Medical assistants exist because doctors need heroes.“
– Anonymous
Ted Rosen, MD, FAAD
Editor-in-Chief
I read with vivid interest the following published manuscript by Gold and Harmes: Medical assistants identify strategies and barriers to clinic efficiency, published April 2022 in The Journal of Family Practice.1 If you can find the time, this is a worthwhile, instructive paper.
Despite the expanded role that medical assistants have assumed in many primary care and specialty practices (including dermatology), research into the medical assistant point of view is quite limited.
In our own office, we rely very heavily on medical assistants to do just that: assist the direct care providers. Our medical assistants not only perform mundane functions (rooming the patients, obtaining vital signs, and assuring the examination rooms are cleaned between occupants) but may also assist with procedures and other aspects of patient management. For example, our medical assistants may help with documentation in the electronic medical record, assembly and filing of prior authorizations and appeals, order entry, pre-visit planning, and fulfillment of institutional required quality metrics.
Their observations and suggestions, therefore, can be and often are invaluable. In addition, their criticisms and concerns can be quite enlightening.
In the aforementioned study, 75/86 medical assistants working in six academic primary care clinics responded to an email survey. Eighteen of the respondents were subsequently interviewed face-to-face to obtain clarification and elaboration on some common themes expressed during the survey.
Of note, all those who responded felt that they served an “essential role” in the delivery of quality care. Moreover, virtually all felt that health care was a personal calling, not just a job. At the same time, some frustrations were also clearly expressed.
Perhaps you might consider performing a similar survey of your own employees? At the very least, listen to what the participants of this survey had to say!
One suggestion was to have a daily pre-clinic huddle. This may identify in advance which patients are likely to need a biopsy, for example, and gives the medical assistant an opportunity to prepare requisite materials. It also facilitates schedule planning—at which times might it be possible to add a “work-in” who calls with an urgent complaint and, conversely, at which time slots will there be a danger of falling behind (a complex patient, a patient known to be excessively talkative)?
Another clear suggestion was to establish a more-or-less uniform medical assistant workflow. Do you want vital signs taken on all patients? Older patients? Only select, designated patients? How many “guests” may be allowed in the examination room, aside from the patient? These and other practical questions should be codified for the medical assistant/provider team.
Speaking of teams, while the medical assistants in this survey understood the need for widespread cross-training (to account for both planned and unexpected staff absence), they indicated that team composition should be as relatively stable as possible. When a medical assistant consistently works with the same provider, workflow uniformly improves. Conversely, the provider learns to trust and feel comfortable with the medical assistant’s skillset.
What about the common critical observation that medical assistants made? Provider procrastination is the number one problem from the medical assistant perspective. This could consist of a delay in signing or co-signing orders already entered. This might manifest in a failure to convey lab/pathology results to patients, leaving the medical assistant in the uncomfortable position of trying to create an alibi or of trying to transmit results but being unable to answer follow-up questions from the patient. This might be failing to sign refill requests or prior authorization forms or other documents that require actual provider signatures.
While various forms of “paperwork” are not my (or your) favorite thing to do, it simply is unfair to make the medical assistant try to deal with an ever-increasing burden of such documentation.
Another complaint from the medical assistants was the failure of the provider to do anything to help create efficiency. Case in point, as an incidental complaint during a rosacea follow-up, a patient pulls up the shirt sleeve and asks about a lesion on the upper arm, and the lesion clearly needs a biopsy. After informing the patient of that, the provider can offer a gown, instruct the patient to change, and inform the patient that the medical assistant will be right back to obtain a signed informed consent (efficient). Or the provider can leave the room and say that the medical assistant will be right back to set up everything (inefficient).
A final major criticism might or might not hit home with you. Don’t bring your personal or familial disappointments or difficulties into the office. Following this dictum, never take out your frustrations on the medical assistant! Being rude, imperious, demeaning, or insulting because you had a disagreement with the spouse or offspring is simply inexcusable. The medical assistant is not your personal punching bag—neither literally nor figuratively. Your relationship with the medical assistant should always be polite and collegial.
The medical assistant can and should be a source of useful information and a constant source of aid. Pay heed to the feedback these authors discovered.
I have given you the highlights! And here’s what my favorite medical assistant once told me: “I call myself a medical assistant because ‘full-time-multi-tasking-ninja’ is not an actual thing.”
Reference:
- Gold KJ, Harmes KM. Medical assistants identify strategies and barriers to clinic efficiency. J Fam Pract. 2022;71(3):E1-E7. doi:10.12788/jfp.0364.
This is Ted’s take. What’s yours? Ted.rosen@thedermdigest.com