Medical Office Procedures Chapter 1 PDF

CHAPTER 1 1 The Role and Importance of Medical Assistants Time allotment: 6 hours In healthcare, professionals like administrative and clinical medical assistants play a vital role in ensuring the smooth functioning of medical facilities and providing essenti...

CHAPTER 1 1 The Role and Importance of Medical Assistants Time allotment: 6 hours In healthcare, professionals like administrative and clinical medical assistants play a vital role in ensuring the smooth functioning of medical facilities and providing essential support to patients and healthcare providers. Throughout this lesson, we will delve into the objectives of understanding the responsibilities and significance of Administrative and Clinical Medical Assistants. We will explore how these professionals contribute to the efficient operation of medical offices, clinics, and hospitals and how they facilitate effective communication and coordination among various healthcare stakeholders. By grasping the significance of this profession, you will be better equipped to make informed decisions regarding your career aspirations in the healthcare industry. TOPICS COVERED Lesson 1 Introduction to Medical Assisting: Administrative and Clinical Lesson 2 Importance of Medical Assistants in Healthcare Settings Lesson 3 Ethical and Legal Considerations in Medical Assisting  LESSON 1 Introduction to Medical Assisting: Administrative and Clinical LEARNING OBJECTIVES After studying this lesson, the students will be able to: Describe the tasks and skills required of a medical assistant. List personal attributes essential for a medical assistant. Describe the employment opportunities in various medical settings and specialties. Define five of the positive work attitudes that make up the work ethic of a medical assistant. Describe the professional image of the medical assistant. Describe the elements of good interpersonal relationships with patients and others within the medical office.  and assist with minor procedures. INTRODUCTION Their role is integral to delivering quality care and maintaining patient Administrative and clinical medical comfort. Trends in the healthcare assistants play crucial roles in the setting show an increasing demand healthcare setting, supporting both for medical assistants due to patient care and operational expanding healthcare services and efficiency. Administrative medical an aging population. Additionally, assistants handle tasks such as with advancements in technology, scheduling appointments, medical assistants are increasingly managing patient records, billing, expected to be proficient in and insurance processing. Their electronic health records (EHRs) organizational skills and knowledge and telemedicine platforms, of medical terminology ensure reflecting broader trends towards smooth office operations and digital healthcare delivery. Medical patient satisfaction. Clinical medical assistants, both administrative and assistants, on the other hand, clinical, are indispensable directly assist healthcare providers members of the healthcare team, with patient care. They may take contributing significantly to patient vital signs, prepare patients for care and operational efficiency in examinations, administer today's dynamic healthcare medications (under supervision), environment. Basics of Medical Office Procedure Medical Office Procedures provides students with the front office (administrative) skills, ideas, and knowledge to work in a healthcare facility or medical office more effectively. TYPES OF DUTIES 1. Administrative - medical assistants complete those tasks and procedures necessary to keep the office of the medical practice running efficiently. 2. Clinical - medical assistants complete those tasks and procedures that aid the physician in the medical treatment of patients. TASKS, SKILLS, AND PERSONAL ATTRIBUTES Administrative Tasks Front Desk Procedures - Greet patients, verify patient data, collect payments, guide patients Scheduling - Telephone work, patient appointments Records Management - Create and maintain patient medical records (charts), file office documents. Maintain confidentiality of patient records  Administrative Duties - Handle mail, transcribe chart notes, maintain physician schedules Billing and Insurance - Code or verify codes, process, and follow up on insurance claims, handle patient billing, take care of office banking, maintain financial record. Clinical Tasks 1. Taking Vital Signs - Measuring and recording blood pressure. Taking and recording pulse and respiration rates. Measuring and recording temperature. Measuring height and weight. 2. Patient Preparation - Preparing patients for examinations. Explaining procedures to patients to alleviate anxiety. Assisting patients with undressing and dressing, if necessary. Positioning patients for examinations and procedures. 3. Assisting with Examinations - Handing instruments and materials to physicians during exams. Holding and positioning instruments and patients as required. Assisting with minor surgical procedures, such as suture removal and wound dressing. 4. Specimen Collection - Collecting blood samples via venipuncture or capillary puncture. Collecting urine, stool, and other body fluid samples. Properly labeling and preparing specimens for laboratory analysis. 5. Basic Laboratory Tests - Performing simple lab tests on the premises, such as urinalysis, hemoglobin tests, and blood glucose tests. Recording and reporting test results. 6. Administering Medications - Administering oral, topical, and injectable medications under the supervision of a physician. Preparing and administering immunizations and vaccines. 7. Wound Care - Cleaning and dressing wounds. Removing sutures and staples. Applying bandages and other wound coverings. 8. Performing Diagnostic Tests - Conducting electrocardiograms (EKGs). Performing vision and hearing tests. Conducting pulmonary function tests. 9. Infection Control - Following proper protocols for hand hygiene and infection control. Sterilizing medical instruments and equipment. Maintaining a clean and sterile environment in examination rooms. 10. Patient Education - Providing patients with instructions for home care following procedures. Educating patients about medication usage and potential side effects. Instructing patients on how to collect specimens for lab tests. Medical Assistant General Duties: BASICS TO KNOW Their administrative duties may include: 1. Greeting patients 2. Answering phones and scheduling appointments 3. Filing and updating medical records 4. Coding and completing insurance forms 5. Arranging for a hospital visit or lab test 6. Handling billing, bookkeeping, and general office mail 7. Medical assistant clinical duties Their clinical duties may include: 1. Showing patients to the exam room 2. Recording symptoms and updating medical histories 3. Helping patients get ready to see the doctor 4. Assisting doctors during physical exams 5. Discussing prescriptions as well as dietary and lifestyle changes with patients 6. Dispensing medications 7. Submitting prescription refill requests 8. Removing stitches or changing wound dressings 9. Drawing blood for lab tests 10. Performing basic lab tests 11. Doing medical tests such as EKG (a heart test) Administrative and Clinical Skills 1. Communication Skills - Writing, speaking, and listening 2. Mathematical Skills - Maintain financial records; handle patient billing; handle cash, check, and credit card payments 3. Organizational Skills - Develop systematic work habits, develop time management skills, and prioritize important and needed things 4. Computer Skills - Mastery of basic computer skills essential. Working knowledge of wireless technologies, telecommunications, electronic communications, voice recognition. 5. Interpersonal Skills - Genuine desire to work with people. Initial contact for most patients. Ability to set a positive tone for the entire office. Sensitivity to the feelings and situations of others 6. Attentive to details - paying attention to all the particulars and finer points of a task. All the data must be accurate, so patients receive the best possible care. Administrative and Clinical Personal Attributes  A medical assistant plays a crucial role in healthcare settings, assisting physicians and ensuring smooth operations. Here are some key personal attributes of a successful medical assistant: 1. Compassionate - Shows empathy and care for patients' well-being. 2. Detail-oriented - Pays attention to details, essential for accurate record- keeping and patient care. 3. Organized - Manages multiple tasks efficiently, ensuring a well-ordered work environment. 4. Reliable - Dependable and punctual, ensuring that tasks are completed accurately and on time. 5. Good Communication Skills - Communicates effectively with patients, families, and healthcare team members. 6. Adaptable - Handles changes and unexpected situations with ease. 7. Technical Proficiency - Familiar with medical software, equipment, and procedures. 8. Ethical - Maintains patient confidentiality and adheres to ethical guidelines. 9. Team Player - Works well within a team, supporting colleagues and contributing to a positive work environment. 10. Patience - Demonstrates patience, especially when dealing with anxious or difficult patients. EMPLOYMENT OPPORTUNITIES Administrative Medical Assistants 1. Medical Offices and Clinics: Handling front office tasks such as scheduling appointments, managing patient records, billing, and insurance claims. 2. Hospitals: Managing patient admissions, coordinating communications, and performing clerical duties. 3. Specialty Clinics: Working in specialized medical fields like dermatology, cardiology, or orthopedics, managing specific administrative tasks relevant to the specialty. 4. Insurance Companies: Reviewing claims, managing patient information, and communicating with healthcare providers. 5. Medical Billing and Coding Companies: Focusing on coding patient diagnoses and procedures for billing purposes. 6. Public Health Agencies: Assisting with administrative tasks in community health programs and initiatives. 7. Medical Research Facilities: Supporting administrative tasks in clinical trials and research studies. Clinical Medical Assistants  1. Physician Offices and Clinics: Assisting with patient care, performing basic laboratory tests, taking patient histories, and preparing patients for examinations. 2. Hospitals: Working in various departments, such as emergency, pediatrics, or outpatient care, assisting with patient procedures and care. 3. Outpatient Care Centers: Providing support in ambulatory surgery centers, urgent care facilities, and specialty care centers. 4. Specialty Clinics: Assisting in specialized practices such as ophthalmology, podiatry, or oncology, performing tasks specific to the field. 5. Nursing Homes and Assisted Living Facilities: Supporting patient care, monitoring vital signs, and assisting with daily activities. 6. Diagnostic Laboratories: Collecting specimens, performing basic lab tests, and recording results. 7. Home Health Agencies: Providing clinical support to patients receiving care at home, under the supervision of a healthcare provider. WORK ETHICS AND PROFESSIONALISM 1. Accuracy - avoid even minor errors, which can pose serious health consequences 2. Initiative - act independently; offer help 3. Thoroughness - be attentive to detail; follow through 4. Problem-solving ability - be logical in planning and prioritizing Problem-solving is best accomplished when these steps are followed: Step 1 Identify the problem. Step 2 Set a goal (resolution of the problem). Step 3 Gather information. Step 4 Brainstorm possible solutions. Step 5 Select and implement a solution. Step 6 Evaluate the result(s). Step 7 If the desired results did not meet the established goal, begin again with Step 1. 5. Dependability - avoid mistakes, take clear and complete messages 6. Punctuality – be on time 7. Efficiency - be efficient with time and resources; use good organizational skills 8. Self-motivation - be willing to learn and do new duties/tasks 9. Flexibility - respond to changing situations, handle interruptions and delays 10. Tact - act and speak considerately; be sensitive to people’s reactions; do not offend; create goodwill 11. Good judgement - use knowledge, experience, and logic 12. Being a team player - be generous with your time and help 13. Honesty - tell the truth; be trustworthy; maintain confidentiality 14. Assertiveness - be assertive but not aggressive; communicate ideas in a confident, positive manner PROFESSIONAL IMAGE 1. Healthcare Profession’s Image - health, cleanliness, and wholesomeness 2. Style - personal style shows your vision of your actions, dress, hairstyle, etc.; workplace style reflects the employer’s preference, not necessarily your style 3. Physical Attributes - maintain good posture; eat a balanced diet, get sufficient rest; exercise regularly 4. Grooming - clean hair; daily bath or shower; deodorant; dental care; neat overall appearance; short, manicured nails; hair controlled¡ little or no fragrance; modest makeup; clean, pressed clothes; comfortable well- kept shoes; limited jewelry 5. Maturity - not dependent on age; includes a determination to acquire and practice attitudes, habits, and skills that contribute to maturity; ability to work under pressure, use good judgment, follow through INTERPERSONAL RELATIONSHIP 1. Taking Care of Patients - show respect and concern without regard to age, race, gender, or socioeconomic situation, learn patient names 2. Familiarity - leads to friendlier atmosphere; address physician by title; learn patient name preference 3. Social Relationships - maintain confidentiality; many offices have policies prohibiting social relationships between employees 4. Conversation with Patients - Let the patient choose topic; Never offer advice or comment on the treatment 5. Difficult Patients - practice patience, understanding, restraint; be considerate of the patient’s condition; the patient should leave with a feeling of goodwill 6. Terminally Ill Patients - Be sensitive to the situation¡ keep conversation short; do not ask “how are you?” 7. Confidentiality - confidentiality of patient information is a legal requirement; neither physician nor staff may divulge without the patient’s permission (not even to family, friends, or clergy); physician decides what information in the medical records were given or withheld (the medical assistant refers questions to the physician); use care on the telephone, computer screens, front desk location 8. Cultural Diversity - our beliefs, value system, language, and understanding of the world grow from the culture in which we are born and raised; be sensitive to the fact that others have their unique cultures; one culture is not better than another, culture is displayed in many different ways; be respectful of people of all cultures; avoid stereotypes; treat each person as an individual 9. Language Barriers - can offer the greatest cultural barrier; often patient is accompanied by someone who can interpret for them; refer to foreign- language phrase books; speak slowly and clearly; don’t shout; use simple words; be brief 10. Deaf Patients - use sign language or write notes 11. Nonpatients - includes business visitors such as pharmaceutical representatives and office supplies vendors; be courteous; most offices schedule a specific time each month or make appointments to see these visitors Problem 1. Managing a Busy Day at the Medical Clinic You are an administrative medical assistant working at a bustling medical clinic. Today is exceptionally busy, and you need to handle various tasks to ensure the smooth operation of the clinic. A patient call to schedule an urgent appointment with a specific doctor due to severe flu symptoms. The patient insists on being seen today. Inside the clinic, several patients are waiting at the front desk to check in for their appointments. A patient approaches the desk, visibly frustrated, stating that they have been waiting for over 30 minutes past their appointment time. A new patient arrives for their first appointment. You must gather their personal information, medical history, and insurance details to create their electronic health record. Another patient called to reschedule their appointment due to a last-minute work meeting. They initially had an appointment for a routine check-up. A delivery of medical supplies has just arrived. You must ensure they are properly stored and distributed to the appropriate departments. A patient wants a copy of their medical records to share with a specialist they are consulting next week. A patient at the front desk is confused about their bill, as they received a charge they were not expecting for a recent procedure. The clinic's printer and copier are malfunctioning, and a staff member needs some patient forms printed urgently. You need to verify insurance coverage for a patient who is scheduled for a minor surgical procedure next week. Their insurance details seem to have changed since their last visit.  LESSON 2 Importance of Medical Assistants (MAs) in Healthcare Settings LEARNING OBJECTIVES After studying this lesson, the students will be able to: Understand the importance of administrative and clinical medical assistants Acknowledge the role of medical assistants in the healthcare facilities Efficient Patient Flow MAs are responsible for scheduling appointments, managing patient check- ins, and ensuring that the patient flow within a healthcare facility runs smoothly. Accurate Patient Information MAs collect and update patient demographics, medical histories, insurance information, and other vital data. Billing and Coding MAs handle billing and coding tasks, including submitting insurance claims and processing payments. Medical Records Management MAs maintain electronic health records (EHRs) or paper records, organizing them for easy access by healthcare providers. Communication Hub They act as a communication hub between patients, healthcare providers, and other staff members Compliance MAs help healthcare facilities adhere to regulatory requirements, including patient privacy and data security regulations. Patient Experience MAs contribute to this by providing friendly and helpful interactions during check-in and discharge processes, making patients feel valued and cared for. Time Management for Clinical Staff By handling administrative tasks, MAs free up clinical staff, such as physicians and nurses, to focus on providing direct patient care. Reduced Administrative Errors MAs are trained in healthcare procedures, medical terminology, and coding. Overall Healthcare Quality When administrative processes run smoothly, healthcare providers can concentrate on diagnosing and treating patients effectively. Financial Viability Effective billing and revenue cycle management, overseen by MAs, ensure that healthcare facilities receive timely payments for their services Team Collaboration MAs collaborate with clinical staff and other healthcare professionals to ensure that patient care is well-coordinated.  LESSON 3 Ethical and Legal Considerations in Managing the Medical Office LEARNING OBJECTIVES After studying this lesson, the students will be able to: Know the ethical behavior of medical office professional Identify unethical workplace behaviors Identify the unethical behaviors of the management or the employers Understand the code of conduct in legal & ethical concern for healthcare professionals  ETHICAL BEHAVIOR OF A MEDICAL OFFICE PROFESSIONAL 1. Obey The Company’s Rules & Regulations At the start of an employee contract, companies may need the employee to sign various documents, including the company rules and regulation agreement form. Also, the employee may be given a handbook that may serve as a guide. Some common rules are tardiness, inappropriate dressing, and language, etc. Due to the excitement of getting a new job, some employees do not properly read these rules and may end up deferring them in the future. Therefore, it is important that new employees properly read these rules & regulations in other not to defer them. 2. Communicate Effectively Effective communication is very important to avoid misunderstandings when dealing with issues in the workplace. Communicating effectively may mean different things to people at different points in time. Let us consider the hypothetical situation of an employee trying to relay information to a French-speaking customer. The best way to communicate effectively with the customer is to have an employee who can speak French relay the information. Effective communication may also have an employee breaking one of the rules and regulations of the company without getting penalized for it. An employee reaching out to HR that they will be coming in late due to some unforeseen circumstances may be spared for coming late if the situation is properly communicated. 3. Develop Professional Relationships Good professional relationships are not only a thing that fosters teamwork among employees, but also help with individual career development for employees. Developing professional relationships with coworkers or other professionals outside the workplace will also directly or indirectly improve productivity. Professional relationships between low-level and high-level employees will make it easier for ideas to be shared and knowledge to be passed to junior employees. That way, the company can confidently have an intern work on a tough project to meet a pending deadline due to the guidance from older employees. Salespeople, for one, need to build external professional relationships with professionals from other organizations—especially those who are potential clients. These relationships will help create a contact person in another organization in case they need to sell a product to them. 4. Take Responsibility  It is important for employees to always take responsibility for decisions made both individually and in a team. This is, in fact, a leadership trait that every employee who is looking to take up a managerial position in the future should exhibit. Understandably, employees may want to save their job and are therefore scared of taking responsibility for a particular event. However, they should not let this fear take them out of the team. For example, the communications team came up with a marketing strategy for the company and it failed. The team members are to jointly take responsibility for this failure, not individuals coming out that they were not part of the decision-making process. If the strategy has gone the other way round, they would not have said the same. 5. Professionalism/Standards There are professional standards that everything an employee does in the workplace. The use of informal words in a formal workplace is highly unprofessional. These standards should be held high and applied to every part of an employee’s activity in the workplace. This should include the way they speak, kind of work they deliver and their relationship with coworkers and customers. 6. Be Accountable Accountability is also a very good trait of an employee. One of the things that may shortchange a talented and responsible is the lack of accountability. Lack of accountability may result in your boss thinking you have an “I don’t care attitude” to the company’s project or worst take you as a liar and may lead to job loss in the long run. For example, at the beginning of each year, a certain amount of money is allocated to each department. The manager is meant to oversee how this money is spent. If at the end of the year, the manager cannot make an account of how the money was spent, he may then be suspected of stealing company funds. 7. Uphold Trust An employee should not do anything that may make his or her employee withdraw trust. As an employee of a company, your employee trusts you to get work done perfectly on time. Things like missing deadlines regularly or delivering work that needs to be revised repeatedly will deny you a promotion. It may even leave the employer not giving you tasks to complete in the future—a nightmare for freelancers. 8. Show Initiative without being told Is the company running behind deadline and you feel you can stay a few extra hours after work to finish up? Do it. You are a freelance designer, and your client wants a particular poster designed but does not have a copywriter to write the content. If you can write the contents, do so. Do not delay a client’s work because of a few contents. 9. Respect Your Colleagues It does not matter whether you are dealing with the intern, a junior, janitor, etc. they should all be treated with respect. As a manager, treating your team members with respect will help improve their productivity. Giving constructive criticism and saying kind words to them even when they are not able to deliver perfectly will help them strive to do better in the future. 10. Work Smarter Do not just work hard, work smarter. The reason why you see an employee promoted to the post of manager after just 2 years and a hardworking employee who has been with the company for 10 years failed to get a promotion is smart work. Assume that these 2 employees are data scientists who collect data and analyze them. A smarter employee will use the Formplus data collection tool to collect data and receive real-time data analytics, while a hard-working employee will print paper- based forms and do the hard work of sharing it to respondents. UNETHICAL WORKPLACE BEHAVIORS Lies Lying is a trait that is detested in and outside the workplace. It kills trust, affects relationships, and may even put people in trouble. There are different situations where employees lie in the workplace—with just one lie opening the floor for many others. It could be a sales manager lying about the number of clients they were able to get in a month or an employee calling in sick just to attend another job interview. A lot of employees start lying from their CV, by adding experiences they did not acquire, and the skills they don’t have. Employees need to understand that lying about work may eventually get them in trouble and needs to stop before they lose their job. However, we notice that employees lie due to fear of their employer—an employee will call in sick to go for interviews because companies frown against employees interviewing at another company. HR should put up a more friendly culture that will encourage people to progress in their careers taking up other jobs and even support them throughout the process. Taking Credit for Others Hard Work It is very common for managers to take credit for their team member’s hard work when reporting to the management. A team member may have brought an idea that helped the sales team improve their sales by 200%. However, when giving a report, the manager does not mention the team member’s name but claims the idea as his. Employees need to reduce the use of “I” but embrace the use of “Us”. By taking credit for another person’s work, you will be denying the person a promotion, bonus or commendation for a job well done. This will discourage the person from sharing ideas that will benefit the company in the future. Verbal Harassment/Abuse Employees need to stay away from using foul language on coworkers in and out of the workplace. This is very important when dealing with customers. Customers are known to get angry and may result in verbal abuse due to a bad product or service. They may even get insult you when they are at fault. As a customer care representative, salesperson or any other employee, it is both important that you don’t use abusive words on customers no matter how provoked. Violence Similar to verbal harassment, employees should not be violent when dealing with coworkers and customers. Customers may likely provoke you, but it is better to keep shut and walk away rather than turn violent. Non-Office Related Work A lot of employees have side hustles which they use to supplement salaries. This is very good and only very few companies are against employees working to make money outside work hours. However, some employees still do non-office related work during office hours. Employees who have side hustles should try doing them on weekends or employing other people to handle some of the business logistics to avoid eating into office hours to get the work done. Extended Breaks Companies give lunch breaks to employees and people take advantage of these breaks to do other things outside office work like, go for interviews, meet with friends or even work on their side hustles. They are free to do whatever they want these lunch breaks. Employees, however, take advantage of these lunch breaks and extend them beyond time.  Theft/Embezzlement Some employees are known for diverting company funds into their bank accounts— padding project quotations, invoices, etc. to deceive the company on how much was spent on projects. This act is detrimental to the company because employees who steal sometimes replace quality products with counterfeits which are cheaper but causes damage in the future. Sexual Harassment Sexual harassment is an offense that is not limited to the workplace alone. An employee accused of sexual harassment will not only face consequences in the workplace but also tried at a court of law. Many companies have a zero-tolerance rate for sexual harassment in and outside the workplace. This may tarnish the company’s reputation and the only way to curb is to make an example of defaulters. Corrupt Practices Some common causes of corruption can be seen during the employment process of an organization. They invite so many people to send their CVs and come for interviews but only people with the same political affiliation with them get the job. This is also common with companies that ask for contractors to bid for a project, but the employees will only give them to their friends who may not even bid at all. MANAGEMENT/EMPLOYERS UNETHICAL BEHAVIORS Workplace ethics is not for employees alone. Employers are also bound to workplace ethics and may also be tried for unethical behavior. Sex for Job/Promotion It is common for managers, employers and major decision-makers to use their position in the workplace to influence the hiring decision in exchange for sex. Late Night Out/Unpaid Overtime Some employers take advantage of desperate job seekers and the competitive job market to use employees’ leisure time as they wish. They do so with the mentality that they are doing employees a favor by employing them, not knowing that the favor is mutual. Employees who are scared of queries or job loss are not able to protest the infringement into their private time by the employer. Verbal Harassment It is common among employers to verbally harass employees when they make little mistakes. This will reduce employee morale and productivity. Employers should always say kind words to their employees. Undue Pressure Deadlines are a great way to make sure the work gets done on time. However, when employees are placed under undue pressure, they end up trading quality for on-time delivery. An example of undue pressure will be giving an employee a 1-day deadline for a project that would normally take a week. Nepotism This is a common type of corruption that happens in the workplace. An employee who has been working hard for years while influencing company growth may get sidelined for a promotion because of another employee who is a family friend, family, or friend of the employer. Things like this are what reduce employee morale or even push talented employees to dropping a resignation. Unfriendly Work Environment One of the things that can mar productivity is an unfriendly working environment. This may come as a combination of abusive bosses, lack of commendation, nepotism, etc. An unfriendly environment is an environment that combines various unethical behaviors into one. Unrealistic Expectations Creatives usually have it worse when it comes to having unrealistic expectations from employees. Advantages and Implications of Workplace Ethics It can stimulate positive employee behavior and create a positive ambiance in the workplace Ensures management guides and mentors their employees in a healthy environment A workplace with good ethics usually strengthens the bond employees have with their superior It boosts productivity through employee performance and job satisfaction which in turn increases company growth. Bad workplace ethics can cause a strain in the relationship with company stakeholders  When it leaks (which it most likely will) poor behavior can be recorded and propelled into unsavory headlines online. This can lead to reputational damage to the brand name. HOW TO SOLVE UNETHICAL ISSUES AT THE WORKPLACE 1. Have Rules Organizations need to have predefined rules and regulations regarding workplace ethics. These rules and regulations should be given to new employees together with their employment contracts. Also having the rules written at strategic places at the workplace will also help remind people about the rules. People tend to unconsciously imbibe things they see every day. 2. Accept Feedback/Complaint Make it easy for employees to send feedback or complaint in case of harassment, abuse, or any other unethical activities going on in the workplace. 3. List Consequences for Unethical Behaviors Consequences for unethical behaviors should also be placed alongside the rules at strategic places in the organization. That way, if anyone wants to ignore the rules despite seeing them, the fear of getting punished will stop him or her from going ahead. 4. Swift Justice/Disciplinary Action Some Companies often cover up issues of rape, sexual harassment, etc. when the perpetrator is a high-ranking member of the organization. Things like this should not be accommodated. Irrespective of who breaks the rule, there should be swift disciplinary action by the organization. CODE OF CONDUCT IN LEGAL & ETHICAL CONCERN FOR HEALTHCARE PROFESSIONALS Healthcare professionals continually face ethical and legal issues in the workplace, putting them at risk for burnout. Efforts to lasso health care costs puts increasing pressure on staff to do more with less. Limited resources force tough choices in quality of care. Patient safety may be compromised, resulting in injury and lawsuits. Bioethicists suggest that when medical professionals practice ethical principles of autonomy, justice, doing good and doing no harm can help health care professionals resolve difficult situations. Informed Consent The ethical code of health care professionals’ states that patients have the right to know the truth about their medical condition, and that they can choose treatment options. Information must be sufficient and understandable, to enable the patient to make informed decisions that are in his best interest. Ethical and legal dilemmas arise when the health care provider and the patient, or the patient’s family, have differing opinions on appropriate care. A health care professional may be torn between the ethics of beneficence (doing good) and autonomy (respecting patient’s wishes). If resolution cannot be reached, a judge may need to rule on the matter. Example: A patient’s family asks the doctor not to tell their elderly mother that her tumor is malignant. The doctor disagrees with the patient’s request to forgo treatment. A teenager requests medication for a painful condition, but his parents refuse, based on religious beliefs. The patient asks the X-ray technician if her doctor is disclosing everything, he knows about her test results. Professional Boundaries Health care professionals must maintain appropriate boundaries. Patients are vulnerable, and that vulnerability needs to be acknowledged and always respected. Successful treatment outcomes can give rise to deep feelings of gratitude that may possibly mistake for physical attraction. Professional ethics and sexual exploitation laws prohibit inappropriate involvement with clients such as dating or accepting gifts that exceed nominal value. Genuine concern, trust and empathy should frame all interactions. Intervention is required if mutual respect is not shown or if boundaries are crossed. Example: A patient persists in telling sexist jokes, which offends nursing home staff. A nursing home patient offers cash to a certified nursing assistant who has money problems. A patient asks his oncology nurse to go on a date with him the day he is discharged. A doctor treats her own family members when the family's primary care doctor is out of town. Data Privacy Protecting patient privacy is essential, in accordance with the Health Insurance Portability and Accountability Act. Health care professionals must know and follow HIPPA laws and cannot disclose patient information. Legally and ethically, health care professionals cannot violate patient trust, which is an essential component of treatment. When a patient dies, privacy rights still apply. Accidental or intentional disclosure of private patient information can result in litigation, huge fines, and jail time for the violator. Example: The medical secretary thinks she may have mistakenly mailed Patient A’s medical records to Patient B. A plastic surgeon discloses names of his well-known clients at a cocktail party. A medical coder accidentally put sensitive medical records in a hallway trash bin, instead of in the shredder. Nurses discuss a patient in the hospital cafeteria, where confidential information is overheard by visitors. Access to Care Access to care poses difficult ethical and legal dilemmas for health care professionals, who sign an oath not to harm their patient. Striking a balance between quality care and efficiency can be challenging. Health care professionals struggle to help patients who lack the resources to cover the treatment they need. Pressure from hospital administrations, insurance companies and managed care organizations further constrain the choices for treatment and prescriptions. A malpractice suit is more likely to happen if a patient claims that his condition was misdiagnosed by a harried medical practitioner. Example: An insurance company refuses to pay for a procedure or a drug that a doctor strongly believes the patient needs. Due to staff shortages, a nurse is reassigned to another area, where the nursing staff lacks sufficient skill or training. The doctor wants to see a child for a follow-up visit, but his parents refuse, because of limited insurance coverage. A patient without insurance asks if she can have free samples of the medicine she needs. PROBLEM 1: PATIENT CONFIDENTIALITY Peter Parker is a certified administrative medical assistant working at a busy healthcare clinic. He is responsible for managing patient records, scheduling appointments, and handling billing and insurance claims. Peter's job is crucial to the efficient functioning of the clinic, and he interacts with both patients and healthcare providers on a daily basis. In this case study, we will explore various ethical and legal considerations that Peter may encounter in his role and provide answers to the associated dilemmas. Peter accidentally overhears a conversation between two physicians discussing a patient's sensitive medical condition in a common area of the clinic. He is unsure of what to do with this information. Ethical Considerations: 1. Should Peter report the breach of patient confidentiality, even though he was not directly involved in the conversation? 2. What ethical principles are at stake in this situation? Legal Considerations: 3. Are there any legal obligations for Peter to maintain patient confidentiality? 4. What legal consequences could the physicians face for their breach of patient confidentiality? PROBLEM 2: HANDLING PATIENT BILLING Peter notices that his supervisor, who is responsible for billing and insurance claims, has been altering the billing codes to maximize reimbursement from insurance companies, even if the services provided do not fully align with the codes used. Ethical Considerations: 1. Should Peter confront his supervisor about the unethical billing practices? 2. What ethical principles are relevant in this situation? Legal Considerations: 3. What are the potential legal consequences for the supervisor and the clinic if these billing practices are discovered? PROBLEM 3: MANAGING PATIENT Peter is responsible for maintaining and updating patient records. He comes across a request from a patient's estranged spouse to access the patient's medical records, even though the patient has explicitly denied access in writing. Ethical Considerations: 1. Should Peter grant access to the estranged spouse, considering the patient's denial of access? 2. What ethical principles are involved in this decision? Legal Considerations: 3. What legal obligations and potential consequences should Peter consider when handling this request?