicine as further research in recombinant DNA, transplantation, immunizations, diagnostic procedures, and so forth push back the boundaries of health care and make today’s therapies seem as primitive as those we have just covered. You will be present during this fascinating evolution of health care.
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18. Recent Medical History (cont’d.)
Regenerative medicine
Restores damaged tissues and organs
Goal is to one day maintain the body so that there will be no need to replace whole organs
Stem cell procedures have restored sight to the blind
Patients have received urinary bladders grown from their own cells
Scientists at Wake Forest Institute for Regenerative Medicine are using a specialized printer to print skin cells directly onto burns. Various types of skin cells are placed in vials, rather than cartridges, and then “printed” directly on the wound.
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19. Recent Medical History (cont’d.)
Dr. Anthony Atala of Wake Forest University Institute for Regenerative Medicine and other scientists can now make a human bladder from the patient’s own cells.
medical assistant: a multiskilled health professional who performs a variety of clinical and administrative tasks in a medical setting
Within the next decade, expect to see immunization against or cures for many of the illnesses that continue to plague us. And when we need a new kidney, we can make one in the laboratory!
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20. The American Health Care System
Complex and changing
Patient Protection and Affordable Care Act (PPACA)
Also called the Affordable Care Act (ACA)
Medical insurance versus managed care
Managed care is attempt to control costs
HMOs
Insurance companies and government now have much control over doctor-patient relationship
Population is aging, so insurance and care will change in future
Medicare and Medicaid cover older people
Government monitors Medicare and Medicaid systems through Centers for Medicare & Medicaid Services (CMS)
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21. The American Health Care System (cont’d.)
Health Insurance Portability and Accountability Act of 1996 (HIPAA) simplifies administrative processes:
Transmitting insurance claims
Receiving payments
Sharing private health information
New professions have developed, including medical assisting
Allied health care fields
Outpatient facilities need management to adhere to government rules and regulations
administrative: pertaining to administration (e.g., office procedures and nonclinical tasks that a medical assistant will perform)
outpatient: a medical setting in which patients receive care but are not admitted
The allied health care arena has grown quickly. New professions have been added to the health care team, and each one is an important part of a patient’s total care.
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22. The Medical Office Has changed over the years
Now often owned by corporations
Computerized patient records and billing
Insurance and legal aspects important
New technologies
Staff of medical office
Health care providers
One or more physicians
Physicians are assisted by physician assistants or nurse practitioners
Support staff
The patient’s health care encounter can be pleasant or unpleasant, depending on the skills and the attitude of the team.
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23. The Medical Office (cont’d.)
Administrative
Clinical
Depends on office specialty
Concierge medicine
Annual fee or retainer
Insurance may not cover
Physician provides enhanced care
concierge medicine: relationship between a patient and a primary care physician in which the patient pays an annual fee or retainer
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24. What governmental agency monitors medical care finances?
Checkpoint Question
What governmental agency monitors medical care finances?
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25. CMS monitors medical financing.
Checkpoint Answer
CMS monitors medical financing.
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26. Medical Specialties
Specialty is choice of physician after completing education
Family medicine or internal medicine practitioners provide primary care to many patients
Specialists provide care in specific areas
Surgery — further divided into subspecialties
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27. Medical Specialties (cont’d.)
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28. What is the specialty that treats newborn babies?
Checkpoint Question
What is the specialty that treats newborn babies?
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29. The specialty that treats newborn babies is neonatology.
Checkpoint Answer
The specialty that treats newborn babies is neonatology.
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30. The Medical Assisting Profession
What is a Medical Assistant?
Multiskilled allied helath professional
Work in ambulatory settings
Scope of practice depends on your physician-employer’s delegation of duties according to state law regarding patient care
clinical: pertaining to direct patient care (e.g., non-administrative tasks that a medical assistant will perform)
scope of practice: the procedures, actions, and processes that are permitted for a particular health care profession
The practice of medical assisting directly influences the public’s health and well-being, and requires mastery of a complex body of knowledge and specialized skills requiring both formal education and practical experience that serve as standards for entry into the profession.
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31. The Medical Assisting Profession (cont’d.)
Duties of a Medical Assistant?
Administrative tasks
Clinical tasks
Laboratory tasks
laboratory: a place where research, investigation, or scientific testing takes place
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32. The Medical Assisting Profession (cont’d.)
Administrative Duties
Managing and maintaining the waiting room, office, and examining rooms
Handling telephone calls
Using written and oral communication
Preparing and maintaining medical records
Bookkeeping
Scheduling appointments
Ensuring good public relations
Maintaining office supplies
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33. The Medical Assisting Profession (cont’d.)
Screening sales representatives
Filing insurance forms
Processing the payroll
Arranging patient hospitalizations
Sorting and filing mail
Instructing new patients regarding office hours and procedures
Applying computer concepts to office practices
Implementing diagnostic and procedural coding for insurance claims
Completing medical reports
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34. The Medical Assisting Profession (cont’d.)
Clinical Duties
Preparing patients for examinations and treatments
Assisting other health care providers with procedures
Preparing and sterilizing instruments
Completing electrocardiograms
Applying Holter monitors
Obtaining medical histories
Administering medications and immunizations
Obtaining vital signs (blood pressure, pulse, temperature, respirations)
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35. The Medical Assisting Profession (cont’d.)
Obtaining height and weight measurements
Documenting in the medical record
Performing eye and ear irrigations
Recognizing and treating medical emergencies
Initiating and implementing patient education
Laboratory Duties
Low-complexity laboratory tests as determined by the Clinical Laboratory Improvement Amendments (CLIA) of 1988
Collecting and processing laboratory specimens
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36. Checkpoint Question
What are five administrative duties and five clinical or laboratory duties performed by a medical assistant?
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37. Checkpoint Answer Administrative Managing and maintaining rooms
Handling telephone calls
Using written and oral communication
Maintaining medical records
Bookkeeping
Scheduling appointments
Ensuring good public relations
Maintaining office supplies
Screening sales representatives
Filing insurance forms
Processing payroll
Arranging hospitalizations
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38. Checkpoint Answer Sorting and filing mail
Instructing new patients regarding office hours and procedures
Applying computer concepts to office practices
Implementing diagnostic and procedural coding for insurance claims
Completing medical reports
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39. Checkpoint Answer Clinical duties Preparing patients for examinations
Assisting other health care providers with procedures
Preparing and sterilizing equipment
Completing ECGs
Applying Holter monitors
Obtaining medical histories
Administrating medications and immunizations
Obtaining vital signs, height and weight
Documenting in the medical record
Performing ear and eye irrigations
Recognizing and treating medical emergencies
Initiating and implementing patient education
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40. Checkpoint Answer Laboratory duties
Low-complexity laboratory CLIA tests
Collecting and processing laboratory specimens
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41. The Professional Medical Assistant
Strong work ethic
Membership in professional organization
Professional appearance
Neat, well groomed
Professional behavior
Dependability, punctuality
Flexibility
Medical assistants play a key role in creating and maintaining a professional image for their employers.
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42. The Professional Medical Assistant (cont’d.)
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43. The Professional Medical Assistant (cont’d.)
Characteristics vital to the profession:
Excellent written and oral communication skills
Maturity and calm demeanor
Accuracy
Honesty
Discretion
Empathy
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44. The Professional Medical Assistant (cont’d.)
Courtesy
Good interpersonal skills
Confidence
Team player
Initiative and responsibility
Tactful and diplomatic
High moral and ethical standards
Adaptive coping mechanism
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45. Checkpoint Question
What are eight characteristics that a professional medical assistant should have?
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46. Checkpoint Answer
Professional characteristics include punctuality, dependability, honesty, respect for patient confidentiality, courtesy, diplomacy, having high ethical and moral standards, excellent communication skills, maturity, accuracy, empathy, interpersonal skills, team player, initiative, responsibility, tact, and adaptive coping mechanisms.
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47. The Professional Medical Assistant (cont’d.)
Scope of Practice and Standards of Care
Scope of practice: the specific activities allowed by state licensing boards and laws or by the practice itself
A medical assistant’s scope of practice is based on his or her education
Medical professional who oversees you is held personally responsible for your actions
Standards of care: generally accepted guidelines and principles that health care practitioners follow in the practice of medicine
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48. The Professional Medical Assistant (cont’d.)
Figure 1-4 Scope of Practice Decision-Making Tree.
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49. The Professional Medical Assistant (cont’d.)
Figure 1-5 Sample flow sheet representing established protocol set by physician.
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50. The Professional Medical Assistant (cont’d.)
Self Boundaries
Self boundaries delineate personal from professional
Enable medical assistant to avoid inappropriate behavior with patients or even being perceived as displaying such inappropriate behavior
self boundaries: the limits set on the relationships between health care professionals and their patients
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51. The Professional Medical Assistant (cont’d.)
Boundary violations include:
Not respecting the patient’s religious, cultural, and social beliefs and values
Neglecting the patient
Abusing the patient financially, verbally, emotionally, or physically
Crossing the sexual line
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52. Why is it important to set self boundaries?
Checkpoint Question
Why is it important to set self boundaries?
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53. Checkpoint Answer
It is important to set self boundaries in order to help delineate the personal from the professional and enable you to avoid inappropriate behavior with patients.
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54. The Professional Medical Assistant (cont’d.)
Adaptive and Maladaptive Coping Mechanisms
Health care setting is stressful
Adaptive:
Identifying ways to modify the stressor
Reframing the situation
Creating boundaries
Maladaptive:
Complaining
Doing bare minimum
Turning to food, drugs, or alcohol
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55. Members of the Health Care Team
Team may be broken into three groups:
Health care providers
Nurses
Allied health care professionals
multidisciplinary: involving many disciplines; a group of health care professionals from various specialties brought together to meet the patient’s needs
A multidisciplinary team is a group of specialized professionals who are brought together to meet the needs of the patient.
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56. Members of the Health Care Team (cont’d.)
Health Care Providers
Physicians (MD or DO)
Team leaders
Physician assistants (PA)
May perform some procedures traditionally done by physician
Nurse Practitioners (NP)
Practice medicine independently
In some states can write prescriptions, operate own offices, admit patients to hospital
In other states, NP works closely with physician
Recertification: certification renewed either by taking the examination again or by completing a specified number of continuing education units in a 5-year period
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57. Members of the Health Care Team (cont’d.)
The Nursing Profession
Registered nurse (BS; AAS)
Licensed practical nurse (LPN)
Licensed vocational nurse (LVN)
Certified nursing assistant (CNA)
Inpatient: a medical setting in which patients are admitted for diagnostic, radiographic, or treatment purposes
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58. Members of the Health Care Team (cont’d.)
Allied Health Professionals
Educational requirements and responsibilities vary greatly among these professionals but all have a related professional organization
Examples: medical assistant, emergency medical technician, occupational therapist, physical therapist, dental assistant, health information technologist, laboratory technician, pharmacist, respiratory therapist
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59. The History of Medical Assisting
Need for formal training led to opening of school 1934
1955: American Association of Medical Assistants
1963: certification exam for CMA
1991: definition of medical assistant
Allied health professional
Member of health care delivery team
Performs administrative and clinical procedures
The need for a highly trained professional with a background in administrative and clinical skills led to the formation of an alternative field of allied health care.
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60. What prompted the establishment of a school for medical assistants?
Checkpoint Question
What prompted the establishment of a school for medical assistants?
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61. Checkpoint Answer
The first school for medical assistants was established because of the need for a highly trained professional with administrative and clinical skills.
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62. Medical Assisting Education
Programs in private business schools, technical colleges, community colleges, and 2-year colleges
Programs vary in length
Accredited program includes practicum (hands-on experience)
Education continues after graduation through ongoing education, conferences, etc.
Continuing education units are required to maintain membership in professional organization
Figure 1-6 Students practice competencies taught in their medical assisting classes. Their scope of practice is determined by their training.
Practicum: an educational course that allows the student to obtain hands-on experience; also referred to as externship
After you finish school, your education should not stop.
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63. Medical Assisting Education (cont’d.)
Medical Assisting Program Accreditation
Based on school’s adherence to essentials of sound education and service to students
Skills taught and documented in competency-based format
Entry-level competency is acquired
Specific skill to be mastered
Includes equipment and supplies
accreditation: a non-governmental professional peer review process that provides technical assistance and evaluates educational programs for quality based on pre-established academic and administrative standards
After you finish school, your education should not stop.
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64. Medical Assisting Education (cont’d.)
The Commission on Accreditation of Allied Health Education Programs (CAAHEP)
Accredits medical assisting programs in both public and private postsecondary institutions in U.S.
Mission: assure quality health profession education to serve the public interest
Accrediting Bureau of Health Education Schools (ABHES)
Accredits private postsecondary medical assistant programs
Mission: assure quality of the programs it accredits and assist in the improvement of the programs
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65. Checkpoint Question
What are the two accrediting agencies for medical assisting education programs?
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66. Checkpoint Answer The two accrediting agencies are:
Council on Accreditation of Allied Health Education Programs (CAAHEP)
Accrediting Bureau of Health Education Schools (ABHES).
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67. Medical Assisting Credentials
Certified Medical Assistant (CMA)
Sponsored by American Association of Medical Assistants (AAMA)
CMA certification exam
Can take upon graduation from a CAAHEP- or ABHES-accredited program
To maintain credential, 60 continuing educational units (CEU) must be obtained every 5 years in three categories
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68. Medical Assisting Credentials (cont’d.)
Registered Medical Assistant (RMA)
Sponsored by American Medical Technologist (AMT)
RMA exam can be taken by:
Graduates of CAAHEP- or ABHES-accredited program
Anyone who completes program in postsecondary school or college that is regionally or nationally accredited
Anyone who completes a formal training program as part of U.S. Armed Forces
Individual who has worked in field for 5 years
Anyone who has passed a certification exam offered by another certification agency
Ongoing education not required if certified prior to January 1, 2006, but otherwise need 30 point every 3 years through a Certification Continuation Program (CCP)
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69. Medical Assisting Credentials (cont’d.)
Certified Clinical Medical Assistant
Sponsored by National Healthcareer Association (HNA)
CCMA certification exam
Applicant must be at least 18 years of age, have high school diploma or equivalent, successfully completed allied health training program in past year or have 1 year experience as medical assistant
Must recertify every 2 years
10 CE hours required every 2 years
If certification expires,10 CE credits, payment of the 2-year recertification fee, and a reinstatement fee are required
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70. Medical Assisting Credentials (cont’d.)
National Certified Medical Assistant
Sponsored by National Center for Competency Testing (NCCT)
NCMA certification exam can be taken by graduates of NCCT-approved medical assisting program within last 10 years or 2 qualifying years (4,160 hours) of full-time employment (or equivalent part-time employment) within the last 10 years as a medical assistant
Also need high school diploma or equivalent
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71. Checkpoint Question
What is required to maintain current status as a certified medical assistant?
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72. Checkpoint Answer
To remain current, a CMA who takes the AAMA examination must obtain 60 CEUs every 5 years in three categories.
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73. Medical Assisting and Related Allied Health Associations
Association Membership
Professional membership not required, but offers:
Seminars
Continuing education units
Professional journals
Conventions
Group insurance
Networking opportunities
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74. Medical Assisting and Related Allied Health Associations (cont’d.)
American Association of Medical Assistants
Figure 1-7 Logo for the American Association of Medical
Assistants–sponsored Medical Assisting Recognition Week.
The purpose of the AAMA is to promote the professional identity and stature of its members and the medical assisting profession through education and credentialing.
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75. Medical Assisting and Related Allied Health Associations (cont’d.)
American Medical Technologists
Figure 1-8 Insignia of American Medical Technologists. .
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76. Medical Assisting and Related Allied Health Associations (cont’d.)
Professional Coder Associations
American Academy of Professional Coders (AAPC) provides education and professional certification to physician-based medical coders and elevates the standards of medical coding by providing student training, certification, ongoing education, and networking and job opportunities
American Health Information Management Association (AHIMA)
National professional organization dedicated to supporting the medical records or health information specialists
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77. List six benefits of membership in a professional organization.
Checkpoint Question
List six benefits of membership in a professional organization.
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78. Checkpoint Answer The benefits include: Access to educational seminars
Access to continuing education units
Subscription to the professional journals that alert you to new procedures and trends in medicine
Access to the annual conventions
Group insurance plans
Networking opportunities
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79. Employment Opportunities
Medical assistant employment ambulatory settings:
Physicians’ offices
Chiropractors’ offices
Podiatrists’ offices
Physical therapy facilities
Laboratories
Imaging centers
Research facilities
Walk-in clinics
Ambulatory surgical centers
Insurance companies
Because of the flexible, multiskilled nature of their education, medical assistants can work in a variety of health care settings.
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80. Why is it important that medical assistants are multiskilled?
Checkpoint Question
Why is it important that medical assistants are multiskilled?
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81. Checkpoint Answer
Medical assistants are the most cost-effective employees because they can perform so many different skills.
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