PUBLIC DUTIES OF PHYSICIANS 

Physicians have responsibilities to the general public. Some  of these duties include reporting births, stillbirths, deaths,  communicable illnesses or diseases, drug abuse, certain injuries such as rape, abuse of children or older adults, gunshot  and knife wounds, and animal bites. Table 3-3 outlines the  public duties of the physician. 

When abuse is suspected, you must share your concerns  immediately with the physician. It is best not to make  assumptions or accusations in front of the patient; rather,  discuss your observations privately with the physician. The  physician can help determine the best way to deal with your  concerns and help the patient.

 

TABLE 3-3 | Public Duties Of the Physician

Duty Description 

Births Issuing of a legal certificate, which will be maintained during a person’s life as proof of age. Many benefits  and documents, including Social Security, passport, and driver’s license, depend on having a valid birth  certificate. 

Deaths Physicians sign a certificate indicating the cause of a natural death. Check with your state public health  department to determine specific requirements. For example, in the case of a stillbirth before the 20th week  of gestation, the medical assistant will have to determine if both a birth and death certificate are required. A  coroner or health official will have to sign a certificate in the following cases: 

• No physician present at the time of death
• Violent death, unlawful death
• Death as a result of criminal action
• Death from an undetermined cause

Reportable  Communicable  Diseases  Physicians must report all diseases that can be transmitted from one person to another and are considered a  general threat to the public. Some common diseases that must be reported to the CDC include:  • AIDS/HIV  • Chickenpox  • Chlamydia trachomatis  • Cholera  • Diphtheria  • Gonorrhea  • Hepatitis A, B, and C  • Lyme disease  • Malaria  • Measles  • Mumps  • Rabies (human and animal cases)  • Rubella (including congenital syndrome)  • Salmonellosis  • Severe acute respiratory syndrome (SARS)  • Smallpox  • Syphilis, including congenital syphilis  • Tetanus  • Trichinosis 

Reportable  Injuries  Certain injuries are reportable, according to state requirements. These injuries include gun or knife wounds,  rape and battered persons injuries, and spousal, child, and elder abuse. 

Child Abuse Questionable injuries of children, including bruises, fractured bones, and burns, must be reported. Signs of  neglect, such as malnutrition, poor growth, and lack of hygiene, are reportable in some states. 

Elder Abuse Physical abuse, neglect, and abandonment of older adults is reportable in most states. The reporting agency  varies by state but generally includes social service agencies. 

Drug Abuse Abuse of prescription drugs is reportable, according to the law. Such abuse can be difficult to determine  because the abuser may seek prescriptions for the same drug from several different physicians. A physician  will want to see a patient before prescribing a medication.

 

Physical abuse or neglect of children and older adults  must be immediately reported to the proper authorities.  Every state has child welfare departments and child abuse  and neglect reporting telephone numbers. More information,  including how to report child abuse, can be found at www.  childwelfare.gov. Each state also has adult protection services  (APS). The reporting phone number for elder abuse in each Physical abuse or neglect of children and older adults  must be immediately reported to the proper authorities.  Every state has child welfare departments and child abuse  and neglect reporting telephone numbers. More information,  including how to report child abuse, can be found at www.  childwelfare.gov. Each state also has adult protection services  (APS). The reporting phone number for elder abuse in each state can be found on the National Center on Elder Abuse  website, https://ncea.acl.gov. When dealing with older  adults, signs of possible exploitation by caregivers must also  be recognized. Exploitation is the improper use of someone  else’s money or assets. Unfortunately, sometimes those who  are charged with taking care of an older relative or friend  become greedy and can manipulate the victim out of money or personal property. Like abuse, exploitation is a reportable  incident. Box 3-3 provides additional information pertaining  to identifying elder abuse. 

The subject of domestic abuse is trickier, because sometimes the victim doesn’t want to press charges against the  abuser. These situations must be handled with great care and  delicacy. 

 

Compliance Reporting of Communicable  Diseases 

Federal, state, and local government agencies require medical laboratories and physicians to report when certain  diagnoses are made (refer again to Table 3-3). These reports  help in the identification of trends and possible disease  outbreaks in specific locations. Office personnel, including  the medical assistant, carry out many of the duties that  relate to these responsibilities. Exact reporting requirements vary from state to state, so be familiar with the  requirements of both your state and local county health  departments. 

Many of the diseases that must be reported to local and  state agencies must also be reported to the U.S. Centers for  Disease Control and Prevention (CDC). There are four classes  of mandatory compliance reporting: 

• Total Number of Cases Report—A physician’s office is required to document the total number of cases for a disease over a predetermined period of time. Influenza  and chickenpox are examples of diseases for which the  total number of cases is reported. 
• Mandatory telephone reporting—Some diseases, such as measles and whooping cough, must be reported via a telephone call to the appropriate agency. Again,  state requirements vary. Although some diseases may  be reported within five days of diagnosis, other diseases must be reported within hours of a diagnosis  being made.
• Mandatory written reporting—A written report must be submitted when certain diseases, such as gonorrhea, are diagnosed. •

 Cancer—Each state has a cancer registry. When a  diagnosis of cancer is made, it must be reported to the  cancer registry. 

Figure 3-6 shows the State of New York’s Communicable  Disease Reporting Requirements, and Figure 3-7 shows the  State of New York’s report that must be completed when  reporting communicable diseases. Procedure 3-1 outlines an  example of the steps to complete compliance reporting. 

 

 

 

RISK MANAGEMENT IN THE  MEDICAL OFFICE  The term risk management refers to planning and implementing strategies for reducing the physician’s risk of a  lawsuit in the medical setting. As a medical assistant, dealing so closely with patients, you are in a position to help  reduce those risks. Communicating effectively with the  patient is certainly one of the primary ways to reduce the  risk of being sued. Remember that in many cases you are  the only one in the office who will hear a patient’s complaint. Your ability to handle the complaint professionally  and efficiently may eliminate a potential lawsuit for the  physician. On the other hand, any promise or commitment  that you make to a patient can be legally binding to the  physician who employs you. This means that the physician  can be held responsible for something you have said or  implied to the patient with regard to how the physician  might improve the patient’s condition. 

In addition to the information presented earlier in this  chapter, you can further help your employer and protect  yourself by remembering the recommendations and cautions  that follow.

 

 

BOX 3-3 | Identifying Elder Abuse

Abuse of older adults by family members or caregivers may  occur at home and in institutions. Elder abuse has many  forms, including: 

• Stealing a patient’s belongings
• Inflicting injury and pain
• Mishandling monetary funds
• Withholding care such as food, drink, or medication
• Sexual abuse
• Threatening or confining a patient

 

As a medical assistant, you must be alert to all signs  of abuse. In some cases, especially when the abuser is a  caregiver or family member, the patient may be reluctant  to admit to abuse because of fear the caregiver will become  angry or retaliate. Any concerns or suspicions of abuse  should be immediately discussed, in private, with the treating physician.

 

FIGURE 3-6 New York State requirements for filing a communicable disease report.

FIGURE 3-7 Sample document for reporting a communicable disease.

Procedure 3-1 Performing compliance reporting based on  public health statutes 

Objective ◆ Report the diagnosis of a communicable disease to the appropriate authorities.  Equipment and Supplies  Patient medical record; black ink pen, if completing the form  manually; computer and printer, if completing the form electronically; contact information for appropriate health agencies  or departments; reporting form, either electronic version or  printed document  Method  Scenario: Your patient has been diagnosed with Lyme disease.  He recognized his first symptom on September 18, 20xx. The  diagnosis was made one week later. The patient has not been  hospitalized in relation to this diagnosis.  1. Use the Internet to determine if the disease in question  requires immediate reporting via telephone, or if a case  report documenting the disease can simply be mailed.*  2. Using the patient’s medical record, complete the “Patient  Information” section of the report form. If you are unaware  of the answers to some of the questions, contact the  patient to verify the correct information.  3. Accurately fill out the “Reporter Information” section of  the form.  4. Review the form to ensure all information is complete and  accurate.  5. Give the form to the physician for review and signature.  6. Upload a copy of the report to the patient’s medical record.**  7. Mail the original, signed report to the Department of Health.  *Remember to check the requirements for your specific state. Otherwise, you may choose to reference information from Figure 3-6 in your  textbook.  **If using paper records, make a copy of the record and file the document  appropriately.

 

 

 

Office Management 

Follow these office management guidelines: 

• Treat all patients with the same courtesy and dignity you would expect to receive. Log and return telephone calls promptly. Explain any delays to patients who are  waiting to see the physician. Offer to set up another  appointment if the delay will be very long. 
• Never make promises regarding what the physician can do for the patient. As mentioned before, they can be misconstrued and have the potential to hold the  physician liable for your promises.
• Carefully explain to the patient all fees and responsibilities related to billing, and relay any concerns to office management or the physician.
• Relay any dissatisfied patient’s comments to the physician and practice manager.
• If the physician will be out of town or absent from the office, inform patients by posting the dates in the medical office, making telephone calls, or sending patients letters. Each specific situation will dictate the best method of informing patients. Also provide the name  and telephone number of the on-call physician who will  be managing patient care in the other physician’s stead. 

 

 

 

**Professionalism

 Be respectful of the sexual orientations and preferences of all patients, including those who are lesbian, gay, bisexual, or transgender (LGBT). And,  although laws about what constitutes a “legal” relationship  vary from state-to-state, also respect the patient’s choice of  friends and companions. Severe penalties can be imposed  by the Centers for Medicare and Medicaid Services (CMS)  for discriminating against patients based on gender expression or self-identification. The Joint Commission established  a standard of providing nonbiased care to LGBT patients as  a requirement for accreditation of health care facilities.  Remember that transgender people may need to have tests  or procedures (such a PSA or pap-smear) for a gender other  than the one with which they have self-identified. They may  still have genetic predisposition for illness based on their  original physical gender assignment. As a medical assistant,  you may need to advocate for a patient, for example when an  insurance company refuses to pay for a necessary test that  is not usually done for the gender the patient claims.

 

**PROFESSIONALISM The WORKPLACE

It is important that all members of the office staff  understand their respective roles. No one should  pressure medical assistants to practice outside  their role or scope of practice. If a medical assistant is  pressured to perform tasks that are outside the legal  scope, according to state guidelines or even the company  policy, the medical assistant must notify a supervisor that  she cannot practice outside the scope of responsibility  and training.

 

 

Documentation

 

 These guidelines for documentation must be followed. 

• Carefully sign or initial every entry in a medical record, whether it is electronic or paper. Remember: Medical documents are legal documents and may be used in a  court of law. 
• If the patient did not keep an appointment, be sure to document the fact as a no-show. Document canceled appointments and follow-up attempts to determine  why the patient missed the appointment. This type of  record keeping is especially important if a physician  decides to withdraw from a patient case. It will be used  to establish patient noncompliance. 
• Document when a patient is referred to another physician, and follow up to make sure the patient did see the referral physician.
• Document all patient contacts, including telephone prescription refills, diagnostic tests, and procedures that have been ordered. Call all patients the day after  surgery to check on their progress; document this call. 
• Record all care and treatment given as soon as possible after the patient’s visit. This will keep patient records current and ensure appropriate follow-up treatment if  it is required. 
• Be sure the physician reviews and initials all diagnostic reports in a timely fashion before they are filed.
• Provide all instructions to patients in writing explaining as necessary for complete understanding.

 

Certification and Licensing 

The following considerations pertain to risk management  because they help prevent potential liability issues for your  employing physician. Keep these guidelines in mind when  working in the field. 

• Have a thorough understanding of the limits of certification and standards of care for the medical assisting profession. Never perform any procedure for which you are not trained or qualified to do or that the state  medical practice laws do not permit. 
• Do not diagnose or prescribe, including over the telephone. This applies to all drugs, even those that can be obtained over the counter. You could be charged with practicing medicine without a license.
• Do not call yourself a nurse or allow anyone else to refer to you as the nurse. You must be held to your own standard of care as a medical assistant and not that of a nurse.
• Participate in continuing education and training programs to maintain your skill levels and to stay abreast of the changes in the medical field.

 

Safety  

Office safety is critically important to risk management in the  medical office. Be sure to keep these safety guidelines in mind: 

• Maintain a safe environment in the office or work site for the patients and staff. Promptly handle requests for maintenance repairs. Report any unsafe activities or  hazards at once.  • Carefully check and document medical waste disposal.  Be concerned about the safety of maintenance personnel who must handle the waste containers. Always correctly dispose of syringes and needles as well as  contaminated medical waste in designated hazardous  waste containers. 
• Carefully maintain and document quality checks on laboratory testing equipment.

Box 3-4 highlights examples of unsafe activities and hazards in the medical office. 

 

Compliance Reporting 

Compliance is defined as conforming to a specific rule or acting in accordance with established guidelines to ensure that  specific procedures are performed correctly. Compliance is  an important component of risk management, because it  takes the entire team to understand the importance of avoiding potential liability and work together toward that measure. Unfortunately, compliance with procedures and  regulations is not always observed; sometimes accidentally  and other times on purpose. When there is a break in compliance, it must be reported to the appropriate individuals.

 

Consider the following instances that would mandate compliance reporting. 

 

Errors in Patient Care  Acting under a code of ethics that compels you to safeguard  any patient whose care and safety are affected by the negligent action of someone else, you must follow the chain of  command and report to your immediate supervisor any negligent action you observe. This is discussed later in the chapter. However, it goes without saying that if you accidentally  make an error, you must bring this to your supervisor’s  attention so that it can be corrected immediately. The chapter titled “The Office Environment” outlines how to complete an incident report related to an error in patient care. 

 

Unsafe or Illegal Activities 

Unsafe activities have already been discussed in this section.  The prudent medical assistant will understand the importance of safety and minimizing potential hazards in the  medical office. If you knowingly overlook a hazard that a  reasonable person would report and eliminate, you can be  guilty of negligence. 

Illegal activity, unfortunately, may also occur in the medical practice setting. Examples of illegal activities in the  medical office may include: 

• Fraudulent billing and coding procedures to obtain higher reimbursement for services that were or were not performed 
• Stealing prescription pads and writing illegal prescriptions
• Sexual harassment
• Practicing medicine with an expired license

Any illegal activity that occurs in the health care setting  must be reported to the appropriate authorities, following  protocol. This may include first reporting the issue to an  office manager. If the office manager fails to properly address  the situation, you may need to contact authorities (for example, law enforcement) to report the illegal activity directly.  This should be done in a private location where the utmost level of confidentiality can be employed. Procedure 3-2 provides an overview regarding how to handle illegal activity in  the health care setting.