A Medical Secretary's Career PDF

A Medical Secretary's Career The secretary holds a key position, no matter what the field of her speciality- science, medicine, law, international trade. The need for secretaries has grown by leaps and bounds in the past few decades and shows no signs of abating. A good secretary, in thi...

A Medical Secretary's Career The secretary holds a key position, no matter what the field of her speciality- science, medicine, law, international trade. The need for secretaries has grown by leaps and bounds in the past few decades and shows no signs of abating. A good secretary, in this age, need never be without work. But to be a good secre- tary, she must first attain and perfect the skills of her trade; she must know how to be a good secretary. THE JOB The first step in this career may be the position of a stenographer, for shorthand and typing are the prime requirements. But many other skills are needed to climb to the top of the ladder. A good secretary must be proficient in her use of English: punctuation, grammar, style, pronunciation, and enunciation. She must be trained in office routines, such as handling the telephone, filing, and using duplicating and other business machines. She must know how to write routine business letters, where to look for sources of information, how to keep financial records, and how to order and keep a record of office supplies. She must have some knowledge of the particular field in which she works. Further- more, she needs intelligence, systematic working habits, and a willingness to take care of details. A. young woman with these qualifications can move easily from the job of stenographer to that of secretary. Eventually, she may become an executive secretary-with a secretary of her own! The secretary's choice of location is not limited except by her own pref- erence. East and West, North and South, secretaries are needed everywhere. The choice of a special field is not limited either, and among the choices a  good secretary has, one of the most popular and rewarding is the field of medicine. A Day in the Office Few people-even among those who have decided to become medical secretaries-realize how many and how varied are the opportunities in that field. A medical secretary arrives at work wearing neat, well-groomed street clothes. She greets sach person on the doctor's staff pleasantly and is early in order to be composed for her day. Werner Wolff 1 m. A doctor's life is a many-sided one, and in most of its phases he needs his secre- tary. She is the receptionist who greets his patients, checks their appointments, and takes their names and addresses. She is the careful accountant who keeps a record of his patients' visits and collects his fees. She is the public relations agent who knows all his patients by name-their little foibles and preferences- keeps his office running smoothly, and saves him time and work. When she reaches the office, the medical secretary may change into a white uniform. She will, of course, arrive a bit early so that the first patient will be greeted by a serene, composed, and properly dressed secretary. The morning mail must be sorted and distributed, and the records of the patients who have appointments on that day must be taken out of the filing cabinet and placed on the doctor's desk. The sterilizer may have to be started, and a quick tour of the office must be made to assure that everything is spick and span-fresh towels and sheets in readiness and no soiled instruments, basins, or receptacles about. In a doctor's office the telephone starts ringing quite early in the morning, for every day some appointments are made and others are broken, and these must be marked in the appointment book. Or a patient who has been awake all night with pain may wish to ask the doctor a question. Or there may be a call for an emergency visit to a patient's house,  As the patients arrive for their appointments, the secretary must give careful attention to each case. If a patient has not been to the office before, part of his medical history may have to be taken before he sees the doctor. Many doctors expect their secretaries to handle routine correspondence, but important letters and medical histories will be dictated. Another secretarial duty is the filing of the previous day's mail and records. The secretary must also keep the doctor's books and record all his income and expenses for tax and insurance purposes. Doctors are notably poor businessmen, and they are thankful to find secretaries who can relieve them of financial details. So far, the day of the medical secretary sounds more secretarial than medi- cal; many days are. However, there are always interruptions that break up the day and keep the secretary aware of the word "medical" in her title. Because of the scope and the variety of her duties, her work has crystallized into a distinct career. The routine of office work may be the same day in and day out, but there can be no routine in the handling of patients. They present a cross section of humanity-each one different from the other. All persons coming to a doctor's office are in some kind of trouble, and so the medical secretary is constantly required to be tactful, gentle, understanding, firm, and patient. Delegating Work Over the years numerous surveys have been made to ascertain how many doctors delegate work to their aides and what type of work they delegate. It was found that over 75 percent of all doctors (there are more than 250,000 practicing physicians in the United States) delegate some work. The majority 2 MEDICAL SECRETARIAL PROCEDURES delegate all secretarial work, and many doctors delegate certain clinical  task: as well. The following list is a composite of the various lists that have been com piled. It is divided into two categories: duties expected of the medical secretary and those performed by a medical assistant. (The latter duties may also be performed by a registered nurse or a technician.) However, the medical secretary is frequently asked to assist in, or even to carry on independently, the task listed as "Duties of Medical Assistant." In fact, if the secretary so desires, sh may develop into a medical assistant under the doctor's tutelage. Duties of Medical Secretary 1. Handling telephone 2. Making appointments 3 Receiving patients4. Quoting fees to patients 5. Recording patients' charges and payments 6. Sending out bills 7. Collecting bills -8. Taking dictation and transcribing correspondence and medical histories 9. Completing insurance forms 10. Making hospital reservations for patients 11. Procuring nurses 12. Filing histories and letters 13. Keeping doctor's financial records 14. Making deposits 15. Reconciling bank statements 16. Keeping payroll records 17. Handling petty cash 18. Supervising other personnel 19. Using business machines. 20. Helping patients understand doc tor's instructions regarding diet, pre natal care, exercises, and so forth 21. Keeping track of dates for re newal of licenses,  premiums du membership fees, subscriptions, mee ings, and so forth 22. Checking medical journals fr items of interest to doctor 23. Proofreading doctor's article lectures, manuscripts 24. Preparing records for doctor use in court 25. Ordering, handling, and storic supplies 26. Planning trips for doctor the 27. Taking care of the office in do tor's absence the m Duties of Medical Assistant 1. Taking part of the medical history 2. Taking the patient's temperature, height, weight, and pulse 3. Sterilizing instruments 4. Preparing trays for injections · 5. Assisting with examinations, treat- ments, and office surgery 6. Preparing patients for physical therapy and supervising treatment 7. Taking routine laboratory tests. A MEDICAL SECRETARY'S CAREER 8. Caring for surgical instrumen and equipment 9. Replenishing doctor's bag 10. Dispensing medicines to patien on doctor's orders 11. Taking basal metabolism tests  12. Taking electrocardiograms 13. Taking X rays 14. Changing dressings and applyin bandages པ ་ འ ་  ( THE OPPORTUNITIES Many of the tasks that medical secretaries are expected to perform are the same as those required in business offices. A thorough training in office rou- tine, together with the art of getting along with people, will equip a young woman to be an excellent secretary in almost any field. Few medical secretaries leave medicine voluntarily, for its fascination is great; but sometimes circun- stances make a change necessary. The medical secretary has the assurance that her training will stand her in good stead, no matter what she decides to do. Kinds of Positions Available There is, however, such a wide variety of positions available for a secretary specifically trained in medical stenography and medical terminology that she has a wide choice without looking beyond the field of medicine and its auxiliaries. Here are some of the positions from which she may choose: 1. The Doctor's Office. Here she is the doctor's "right hand." She may be working for a doctor who is in "solo practice" and handle all his medical- secretarial work. Or her employer may have an associate, or share his office with another doctor, who may have his own consultation room but uses the same waiting and examination rooms. She may thus do the work for both doc- tors; or if there are many patients, the work may be shared between two secre- taries. There may be an office nurse or a medical assistant who looks after the patients, and in this eventuality their work may at times overlap. 2. Group Practice. A rapidly developing form of practicing medicine is for specialists in different fields to take a suite of offices or a building together, so that a patient can have the services of both a general practitioner and a specialist without delay and under the supervision of the referring doctor. Such a group needs an executive secretary to keep centralized records, route patients to the different doctors, and be responsible for billing and all other financial matters for the group. This is one of the splendid opportunities open to an efficient and well-trained medical secretary. In addition to the executive secre- tary, each member of the group has his own private secretary, or perhaps there are several who do the work of all the doctors. 3. The Dentist's Office. The duties of a dental secretary are similar to those of a medical secretary and many young women trained in the latter ca- pacity accept positions in dentists' offices. The chief difference in the prerequi- sites is that their training must include a knowledge of dental terminology. 4. Hospitals. One of the widest fields for medical secretaries is the hospital. Even a small hospital needs several secretaries for the chief of the hospital and the heads of the different departments, for the administration and business offices, and for the clinics and the record library. In large hospitals a whole army of them is needed. Probably more medical secretaries are employed in hospitals than in doctors' offices. MEDICAL SECRETARIAL PROCEDURES 5. Clinics. Many clinics are not connected with hospitals but function independently. They may be privately owned by welfare agencies or operated by state or municipal governments. Medical secretaries are needed in these clinics for performing duties similar to those in a private physician's office. 6. Public Health Departments. Each state and almost every municipality has its own health department. Sanitation, supervision of public eating places and of the water supply, quarantining of contagious diseases, and vaccination are just a few of the activities of these departments. The medical division of most state departments issues licenses to physi- cians, nurses, physical therapists, and other medical-technical personnel. Trained persons are needed to take care of the secretarial work. Some of these positions carry civil service status. 7. Foundations. The United States boasts the largest number of founda- tions devoted to medical research of any country in the world. Some of them are concerned with a particular disease (the National Heart Foundation); some undertake different pieces of research as the occasion warrants it. Many secre- taries with medical training are employed in this fascinating field. 8. Institutions. Convalescent homes; nursing homes; sanatoriums; homes for the aged, crippled, destitute; and incurables; children's homes, and many other welfare organizations and institutions all need secretaries. They prefer those who have had training in medical secretaryship. 9. The Armed Services. The Army, the Navy, and the Air Force have medical departments wherever there are military installations. In addition to routine medical services rendered to members of the Armed Forces, there are new specialties where work is often in the experimental stage. Among these are Aviation Medicine, Space Medicine, and Nuclear Medicine. Such positions may be obtained while retaining civilian status, but they also offer an opportunity of joining a branch of the service. 10. Prepaid Medical Care and Hospitalization Plans. There exists a great number of organizations whose members pay a monthly or annual fee in return for which their hospital and doctors' bills are paid partly or in full. The best known of these nonprofit plans are Blue Cross and Blue Shield, Health Insurance Plan of New York (HIP), and Group Health Insurance of Washington, D.C.; but there are many additional private programs operated by clubs, unions, and employees' associations. The operation of any of these plans requires a vast amount of secretarial work: filling out and checking reports received from doctors, mailing out payments of claims, renewing contracts, and keeping records. Nearly every city or town will have openings in a prepaid medical care plan. 11. Insurance Companies. There are at present some 800 different forms of commercial health insurance policies being written throughout  the country. The difference between these policies and the nonprofit plans is that in the former instance the amount to be collected depends on the type of policy selected and the size of the premium paid. A MEDICAL SECRETARY'S CAREER 5 C All insurance companies, whatever type of insurance they write, have a medical department. Usually it serves a twofold purpose; first, to attend to the company's personnel; second, to examine claims for accident and disability indemnity. Insurance companies are particularly anxious to employ secretaries who are familiar with medical terminology. 12. Medicare. The recently passed Medicare Bill will provide many new jobs for medical secretaries at every level-Federal, state, and city agencies, as well as special departments or secretarial responsibilities in hospitals, clinics, nursing homes, and private practice. 13. The Business World There are splendid openings for medical secre- taries in the offices of manufacturers and distributors of drugs, pharmaceutical products, surgical instruments, and hospital supplies. Most of these firms not only maintain production and sales departments but engage in medical research as well. They will give preference to a secretary who is trained in medical terminology and can take medical dictation. 14. Publishers. To many young women the publishing field is of particular interest. There are publishers devoted to medical books exclusively, and others that have a medical department as a part of their operation. Some publish medical journals. A few combine the publication of medical books with the printing of medical records of all types. The need for medical secretaries here is obvious. In this area there are opportunities for assisting in the varied aspects of producing a medical publication. 15. Free-Lance Work. For those medical secretaries with a flair for writing and an interest in editorial work, there are excellent opportunities as medical- editorial assistants. Many doctor-writers employ full-time secretaries; others engage someone to help with a specific book or article. Advanced training is required. It is necessary to know how to use a library and how to prepare a manuscript, compile a bibliography, make an index, and proofread. As a free- lance worker the secretary is not tied down to fixed hours. She can work at home and take time off between assignments, a freedom not often found in secretarial positions. 16. Teaching. Who would be a better teacher of medical secretaries than one who has been a medical secretary herself? Many years of experience are necessary for this career. In addition, the right educational background and an ability to teach are prerequisites. The demand for such teachers will be high. 17. Laboratories. Working for a doctor who heads a medical laboratory is also a challenging career. Some directors of such laboratories conduct re- search in addition to their regular diagnostic work. The Medical Assistant Not included in the above list of 17 different ways to serve as a medical secretary is the career of medical assistant, which requires additional specialized training. Many a secretary working with a doctor becomes interested in the 8 MEDICAL SECRETARIAL PROCEDURES clinical side of the office practice. If she is lucky, her employer will be willing to train her. But she may take courses in these procedures. Requirements for qualifications vary. A high school diploma is an almost universal requirement, and frequently some college training is required. Courses for medical assistants are given by many colleges. In larger cities there may be vocational schools that give a one-year course, perhaps in the evening. In some instances the local county medical society offers training to employed medical secretaries. Information can be obtained from the state educa- tion department or the local chapter of the state medical society. Training as an X-ray or a laboratory technician also is available and would lead to a wider field of employment. PERSONAL QUALIFICATIONS Personality has been defined by Newton and Green as the "outward evi- dence of one's character." In the following pages certain attributes of personal- ity and character necessary to a medical secretary are described. Kindness and Sympathy It has been said that only a good man can be a good doctor. Certainly, then, for a good medical secretary, the qualities of kindness and sympathy are prerequisite. Every medical secretary has probably been a patient herself at one time or another. She can have no better guide to her conduct in dealing with patients than to remember her own experience and to ask herself how she would like to be treated when she visits a doctor's office.. Accuracy and Dependability Some time ago a circular letter was addressed to executives in various industrial concerns asking them to list what they considered the prerequisites for a good secretary. The two requirements that led the list were accuracy and dependability. If these qualities seem important in the business world, where negligence may mean at most the loss of money, it is easy to see how much more important they are in a medical office, where carelessness, negligence, or forgetfulness may cause bodily harm to a patient or even endanger his life. Therefore, these two words, accuracy and dependability, may well be adopted by the medical secretary as her motto. The medical assistant may be required to give injections, administer treat- ments, or dispense medicines. The doctor issues exact instructions, but he can- not always be present to supervise them. The press reports almost daily cases where patients have been badly injured or have died as the result of an assistant's error or negligence. In one such case, a patient died under anesthesia because he was given carbon monoxide instead of  ether; an employee had shifted the two tanks. In another case, a nurse gave the wrong drops to a baby, and the A MEDICAL SECRETARY'S CAREER 9 baby died, She had not read the label before dispensing the drops but had just taken the bottle that was standing in the accustomed place for the right one. Unfailing vigilance and constant attention to details are imperative. If a patient is injured during a treatment as the result of an assistant's carelessness or igno- rance, the physician is legally responsible. A doctor would be better off with no assistant at all than with one on whom he could not rely absolutely. Punctuality One aspect of dependability-and of accuracy as well-is, of course, punctuality. If the office opens at 9 a.m., the secretary should be there and ready to start work at 9 a.m. Traffic delays, missed trains, last-minute interrup- tions at home are no excuse for being late. A person who expects to take a train that leaves at 11:20 will not arrive at the station at 11:20, probably not even as late as 11:15, and certainly not at 11:25. He will plan to be there in ample time to board the train and will make allowance for delays in traffic. Surely, a job is as important as a train trip. A patient who has an appointment at the hour the office opens may be in a hurry to reach his own place of business, or he may have had an uncom- fortable night and therefore be anxious to see the doctor right away. Such patients are quite likely to arrive even before the appointed time, and the secre- tary should be there to receive them. In a busy doctor's office, the telephone often begins ringing at 9 a.m. sharp, as patients may have been waiting for hours to call the doctor for some advice or to make appointments for that day. A "no answer" signal does not help to create a good reputation for the doctor, and a patient who is not willing to wait may call another office. There are many matters to be attended to before the doctor begins seeing his patients: the mail must be sorted so that the doctor can at least glance over it, the patients' records must be given to him, instruments sterilized, solutions prepared for tests or injections, and so on. If these things are done hurriedly, mistakes are likely to occur, the secretary becomes flustered, the patient grows irritated; the day starts all wrong. It is much easier to be on time and to attend to everything without haste. Thoroughness The virtue of thoroughness cannot be too highly extolled. Because many people are not thorough, it is necessary to check almost everything that is of any importance. To give an illustration of this, when a secretary called up a large hospital to inquire at what hours one of the pay clinics was open, the answer was, "The clinic is open all day." As this did not inform her at just what hour the clinic opened and closed, she inquired further and was then told that the clinic hours were from 8:30 to 11:00 a.m. and from 1:00 to 3:30 p.m., which certainly is not "all day." Had she accepted the first information and passed it on to the patient whom she was referring, the latter might have arrived at the 10 MEDICAL SECRETARIAL PROCEDURES clinic at 11:15 a.m. and then would have had to wait for nearly two hours before it opened again. It is far more practical to ask a question two or three times, or to check something at once, than to find out later that wrong informa- tion has been passed on. It will take several times as long to rectify the mistake and, in addition, a number of people may have been inconvenienced. Attending to a great many details is irksome and may seem to be a waste of time. But it is surprising how often one will find out many weeks or months later what a saving of time was accomplished by making an extra notation or preserving some printed statement. A doctor is too busy to remember routine matters or office details. He may blame the secretary for his own oversight. If she can prove to him tactfully that she was right, he will be glad to have an- other proof of her reliability. If she is blessed with a good memory, she will be just so much more valuable. Memory can be trained and, when well devel- oped, greatly facilitates the work. Yet, no matter what may be the ability to remember, it is dangerous ever to rely on memory alone when important mat- ters are involved. Making a memorandum of everything is a good habit to cultivate, as is checking all facts and, information before passing them on to others or acting on them. Tact Much of the medical secretary's work will require infinite tact. Tact is the ability, either instinctive or acquired, to speak and to act perceptively and effectively in difficult situations or with difficult people, in a manner that will not give offense but will create goodwill while still achieving the purpose at hand. Although tact cannot be taught, it certainly can be developed, especially if the individual is sensitive to the reactions of others and keeps in mind that one of the principal ways of being tactful is to avoid offending others and to put people at their ease. Other Qualifications The above are the qualifications required by employers. But what about patients? What do they consider the most desirable qualities in a medical office assistant? The periodical Medical Economics was interested enough in this subject to take an opinion poll to try to find the answer. The result was that 61 percent of the persons asked named a friendly, pleasant personality as the most desirable quality in a doctor's secretary. Patience, understanding, helpfulness, and effi- ciency came next. Qualities they disliked in a doctor's assistant were inefficiency, appearing bored, and being "too nosey."  A cheerful personality will prove to be one of the greatest assets. Not even a well person wants to see a gloomy face, and it is certainly not any more acceptable to those who are ill. They want to know that at the doctor's office they will be greeted with a smile. So, no matter what worries, cares, or irrita- tions there may be in her personal life, the medical secretary must know how to A MEDICAL SECRETARY'S CAREER 11 suppress them and to show a serene and pleasant face. A grouchy, gruff secre- tary will quickly drive patients away, whereas a pleasant, tactful secretary can greatly help to smooth out many of the difficulties that come up in every human relationship, in a doctor's office as well as elsewhere. PROFESSIONAL CONDUCT Commercial firms usually have fixed rules by which their employees must abide and which are strictly enforced. No such rules are made by physicians for their secretaries. A doctor usually trusts his secretary to know what is right and to act accordingly. She must not abuse this confidence. The atmosphere in a professional office is at once more informal than that in a business office and more official. For her conduct, the secretary must be guided by her own feeling of what is appropriate and what is not, She must know when to be sociable, when professional, and when businesslike. Good breeding and good manners- which mean, after all, doing the right thing at the right time and not the wrong thing at any time-will be invaluable qualities for the medical secretary. to possess. Smoking should not be indulged in during office hours unless during a lull, and then only in the rest room. Nothing produces a more unprofessional impression on someone walking into a doctor's office than to find the receptionist smoking-except perhaps to see her manicuring her nails! Chewing gum, that most unbecoming of habits, had best be abandoned altogether.  Personal telephone calls, both incoming and outgoing, should be kept to a minimum in number and length. If the secretary will explain to her friends that she cannot "visit" over the telephone during office hours, they will respect her attitude and will confine themselves to essentials when telephoning. The doctor's telephone serves the doctor's practice and may be needed at any minute for an emergency. One can easily imagine a patient's reaction who, when frantically trying to get in touch with a doctor, is given the busy signal for 15 minutes. Or the doctor himself may be trying to reach his office. He will hardly be pleased when, after trying for a long while, he finally gets in touch with his secretary and, finding that there is no message, realizes that she must have been using the telephone all that time for a personal call. Serenity A person who undertakes to work in a doctor's office must realize from the beginning that her hours may be as irregular as those of the doctor himself. Patients cannot always choose the time when they can see a doctor. They may have to come after office hours, there may be an emergency case, the doctor himself may come in late, having been detained at the hospital or at the home It is particularly important for a medical secretary to show warmth, interest, consideration, and understanding in her work with patients. These qualities can be developed by effort and practice. Warner Wolf 13 of a patient. Even where office hours are regular, something is quite likely to occur to cause delay, and this inevitably happens when the secretary has an important engagement. However, she must not show her disappointment but must be patient, gracious, and pleasant. Patients are very sensitive to the secre- tary's mood. If they feel that she resents their coming late, or that she is in a hurry to get away, they will blame the doctor and perhaps will go to another one rather than come again at a late hour. While taking dictation, especially over long periods of time and when the rate of dictation is slow, the secretary should relax and sit quietly and com- fortably. Fidgeting is very disturbing to a person who is trying to formulate his thoughts carefully to express a difficult subject matter. Common Sense A secretary who has been with a doctor for some time and who is alert and interested in her work no doubt will soon learn to recognize many symp- toms of the conditions the doctor sees most frequently and will know the remedies he prescribes. In the doctor's absence or when the doctor is busy, her inclination will be, should the opportunity present itself, to tell the patient what to do. Under no circumstances must she yield to this impulse. Nobody but a physician can know just what a symptom means and what treatment is indicated in the individual case. She would be guilty of practicing medicine without a license. This does not mean, however, that she should not attend to an emer- gency case when alone in the office. She should have some knowledge of first aid and enough presence of mind to apply it until the doctor arrives if a patient comes in bleeding profusely from a cut, faints, or has just had an accident. A course in first aid, such as that given by the American Red Cross, is invaluable for any doctor's assistant. In any case, she should have available a standard book on the subject, so that in an emergency she may refer to some of the most important points. Familiarity A word Inay be in order here for the secretary who works for her husband, a relative, or an old friend of the family. Regardless of the degree of familiarity, the doctor should always be addressed by his last name and title, and it is advis- able that the doctor call his secretary by her last name. Nothing in their conver- sation before patients should indicate that any other but a professional relation- ship exists. Theoretically, it should not make any difference to patients whether the doctor and his assistant are married or related, but somehow it does; it gives rise to gossip, jealousies, imagined slights, and an air of familiarity which do not belong in a doctor's office. Patients believe that they may be discussed, and the doctor's success is threatened. The doctor should always be referred to by his name and title, as "Dr. Taylor will see you now" or "Dr. Taylor is away at present." Referring to him 14 MEDICAL SECRETARIAL PROCEDURES as "Doctor" only-for example, "Doctor will see you now"-has become popu- lar, but this has a ring of familiarity which is out of place in the professional office. If the secretary will remember that she is playing hostess for the doctor, she will instinctively find the right tone, preserving the professional atmosphere of the office and, at the same time, making the patients feel at home. Accepting Criticism The medical secretary, like any other worker, must be able to take criti- cism. No matter how capable and efficient she is, the doctor for whom she works may prefer things done in a way different from that to which she has been accustomed or in which she has been trained. The doctor alone decides what is to be done and how it is to be done. By being shown and corrected, the assistant can learn her employer's ways. Tears or sulks are out of place in any office, but especially so in a doctor's office full of patients. No one is perfect; to possess the humility to recognize one's limitations and accept the fact is a sign of maturity. Professional Secrecy The doctor's assistant must realize that her position is of a highly con- fidential nature. Professional secrecy is one of the requirements that the law demands and upholds. A doctor who divulges information about a patient with- out due authorization from the patient, except to another doctor, can be prose- cuted under the law, and his license may be revoked. This naturally applies also to any person employed in the doctor's office. The secretary who works for a doctor assumes the obligation of the code of medical ethics for herself. She will learn a great many things about personal affairs of patients and doc- tors alike, but nothing that she hears or sees must ever be repeated. The medi- cal histories of patients yield much confidential information, not only regarding the patients themselves, but also about other members of their families and perhaps their friends as well. No details of the patient's illness, his personal history, or matters relating to his family must be disclosed to anyone under any circumstances. A patient often questions the secretary about his own case, hoping to learn more than the doctor has told him. It is not the secretary's place to tell the patient what the doctor's opinion is, either in regard to his diagnosis or the outlook of the case, even if she knows it. The doctor has his reasons for not telling more than he has done. He alone is the judge of what the patient should know about his condition. If the patient feels that he ought to be more fully informed, he must take this up with the doctor himself, not with the secretary. A patient may be suffering from an incurable disease, his days may be numbered, and the doctor's treatment may be just a means to alleviate his pain or discomfort. There is no reason to hasten his death or cause him additional A MEDICAL SECRETARY'S C CR 15  anxiety by informing him of the facts. Or, in some cases, the doctor may fear that, if the patient is told the diagnosis of his condition, he may look up infor- mation about his illness in a dictionary or in some book on home remedies and may interfere with the treatment. Patients are often curious regarding other patients, especially if these seem to be suffering from similar afflictions; they want to know how long another patient has been coming to the office, what the doctor prescribed for him, how much he has improved, and so forth. Friends or relatives of a patient may also- for the patient's own good, as they will say-inquire about the doctor's opinion, sometimes not quite daring to ask the doctor himself or sometimes wishing to check what they have heard. Patients and their friends alike may try to obtain information about the doctor personally or about routine matters in his office. In such cases the secretary must refuse information without giving offense. A tactful, courteous but firm refusal will prevent further questioning. Papers should be carefully guarded from prying eyes. No patients' histories, laboratory reports, letters, or other data should be left lying on the desk while the secretary is out of the room. A person may innocently enough walk up to the desk to borrow a pencil, for instance, and casually glance at some paper that may contain information of a most private and personal kind. Telephone calls to patients that may reveal confidential information should not be made when other patients are in the same room. When a call comes in, the name of the caller should not be mentioned if this can be avoided. Of course, the problem depends somewhat on the specialty of the physician. Patients who consult a doctor for a nervous disorder, venereal disease, or cancer are more sensitive about having their visits known than are other patients. More discretion must, therefore, be exercised in such offices than would be necessary in the office of an eye specialist, for instance. Special care must be taken never to mention a patient's name outside the office. There may be a good reason why he wishes to keep from his family or his business associates the fact that he is under medical care. The doctor's' specialty may be an indication of the disease for which  the patient visits him, and the patient may not wish this to be known. It is a good rule, therefore, for the medical secretary to forget all patients' names when she leaves the office in the evening. Nothing that happens in the office should be repeated at home or to the secretary's friends, even without mentioning names. The arm of coincidence is long indeed, and more than once an indiscretion of this kind has had serious consequences because the persons concerned were identified from peculiar circumstances connected with the case. This does not mean, of course, that the secretary should not speak of her employer at all. If she is loyal to him and enthusiastic about his work, she will know how to sing his praise without exag- geration, how to tell of his successes and of the good work he is doing without taking the risk of giving away confidential information. MEDICAL SECRETARIAL PROCEDURES ་བས་--་ APPEARANCE In many offices the medical secretary wears a white uniform even if she is not a nurse. The advantage of wearing a washable uniform while in contact with patients, handling medicines, and so forth, is obvious. But a uniform also has a definite psychological effect. Many patients instinctively have more confidence in an assistant's ability to give a treatment or a test if she wears a uniform. They seem less embarrassed to disrobe or to give personal information, and in general cooperate much more willingly when confronted with a uniformed attendant. Needless to say, the uniform must be crisp and snow-white and should not be wom over a dark dress or slip. · However, wearing a uniform is not required everywhere. In fact, some doctors-especially those who deal with patients suffering from nervous dis- orders-like to have as little of the medical atmosphere in their offices as possible. In such circumstances, the secretary might avoid dresses that are too severe, of unrelieved black or dark colors, which have a depressing effect. In any event, her dress should be simple and appropriate. Vivid colors, elaborate ornamentation, trailing lace flounces, exotic jewelry do not belong in a doctor's office. Neither does heavy or strong perfume. Good grooming is even more necessary in a doctor's office than elsewhere. A well-groomed woman is a pleasure to behold, no matter what her age or her portion of good looks. Grooming implies much more than just cleanliness. The daily bath, the weekly shampoo, well-kept hands, personal daintiness are in- dispensable to it, but so is a neat, tidy appearance. There should be no ripped seams, open hems, loose buttons, wrinkled dresses, spilled powder. Hair that flows about the wearer's head like a mane, or straggles in unmanageable straight ends, or drops hairpins everywhere is neither pretty nor sanitary, and certainly is not appropriate for a medical secretary. Discreet makeup is important. The purpose of cosmetics is to help a woman look better and healthier, not to make her conspicuous. spicuous person in a doctor's office should be the The only con- doctor himself. As for gaudy, vividly painted nails-let the reader remember her own visits to a doctor and what her reaction would have been had she been touched by a nurse whose fingernails seemed to have been dipped in blood. Jewelry, such as necklaces, earrings, and bracelets, does not harmonize with a uniform. Nor do flowers or ornaments in the hair. If the secretary expects to go out after office hours, she should keep jewelry and hair ornaments in her locker or in her desk until it is time to leave the office. Being well-dressed means, above all, being appropriately dressed. Being well dressed gives one a sense of well-being and helps one to develop self-con- fidence and poise. The secretary to a doctor must wear clothes that reflect the dignity of the doctor's profession, for she is a representative of that profession. For the office, tailored suits in a basic color (black, brown, navy blue, beige, A MEDICAL SECRETARY'S CAREER 17 gray) are very satisfactory. The appearance of a suit can be varied with a crisp, light blouses If the secretary prefers dresses, they should be simple and in plain color. Print dresses are not recommended unless they are quite subdued. Good grooming includes freshly polished shoes, or if they are worn with a uniform, white shoes that are kept really white. Shoes should be plain, with medium heels and, above all, comfortable. Extremely high heels look out of place in an office. In fact, all extremes are to be avoided, whether in hairdo, dress, or accessories. For the street, gloves are an absolute must for the well- groomed, well-dressed medical secretary. Also essential is a bag that harmonizes with the general color scheme and is neither gaudy, excessively large, nor shabby. The secretary's personality is of basic importance to the overall efficiency of any office. Both employers and educators, recognizing this fact, have found that the student or the beginning secretary can, by conscientious effort, develop a manner pleasing to her employer's clients and appropriate to his professional requirements. PROFESSIONAL STATUS The successful medical secretary enjoys an enviable professional status. Nor is formal recognition lacking. She is eligible to join several associations and apply for certification in her particular field. Secretarial Associations.  Any secretary with two years' practical experience may join The National Secretaries Association (International)-NSA. This organization has over 500 chapters throughout the United States and overseas and comprises about 25,000 members. Its aim is to "elevate the standards of the secretarial profession" and to provide members with the benefits that come from contact and companion- ship among workers with mutual interests. Members receive copies of the offi- cial publication, The Secretary; have the opportunity of attending meetings of local chapters and the annual convention; may participate in residential semi- nars; and can share in a group insurance plan for retirement and income protection. Examinations are held periodically for applicants who want to become Certified Professional Secretaries. The Association actively promotes the desig- nation CPS for those who have passed this examination, thereby setting a defi- nite educational goal for secretaries. These examinations are open to nonmem- bers also. Students taking secretarial courses may join the affiliated Future Secre- taries Association (FSA). Members are able to participate in the various programs developed by the NSA and have an opportunity of associating with experienced secretaries. 18 MEDICAL SECRETARIAL PROCEDURES Information regarding the different projects may be obtained from The National Secretaries Association (International), 1103 Grand Avenue, Kansas City, Missouri 64106. Medical Affiliation The American Association of Medical Assistants (AAMA) is open only to those who have worked under the direct supervision of a physician. The AAMA  MA is patterned along the lines of medical societies. That is, local county societies are members of the state society. The state society in turn is a member of the national association. Each county society has full autonomy and the bylaws vary from state to state. Most chapters hold monthly meetings, offer seminars, pub- lish a bulletin, and arrange social gatherings. Residents of a state where there is no state society may join the national association directly. The AAMA holds an annual convention attended by members from all over the country. The program consists of scientific lectures, practical seminars, commercial exhibits, and various social affairs. The Association also offers its members a group health insurance plan. Through the AAMA it is possible to become a Certified Medical Assistant, Clinical, or a Certified Medical Assistant, Administrative. Examinations are given each year during the annual convention. The standing of a Certified Medical Assistant is a high one. Subjects covered in the examination comprise medical terminology, anatomy and physiology, office skills, medical and nonmedical records, medical ethics and medical etiquette, medical law, and economics. It is not necessary to be a member of the AAMA to apply for this examination. Infor- mation regarding membership and application for examination may be obtained from the Executive Secretary of the American Association of Medical Assistants, 510 North Dearborn Street, Chicago, Illinois 60610. Financial Benefits Financially, too, the medical secretary enjoys many advantages. Her salary is among those in the top bracket for secretaries. She can also look for- ward to a pension. Under the Keogh Act, which became law on January 1, 1963, a doctor may put a certain amount into a retirement fund for himself that is tax-exempt if he also covers all full-time employees who have been with him for three years. He may contribute to the fund if an employee has been with him for less than three years, provided he treats all employees alike. The con- tribution to the employee's pension fund must be in addition to salary.  MEDICAL ETHICS Every organized field of human endeavor is governed by a code set up by its practitioners. Medicine is perhaps the oldest profession to have developed such a set of rules. A MEDICAL SECRETARY'S CAREER 19 The Hippocratic Oath Hippocrates was a Greek physician who lived in the fifth century B.C. Hic is called the "Father of Medicine," and the principles laid down by him to govern the conduct of physicians toward their patients and the public are incorporated in the oath that has been taken by physicians for many cen- turies. Although the words of the oath cannot be directly attributed to Hippo- crates, they nevertheless represent his ideals. One version of the oath is given below. With OATH OF HIPPOCRATES"  don females the physician, and Aesculapius, and Health, and Allheal, goddesses, that, according to my ability and judgment, and stipulation, to reckon him who taught me this me as my parents, to share my substance with him des if required; to regard his offspring as on the same wwn brothers, and to teach them this art if they should. ithout fee or stipulation, and that by precept, lecture of instruction, I will impart a knowledge of the art to those of my teachers, and to disciples bound by a cath, according to the law of medicine, but to none others. hod of treatment which, according to my ability and the benefit of my patients, and abstain from what- and mischievous. I will give no deadly medichie  to suggest any such counsel; furthermore, I will not give ment to produce abortion. with holiness I will pass my life and practice my art. person who is suffering with a stone, but will leave this to practitioners of this work. Into whatever houses I enter I will for the benefit of the sick and will abstain from every volun- ischief and corruption; and, further, from the seduction of males, bond or free. Whatever, er, in connection with my professional practice, or not in con- nection with it, I may see or hear in the lives of men which ought not to spoken abroad, I will not divulge, as, "eckoning that all such should be Secret While I continue to keep this oath unviolated, may it be granted to me to the practice of the art, respected by all men at all times, and violate this oath, may the reverse.be my lot. Midical Assistant. MEDICAL SECRETARIAL PROCEDURES Principles of Medical Ethics Over the years many rules were added and later discarded, and confusion reigned. To guide doctors in this country, the American Medical Association formulated its own principles of medical ethics. In the present form, which appears on pages 22 and 23, these principles are now accepted by the medical profession and are expected to endure for a long time to come. The Secretary's Responsibility The underlying principle of the physician's devotion to his calling is evi- dent in the above documents. But in what way do they concern the medical secretary? Here are the answers: 1. Keep everything you hear, see, and read about patients completely con- fidential. 2. Never criticize a doctor to a patient. 3. Do not engage in any activity that might be construed as advertising the doctor's services. 4. Notify your doctor if you leam that a patient of his is under treatment by another physician for the same condition. It would be unethical for your employer to treat him also. 5. If a referred patient mentions to you that he does not intend to return to the referring physician, inform your doctor. He will want to discuss this with the patient, for it would be unethical for him to keep the patient on these terms. 6. Do not collect payment or send a bill to another physician or members of his family unless expressly told to do so by your employer. Medical ethics dic- tates that doctors do not charge each other or their families for services rendered. An exception to this rule is the service rendered by a psychoanalyst. 7. Never keep a doctor waiting for his turn in the reception room, Usher him into your employer's office as soon as the latter is free. -8. Always connect another doctor immediately on the telephone without asking the reason for his call. Items 7 and 8 concern medical etiquette rather than medical ethics. These two areas complement each other, and at times they even overlap, UNDERSTANDING MEDICAL TERMS  One of the most important requirements of a medical secretary is a knowl- edge of medical terms. She must know what the doctor means when she takes his dictation, and she must know how to spell the words he uses. A student or a beginning secretary may find herself in awe of medical terminology, but a little study will solve this problem. It is necessary in the beginning to understand that medical terms are combinations of words or word roots. One part of the term will denote a particular part of the anatomy; and another part will indicate the condition, process, or procedure taking place A MEDICAL SECRETARY'S CAREER 21 PRINCIPLES OF MEDICAL ETHICS' Preamble. These principles are intended to aid physicians individually and collectively in maintaining a high level of ethical conduct. They are not laws but standards by which a physician may determine the propriety of his conduct in his relationship with patients, with colleagues, with mem- bers of allied professions, and with the public. Section 1. The principal objective of the medical profession is to render service to humanity with full respect for the dignity of man. Physicians should merit the confidence of patients entrusted to their care, rendering to each a full measure of service and devotion. Section 2. Physicians should strive continually to improve medical knowl- edge and skill, and should make available to their patients and colleagues the benefits of their professional attainments. Section 3. A physician should practice a method of healing founded on a scientific basis; and he should not voluntarily associate professionally with anyone who violates this principle.  Section 4. The medical profession should safeguard the public and itself against physicians deficient in moral character or professional competence. Physicians should observe all laws, uphold the dignity and honor of the profession and accept its self-imposed disciplines. They should expose, without hesitation, illegal or unethical conduct of fellow members of the profession. Section 5. A physician may choose whom he will serve. In an emergency, however, he should render service to the best of his ability. Having under- taken the care of a patient, he may not neglect him; and unless he has been discharged he may discontinue his services only after giving adequate notice. He should not solicit patients. there, or it will describe the most outstanding symptom of a disease. Sometimes the group of letters indicating a part of the anatomy will come first; sometimes those letters indicating the nature of the disease will come first. Here are two examples of how medical terms are derived: Dysmenorrhea: dys, meaning painful or difficult; meno, referring to month; and rhea, a flow: painful or difficult menstruation. Enterohepatitis: entero, meaning bowel; hepa, liver; itis, inflammation: inflamma- tion of the bowels and liver. 22 MEDICAL SECRETARIAL PROCEDURES PRINCIPLES OF MEDICAL ETHICS (continued) Section 6. A physician should not dispose of his services under terms or conditions which tend to interfere with or impair the  free and complete exercise of his medical judgment and skill or tend to cause a deterioration Of the quality of medical care. Section 7. In the practice of medicine a physician should limit the source of his professional income to medical services actually rendered by him, or under his supervision, to his patients. His fee should be commensurate with the services rendered and the patient's ability to pay. He should neither pay nor receive a commission for referral of patients. Drugs, remedies or appliances may be dispensed or supplied by the physician provided it is in. the best interests of the patient. Section 8. A physician should seek consultation upon request; in doubtful or difficult cases; or whenever it appears that the quality of medical service may be enhanced thereby. Section 9. A physician may not reveal the confidences entrusted to him in the course of medical attendance, or the deficiencies he may observe in the character of patients, unless he is required to do so by law or unless it becomes necessary in order to protect the welfare of the individual or of the community. Section 10. The honored ideals of the medical profession imply that the responsibilities of the physician extend not only to the individual, but also to society where these responsibilities deserve his interest and participa tion in activities which have the purpose of improving both the health and the well-being of the individual and the community. Reprinted with permission of the American Medical Associ Careful study of the section "Building a Medical Vocabulary," found at the end of each chapter in this book, will help the secretary to recognize and understand the meaning of even the most difficult medical terms at a glance. These sections consist of either a "Word beginning" (prefix) or a "Word ending" (suffix) and its definition. Following this, in the left-hand column headed "Term" are word elements that combine with this word beginning or word ending, and in the right-hand column headed "Definition," their corresponding meanings are given. A MEDICAL SECRETARY'S CAREER 23 BUILDING A MEDICAL VOCABULARY Word ending: -itis inflammation Term Definition inflammation of: angiitis vessel (blood or lymph) appendicitis  appendix arthritis joint dermatitis skin gastritis laryngitis meningitis nephritis neuritis pancreatitis peritonitis pharyngitis stomach larynx meninges kidney nerve pancreas peritoneum (lining of abdominal cavity) pharynx phlebitis vein tonsillitis tonsils