PART I: SHORT RESPONSE
Directions: Please answer the questions below.
Part A:
1. List the five steps of ethical decision making.
2. Two sisters have arrived at a medical facility to discuss with the attending physician the course of action they should take regarding their dying father. Mr. Roberts, the patient, is no longer responsive. Cassandra wants to continue all possible medical treatment to keep her father alive. Janet insists that her father would not want his life prolonged by artificial means. Mr. Roberts did not give either sister a power of attorney, and he did not leave a written record of his wishes on this issue.
a. Type of ethical problem
b. Agent or agents
c. Course of action (Suggest one.)
d. Outcome (Suggest one.)
e. How can the medical assistant refrain from inflicting his or her own opinions on patients?
3. Dr. Patrick is the chief of staff at a regional medical center. His specialty is oncology, and the hospital is considering the construction of a cancer center as part of a multimillion dollar project. One of Dr. Patrick's partners, Dr. Adams, is vehemently opposed to the project because of the cost to the local taxpayers who support the hospital. Dr. Adams has threatened to leave the practice unless Dr. Patrick votes against the project. Dr. Patrick wants the center to be built, but he also realizes that if Dr. Adams leaves, the practice will suffer a drastic loss of income.
a. Type of ethical problem
b. Agent or agents
c. Course of action (Suggest one.)
d. Outcome (Suggest one.)
e. How can the medical assistant refrain from inflicting his or her own opinions on patients?
4. Write your personal opinion regarding the following medicoethical issues. After writing your opinion, consider differing opinions by writing a brief opposing argument.
a. Abortion
b. Abortion: opposing opinion
c. Stem cell research: pros and cons
d. Human cloning: pros and cons
e. Genetic counseling: pros and cons
5. Should a woman who has been raped and become pregnant seek an abortion?
6. What harm can come to a patient's family if the medical professionals are incorrect about their assessment of abuse?
7. A medical assistant is recruited to work with a physician who is researching paralysis. Once the project is under way, the assistant discovers that the physician is using embryos that have been questionably obtained in the experimentation. What should the medical assistant do?
8. If your parent mentioned in passing that he or she would want the right to commit suicide in the event of a terminal illness, would you support that decision if the situation did in fact arise?
9. A physician recommends that a patient be taken off life support. The patient lives with his homosexual partner and has not had contact with his parents in more than 10 years. Both the partner and parents discuss the situation with the physician. The partner does not want to remove life support, stating that the patient would want to have every opportunity to live. The parents insist that they know what is best for their son and demand that he be taken off life support. Who should prevail?
10. How would a medical assistant handle the family of a patient who asks for advice about withdrawing life-prolonging treatment? To whom should the medical assistant defer the question?
11. A woman dies with a living will that states she wants to donate her organs. Her mother does not want her daughter's organs donated. What should health professionals do in this situation?
12. A family physician who is extremely religious prefers not to treat patients who are homosexual. A gay patient comes to his office who is infected with HIV. The physician refers the patient to an infectious disease physician. Is this considered ethical?
13. Describe the behavior of an ethical medical assistant in your own words.
14. List several physical places in the physician's office in which confidentiality could be breached.
15. What is the usual consequence of breach of patient confidentiality?
16. Explain why confidentiality is critical in the medical environment.
Part B:
1. List the three steps involved in the creation of the physician-patient relationship.
2. What must a letter of withdrawal of care state?
3. How should a letter of withdrawal be mailed?
4. Does the letter of withdrawal have to explain to the patient the reason the physician chose to withdraw from care of the patient? Explain your answer.
5. Define negligence.
6. List the three general classifications of medical professional negligence.
7. What is contributory negligence?
8. What is meant by the phrase "the medical assistant acts as an agent of the physician"?
9. Explain why medical professional liability falls under the jurisdiction of tort law.
10. A patient was given the wrong medication. No adverse effects occurred. Which of the four Ds is missing? Why does this affect the possibility of a lawsuit?
11. A car accident occurs at an intersection outside a physician's office during normal business hours. Do the physician and staff have a duty to provide direct care to the injured? Why or why not?
12. A patient is treated for low back pain caused by a fall at the local mall. The patient sues the physician because the pain is unresolved. Which of the four Ds would be the most difficult for the patient's attorney to prove? Why?
13. A medical assistant mislabeled a vial of blood that was sent to an outside laboratory. Because of this mistake, a child was given the wrong diagnosis and later died. The child's family sued the medical assistant, the physician, and the hospital that owned the practice. The child's family was awarded $4 million. What type of damages is this?
14. A female patient was awarded punitive damages after a physician sexually molested her during her annual pelvic examination. What are punitive damages designed to do? Do you feel that punitive damages should be limited to a specific amount of money?
Part C:
1. List seven ways computers assist workers in medical offices.
Part D:
For #1-10: For each of the following messages taken from voice mail, determine who should receive the message, three questions to ask the patient when the call is returned, and what actions need to be taken for proper follow-through. Clinical questions may be included but are not required.
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Staff Members at Dr. Julie Beard's Office
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Physician
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Dr. Julie Beard
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Office Manager
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Julia Carpenter
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Clinical Medical Assistant
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Trina Martinez
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Clinical Medical Assistant
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Dean Howell
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Scheduling Assistant
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Stephanie Dickson
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Receptionist
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Ginny Holloway
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1. "Hello, this is Peter Young. I saw Dr. Beard on Monday about a rash on my forearms. This thing isn't getting any better, and the cream she prescribed for me isn't helping the itching, and it's very uncomfortable. Is there anything else we can do to help it? My number is 972-555-9873
972-555-9873 FREE." The message was received at 8:30 AM on Thursday, February 3.
a. Who should receive this message?
b. What action should be taken after speaking with the patient?
2. "Hello, this is Savannah Yarborough. I visited with your receptionist earlier today and she indicated that one of the medical assistants has resigned and you will have a position available in a few weeks. I am very interested in interviewing and presenting myself as a candidate for the job. I am a certified medical assistant with 6 years of experience. Please give me a call at your convenience at 817-555-9902817-555-9902 FREE. I look forward to speaking with you and perhaps scheduling an interview." This message was taken at 1:30 PM on May 1.
a. Who should receive this message?
b. What are some questions to ask Ms. Yarborough when returning the call?
c. What action should be taken after speaking with Ms. Yarborough?
3. Mr. Juan Ross calls to get his prescription for Ambien refilled. His pharmacy is Wolfe Drug, and the drugstore phone number is 214-555-4523214-555-4523 FREE. Mr. Ross is allergic to penicillin. His phone number is 214-555-2377214-555-2377 FREE. Mr. Ross's message was received on July 23 at 10:15 AM.
a. Who should receive this message?
b. What are some questions to ask the patient when returning the call?
c. What action should be taken after speaking with the patient?
4. Mr. Benjamin Adams calls to speak to the office manager to express his dissatisfaction with the times he was offered for an appointment. His job is strict about attendance, and he cannot leave work until 4 PM. He has requested appointment times after 4 PM, but the scheduling assistant tells him that he cannot have an appointment any later than 4 PM. Mr. Adams is concerned that he will not be able to be at the clinic at that exact time, and he is frustrated that the clinic is not more responsive to his needs. He called at 2:15 PM on March 14. His phone number at work is 972-555-6343972-555-6343 FREE and his cell phone number is 214-555-8080214-555-8080 FREE.
a. Who should receive this message?
b. What are some questions to ask the patient when returning the call?
c. What action should be taken after speaking with the patient?
5. "This is Ms. Garrett from Blue Cross/Blue Shield and it is 10 AM on June 5. I am calling to discuss employee benefits for the coming year with the office manager. BCBS provides insurance coverage for your clinic employees. Would you please have the office manager return my call when she has a few moments to talk? My number is 800-555-0024800-555-0024 FREE, extension 415. Thank you."
a. Who should receive this message?
b. What are some questions to ask Ms. Garrett when returning the call?
c. What action should be taken after speaking with Ms. Garrett?
6. "This is Sarah at Cline Meador Lab with a STAT laboratory report. It is 9:35 AM on November 16. The patient's name is Laura Williamson and her WBC count is 18,000. Please notify Dr. Beard immediately. The laboratory phone number is 800-555-3333800-555-3333 FREE and my extension is 255. If she has any questions, please have her give me a call. Thanks."
a. Who should receive this message?
b. What are some questions to ask Sarah when returning the call?
c. What action should be taken after speaking with Sarah?
7. Judy Jordan has migraine headaches and occasionally takes hydrocodone to relieve the pain. Dr. Beard leaves the office for the weekend at noon on Friday, and office policy dictates that she is not to be paged except in emergencies. Patients with routine or lesser health issues are to be instructed to make an appointment to come in and see the physician or to go to the emergency department. Ms. Jordan calls at 4:45 PM on Friday afternoon, March 9, after Dr. Beard has left the office. She requests that the staff authorize a refill for her pain medicine and insists on speaking to the office manager, who currently is in a meeting. Ms. Jordan's phone number is 214-555-9822214-555-9822 FREE.
a. Who should receive this message?
b. What are some questions to ask the patient when returning the call?
c. What action should be taken after speaking with the patient?
8. Gary Burritt is moving out of state, so he calls the office because he needs a copy of his medical records. Dr. Beard prefers to send medical records directly to the receiving physician. Mr. Burritt's phone number is 512-555-6679512-555-6679 FREE. Today's date is December 20, and this message was received at 11:45 AM.
a. Who should receive this message?
b. What are some questions to ask the patient when returning the call?
c. What action should be taken after speaking with the patient?
9. "Hello. My name is Christina Cawtel, and I was referred to your office by Dr. Preston for evaluation of an ovarian cyst. Today is Wednesday, October 4, and it is 8 AM. I would like to make an appointment for early next week if possible. My phone number is 817-555-9325817-555-9325 FREE. Oh, and by the way, I need to know if you are a provider for Aetna, because my company just changed to their managed care plan. I probably need to have a mammogram, too, and want to see whether you will order it before I come in for the appointment. Thanks."
a. Who should receive this message?
b. What are some questions to ask Ms. Cawtel when returning the call?
c. What action should be taken after speaking with the patient?
10. "My name is Janeen Shaw, and I am Dr. Beard's patient. It is just before 2 PM and I am trying to reach you as soon as you open your office after lunch. I am having a hard time breathing, and I have stomach pains. I am hurting all over my upper body, on my chest, my arms, my neck, just everywhere. I'm sweating, and I'm very nauseated. I'm 45 years old, and I'm almost never ill. I wanted to find out if I can come in for an appointment today. Please call me back as soon as possible. My phone number is 601-555-3423601-555-3423 FREE. Thank you. Please call as soon as you can. I really feel awful."
a. Who should receive this message?
b. What are some questions to ask the patient when returning the call?
c. What action should be taken after speaking with the patient?
11. Briefly explain how the following callers and types of calls should be handled.
a. Angry callers
b. Sales calls
c. Emergency calls
d. Unauthorized inquiry calls
e. Callers with complaints
f. Callers who speak foreign languages or have heavy accents.
12. List five questions that might be asked of a patient who calls with an emergency situation.
13. What is the phrase that often calms an angry patient?
14. Explain the procedure for transferring a phone call.
15. What should the medical assistant do if a caller refuses to identify himself or herself?
PART II: CASE STUDIES
Directions: Please provide detailed and elaborate responses to the following questions. Your responses should include examples from the reading assignments, if possible. Your answer to each question should be 1 to 2 paragraphs composed of 3 to 5 sentences.
1. Robert is an HIV-positive patient. His employer invites the local blood bank to come to the workplace every 6 months and conduct a blood drive. Robert has declined donating in the past because of his HIV status but often feels pressured by co-workers to give blood. None of them are aware that he is HIV positive. How do blood banks handle this situation today? Does Robert have alternatives that will resolve the situation? Explain your answer.
2. A 10-year-old girl was brought to a physician's office with a complaint of a headache after gymnastics practice in mid August. The clinic was a freestanding minor emergency center and not the child's regular physician's office. The girl and the adult who had brought the child to the clinic-the girl's aunt-both denied that she had been in any type of accident and stated that her only complaint was the headache and being tired and hot. The adult mentioned that she also seemed a bit disoriented during the drive to the clinic. She didn't recall having been at gymnastics practice less than an hour earlier. The child told the physician that she had been a gymnast for 6 years and that she really liked her coach. The outside temperatures had reached 101° that day. The physician examined the patient and suggested that she be taken home to rest and rehydrate. No prescriptions were written, and the girl left the clinic. Two hours later the girl could not be roused from sleeping and was immediately taken to the emergency room at the closest hospital by her aunt. The girl's mother met them at the hospital just in time to be told that the girl had slipped into a coma. The physician suspected that she had experienced heat stroke. The aunt was shocked and mentioned that she had taken the girl to a clinic earlier, questioning why this diagnosis was not considered at that time. The mother of the child immediately called the clinic and berated the physician for putting her child into a coma. What went wrong in this case? Who is responsible for the child's condition? Is this a "good" malpractice case?
3. Brooke Comis works for Dr. Tomms as a clinical medical assistant. She is a former office computer specialist who worked in the computer field for 12 years before she entered medical assisting school. She changed career fields because of the work prospects in technology and acted on her dream to enter the medical field. Unfortunately, she is the only person in the office who is knowledgeable about computers, the Internet, and networking. Whenever a computer is not functioning correctly or a problem occurs with the network, Dr. Tomms summons Brooke and expects her to fix it. When the physician decided to buy new computers, he expected Brooke to assemble all of them and set up a new network. Brooke gets more and more irate each time she is asked to perform these duties, because she is not compensated other than her normal hourly pay. She knows that if Dr. Tomms paid someone to do this work, it would cost him more than her monthly salary. Brooke is not certain how to approach this situation with the physician. What should she do first? How should she approach the physician? Should she refuse to perform computer work? What could happen if she refuses?
4. Denise has been the receptionist for a moderately large clinic for the past 3 months. She replaced Dorothy, who retired. Denise has been overwhelmed with the calls to the clinic, and the office manager has spoken to her twice about missing calls. Denise insists that she is constantly on the phone answering and transferring calls. She is beginning to lose faith in herself, but as she considers why she is failing at her job, she realizes that two new physicians have joined the practice since Dorothy left, and numerous calls come to the clinic for those two physicians. Denise wants to suggest to the office manager that perhaps the time has come for a second receptionist, but she is unsure how to broach the subject. How can Denise begin her conversation with the office manager? What should she not do or say?