medical science: history and practice lesson 2: the practice of medicine

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Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e

Beaman • Fleming-McPhillips • Routh • Gohsman • Reagan

Pearson's ComprehensiveMedical AssistingAdministrative and Clinical Competencies

Second Edition

CHAPTERCHAPTER CHAPTERCHAPTER CHAPTERCHAPTER 22Medical Science: History and PracticeLesson 2:The Practice of Medicine





Lesson Objectives

Upon completion of this lesson, students should be able to …

• Describe the difference between an internship and a residency in the training of physicians.

• State which type of medical practice is addressed under the medical and surgical specialties.

• Discuss ten allied health fields and the educational requirements for each of them.

• Discuss the current trends in health care that are driving changes in medical practice.





Title of Doctor

• Designates a person who holds a doctoral degree

• Physicians are medical doctors or MDs• Practicing medicine requires a minimum of

9-10 years of education and training– Four-year college degree in premedical

studies– Four years of medical school– 2-6 year internship depending on specialty

area





• State medical board examination– Upon passing the individual is licensed to

practice medicine in that state

• American Board of Medical Specialties– Upon passing the individual is board certified

in a chosen specialty area

To learn more about the American Board of Medical Specialties, click here or go to

http://www.abms.org

Required Examinations for Physicians





Critical Thinking Question

1. What is the difference between a Doctor of Osteopathy (DO) and a Medical Doctor (MD)?





• Learns the skill of manipulation therapy in schools of osteopathy

• Places greater emphasis on the relationship between the musculoskeletal systems and the organs of the body

• Usually able to perform the same procedures as a medical doctor

Visit the American Academy of Osteopathy by clicking here or visiting

http://www.academyofosteopathy.org

Doctor of Osteopathy





Others with Title of Doctor

• DC – Doctor of Chiropractic• DMD – Doctor of Dental Medicine• DDS – Doctor of Dental Surgery• EdD – Doctor of Education• OD – Doctor of Optometry• PhD – Doctor of Philosophy• DPM – Doctor of Podiatric Medicine





Medical Practice Acts

• Indicates who must be licensed to perform certain procedures

• Establishes the requirements for licensure• Denotes duties associated with the license• Sets grounds on which a license can be

revoked• Designates reports that must be made to

the government• Specifies the penalties for practicing

without a valid license





Ways a Medical License May be Granted

• Examination– Offered by each state– Usually taken before the end of medical

school– Federal Licensing Examination (FLEX) –

official medical licensing exam in the U.S.– Upon passing the exam, a license is issued

after an internship is completed






• Examination– Passing the exam entitles one to set up

private practice as a general practitioner– U.S. Medical Licensing Examination (USMLE)

provides a single licensing exam for graduates from accredited programs






• Endorsement– Means approval or sanction– Granted to applicants who have passed the

National Board Medical Examination (NBME)– Most physicians in the U.S. are licensed by

endorsement– If a medical school graduate is not licensed by

endorsement they must pass the FLEX– Graduates of foreign medical schools must

pass the same requirements as American graduates






• Reciprocity– When one state accepts another state’s

license– Allows the physician to practice in the state

without having to take another examination





Re-Registration for Physicians

• Required to maintain license• Required either annually or bi-annually• Physician is notified by mail when re-

registration is required• Requirements of re-registration:

– Payment of a fee– 75 hours of continuing medical education

(CME) units in a three-year period





Causes for Suspension or Revoking of a Medical License• Unprofessional

conduct• Commission of a

crime• Personal incapacity to

perform one’s duties





Health Care in the United States

• Largest industry • Provides about 12.9 million jobs• Costs increasing faster than cost of living• About 14% of gross national product spent

on health care• Heath care costs per year equal to about

1.5 trillion dollars





Health Care in the United States

• Costs of employer-sponsored health care continues to increase

• Only nation that does not provide some type of basic health care for all citizens





Factors Causing Increase in Health Care Costs in the U.S.• Expensive technological advances• Physician specialization• Breakdown of physician-patient relationships

leading to the increase of lawsuits• Higher costs of medications• Older population needing more services• Longer life expectancy • Informed consumers demanding more tests

and options





Factors Causing Increase in Health Care Costs in the U.S.• More uninsured rely on the emergency room

for primary care• Uninsured having less or no access to

preventive care leading to the need for treating more advanced illnesses or ailments

• Social conditions such as:– Homelessness– Substance abuse– Poverty– Child abuse





Let’s take a look at each one of these more closely!

Types of Medical Practices

• Solo practice• Sole proprietorship• Partnership• Associate practice• Group practice• Professional corporation





Solo Practice

• Main form of medical practice in early part of the twentieth century

• Becoming less popular due to increase in costs, changes in practicing medicine, and legal environment

• Physician practices alone and is responsible for all administrative decisions





Solo Practice

• To provide care during off-duty times, physicians enter into agreements with other physicians

• Office expenses can be shared if two solo practice physicians work out of the same building





Sole Proprietorship

• One physician responsible but other physicians may be employed

• Physician-owner pays all expenses and retains all assets

• Owner is responsible and liable for actions of all employees





Partnership

• Legal agreement between two or more physicians to share in the business operation of a medical practice

• Each partner is responsible for the actions of all partners





Associate Practice

• Legal arrangement in which physicians share a facility and staff

• Typically physicians do not share responsibility for legal actions of each other

• Physicians act as if their practice is a sole proprietorship

• Patients should understand that each physician in practice is not responsible for the other





Group Practice

• Consists of three or more physicians who share the same facility and practice medicine together

• A legal form of practice where all expenses, income, personnel, equipment, and records are shared





Group Practice

• Specialties where groups are prevalent include anesthesiology, rehab and OB services, radiology, and pathology

• Practice can be designed as an HMO or as an IPA





Professional Corporations

• Managed by a board of directors• Created for legal and financial benefits• Physician-members become shareholders• The corporation can be sued but not the

individual assets of the members





Professional Corporations

• Benefits offered by corporations include:– Reimbursement for medical expenses– Profit sharing– Pension plans– Disability insurance





Common Medical Specialties

• Allergy and immunology– Treats abnormal responses to acquired

hypersensitivity to substances with medical methods including testing and desensitization

• Anesthesiology– Administers both local and general drugs and

provides respiratory and cardiovascular support during surgery

• Bariatrics– Treats patients who are obese






• Cardiology– Treats diseases and disorders of the heart

and blood vessels

• Dermatology– Treats injuries, growths, and infections

relating to the skin, hair, and nails

• Endocrinology– Treats diseases and disorders of the

endocrine system





Emergency Medicine

• Recognizes, prioritizes, and treats acute injuries, trauma, and illnesses

• Supervises paramedic pre-hospital care






• Family Practice– Treats the entire family regardless of age and sex

• Gastroenterology– Diagnoses and treats illnesses of the gastro-intestinal

system

• Geriatric Medicine– Focused on the care of diseases and disorders of the

elderly

• Hematology– Studies blood and blood-forming tissues






• Oncology– Study of cancer and cancer-related tumors

• Primary Medicine (Internal Medicine)– Diagnoses and treats non-surgical problems in adult

patients

• Neurology– Treats non-surgical patients with disorders and

diseases of the nervous system

• Nephrology– Specializes in disorders and diseases of the kidneys





Obstetrics and Gynecology

• Obstetrician– Provides pre-natal

care up through the postpartum period

• Gynecologist– Provides

medical/surgical treatment of diseases/disorders of the female reproductive system






• Ophthalmology– Opthalmologist: Treats disorders of the eye– Opthamology: Diagnosis and treatment of vision

problems using both medical and surgical procedures

• Orthopedics– Orthopedist: specializes in prevention and

correction of disorders of the musculoskeletal system

– Orthopedic surgeon: specializes in surgical procedures relating to this specialty





Otorhinolaryngology

• Specializes in the medical and surgical treatment of ear, nose, and throat disorders

• Terms:– Otology – study of the ear– Rhinology – study of the nose– Laryngology – study of the throat






• Pathology– Specializes in diagnosing abnormal changes in

tissues– Forensic pathologist – expert in determining

identity of a person based on evidence of body parts, dental records, and tissue samples

• Pediatrics– Specializes in the development and care of

children from birth to maturity

To learn more about the field of pediatrics visit the American Academy of Pediatrics by clicking here or visiting http://www.aap.org






• Physical and/or rehabilitative medicine– Specializes in treating patients with physical

injuries and disabilities

• Sports medicine– Treats athletes using preventive and

diagnostic medicine

• Psychiatry– Specializes in the diagnosis and treatment of

patients with mental, behavioral, or emotional disorders






• Pulmonology– Treats lung problems

• Radiology– Specializes in the study of tissue and organs

based on x-ray visualization• Rheumatology

– Treats disorders and diseases characterized by inflammation of the joints such as arthritis

• Urology– Treats problems with the urinary system and

reproductive health initiatives for men





Surgery and Specialty Areas

• Surgeons correct illness, trauma, and deformities through operative procedures

• Specialties include:– Cardiovascular– Colorectal– Cosmetic/plastic surgery– Hand– Neurosurgery– Orthopedic– Oral (Periodontics, Orthodontics)– Thoracic





Health Care Institutions

• Hospitals• Outpatient surgical centers• Urgent care centers• Nursing homes• Long-term-care institutions• Hospice





Hospitals

• Largest employer in the U.S.• Key resource for health care in the U.S.• Deliver care for acute illnesses• Sites for major surgical procedures• Train and educate health care professionals• Conduct research• Provide education resources to the public• Size varies depending on needs of the

community





• The Joint Commission (formerly the Joint Commission on the Accreditation of Health Care Organizations (JCAHO))

• Private nonprofit organization • Encourages high standards of medical care• Institutions accredited by the Joint

Commission must adhere to strict guidelines

To learn more about Joint Commission accreditation click here or visit http://www.jointcommission.org

The Joint Commisssion





Categories of Hospitals

• General hospital– Provides routine and specialized care such as

intensive care units and emergency rooms– Range in size from 50 to several hundred beds– Usually found in most towns and communities

• Teaching hospital– Provides same type of care as a general hospital– Generally located near a university medical school– Students, interns, and residents treat patients – More specialists may be on staff to educate and train

interns and residents





Categories of Hospitals

• Research hospital– Provides patient care and conducts research to

combat disease– Examples include Veteran’s Affairs hospitals and

Shriners hospitals

• Specialty hospital– Provides specialized care for certain types of patients

such as children, psychiatric patients, or burn victims





General Departments in Hospitals

• Emergency services• Laboratory• Radiology• Oncology• Nuclear medicine• Psychiatry• Pathology• Immunology• Respiratory therapy• Physical therapy

• Occupational therapy• Nursing• Dietary• Pharmacy• Central supply• Housekeeping• Engineering• Health information• Social services





Medical Privileges

• Refers to a physician's right to practice medicine in a particular hospital or other health care facility

• Physicians can also gain “courtesy” or “visiting privileges” – provides the right to see a patient on a referral basis





Outpatient Surgical Centers

• Facility where minor surgical procedures are performed

• Also known as free-standing outpatient surgical centers

• Surgeries performed at these centers generally require very little recovery time

• Medical assistant tasks in this environment include: scheduling and preparing patients for surgery, receiving and admitting patients, assisting with some surgeries, and discharges





Urgent Care Centers

• Offer quick care for non-emergent situations• In some managed care systems, these

centers may be designated as a primary care facilities

• Sites are popular for workers’ compensation cases and occupational medicine

• Other types of care provided include: performing sports physicals, setting fractures, drawing blood levels, treating infections, and providing care beyond the usual physician office hours





Nursing Homes

• Established in the nineteenth century• Long-term-care facilities that provides care

to the elderly• Typically for-profit organizations





Types of Long-Term-Care Institutions

• Skilled nursing facility (SNF)– Intended for patients needing round the clock

skilled nursing care– Patients must be recertified every 100 days to

continue their stay• Immediate-care facility (ICF)

– Intended for patients who no longer can live on their own but do not require 24-hour skilled nursing care

– Facility must meet federal guidelines to receive federal funds for services provided to Medicare patients





Types of Long-Term-Care Institutions

• Extended-care facility (ECF)– Provides services to patients who no longer need

skilled nursing care from a hospital but are too ill or incapacitated to go home

– Provides custodial care rather than skilled personnel

• Assisted-living facility– Offers living arrangements for older adults who

need minimum supervision– Residents have separate living quarters and pay

a fixed fee to have some meals and services





Critical Thinking Questions

1. What is the goal of hospice?

2. How can hospice be helpful in addressing not only the patients’ needs but the families?





Hospice

• Emphasizes improved quality of care for the dying

• Most hospice care is provided at home• Some programs provide care in home-like

centers• Facilitates the care of the patient by family

members or significant others• Goal is to ensure the patient is comfortable

through pain management and support





Credentials of Health Care Professionals

• Certification– Shows that an individual has met the

educational/experience standards in their profession

• Registration– Indicates that an individual is registered with a

specific organization that has determined the person is qualified to perform duties in their profession

• Licensure– Provides proof that the individual has been authorized

by a government agency to perform work in their profession





Career Ladder in Health Care

1. Aide: On-the-job training, high school diploma

2. Assistant: Up to 1-year classroom and clinical preparation, diploma

3. Technician: 2-year community college or vocational program, Associate’s degree (AS)

4. Technologist: 4-year college program, Bachelor (BA, BS)

5. Professional: 4-year degree, advanced degree and clinical training, Bachelor (BA, BS), Master or Doctorate





National Health Care Skill Standards

• Developed to define the body of knowledge and specific skills health care workers should possess for entry-level and technical-level positions

• Core standards are used by schools, colleges, and health care facilities to establish curriculum and competencies

• Therapeutic cluster careers include those that involve the health care status of the patient





Certified Nursing Assistant (CNA)

• Completed a training program and taken a state examination

• Assists nurses in nursing homes, hospitals, and other health care facilities

• Patient care includes bed baths, vital signs, feeding, and ambulation

• Also called a nurse’s aid or orderly• PCT - patient care technician, may have a CNA

or medical assisting background and can perform technical tasks (drawing blood, ECGs)





Critical Thinking Questions

1. What is the difference between a licensed practical nurse and a registered nurse?





Licensed Practical Nurse (LPN)

• Performs some of the same, but not all, clinical nursing tasks of a registered nurse

• Must have graduated from a recognized one-year program

• Must by licensed by the National Federation of Licensed Practical Nurses

• In some states, LPN is known as LVN (licensed vocational nurse)

To discover more about opportunities in nursing click here or visit http://www.bls.gov/oco





Registered Nurse (RN)

• Provide hands-on patient care• Employed in hospitals, physicians’ offices,

industry, governmental agencies, ambulatory care units, emergency services, and schools

• Work ranges from direct patient care, to teaching and supervising others, performing research, and managing agencies

• Two-year or four-year program• Licensed after passing the National Council

Licensure Examination (NCLEX)





Nurse Practitioner (NP)

• RN with additional training

• Provide basic care including diagnosing and prescribing medications and treatments

• Masters-degree, trained individual





Occupational Therapist (OT)

• Provides treatment for those who are physically, mentally, developmentally, or emotionally disabled

• Develops programs that help restore the patient’s ability to manage activities of daily living (ADLs)

• Requirements to practice– Bachelor’s degree and six months on-the-job

training– Certification through the American Occupational

Therapy Association (AOTA)





Physical Therapist (PT)

• Treats diseases or disabilities of the joints, bones, and nerves

• Treatments include message, therapeutic exercises, and heat and cold treatments

• Employed at hospitals, ambulatory care and rehab centers, and schools for the physically challenged

• Can open own private practice• Four-year degree in PT, complete a four-month

clinical internship, pass state licensure exam





Physical Therapy Assistant

• Work under the supervision of a PT

• Two-year college degree

• Pass written licensure examination in some states





• Field emerged in 1970s• Assists the physician in the primary care of

patients• Can prescribe medications in nearly all states• Two-years education after a bachelor’s degree• Work and/or internship experience• Pass an accreditation examination

Visit the American Academy of Physician Assistants by clicking here or visiting http://www.aapa.org

Physician’s Assistant (PA)





Respiratory Therapist (RT)

• Evaluates, treats, and cares for patients with breathing problems

• Employed in hospitals, cardiopulmonary laboratories, nursing homes, HMOs, and ambulatory care facilities

• Certified respiratory therapy technician (CRTT)– One-year internship and pass written exam

• Registered respiratory therapist (RRT)– Completion of college program, one year’s experience

in the field, pass written exam





Dietician

• Work with physicians to coordinate patient diets with treatments

• Provide consulting services, offer seminars, author books, counsel patients, plan food service systems, design nutrition plans for athletes

• Bachelor’s degree with major in foods and nutrition with an internship in a dietary department

• Employed in hospitals, long-term-care facilities, schools, and prisons





Dental Hygienist

• Works directly with patients to clean teeth, take oral x-rays, teach oral health, and discuss results of dental exams with dentist

• Two-year community college program or four-year bachelor’s program

• Pass both a state written and a clinical examination





Emergency Medical Technicians (EMTs)/Paramedics

• Trained in providing emergency care and transporting injured patients to a medical facility

• Skilled in recognizing emergency conditions

• Always work under direct supervision of physician





Emergency Medical Technicians (EMTs)/Paramedics

• Levels of EMTs:– Basic – beginner EMT performs basic life

support– Advanced – has more training and advanced

skills– Paramedic – highest level of EMT, able to

treat cardiac arrest, perform defibrillation, administer certain drugs





Pharmacist

• Deals with ordering, maintaining, preparing, and distributing medications

• Five years education, one-year internship, become licensed

• Pharmacy technician:– Attends a community college or private vocational

program. Assists pharmacists in preparing meds.

• Pharmacy clerk– High-school degree, assists pharmacists with typing

prescription labels, assigning prescription numbers, and maintaining supplies





Medical Social Worker

• Develops programs and services to meet the special needs of the ill, physically and mentally challenged, and the elderly

• Cares for the total person (emotional, cultural, social, and physical needs)

• Assists patients and families to handle problems associated with long-term illness or disability

• Bachelor’s or master’s degree• License or registration depending on state





To learn more about each one of these fields, go online and conduct research!

Diagnostic Career Cluster

• Careers that involve measuring, evaluating, and reporting patient information

• Examples:– Ultrasound technologist (AART)– X-ray Technologist (Radiologic Technologist)– Electroencephalograph Technician– Diagnostic Imaging Technician





Medical Laboratory Careers

• Phlebotomist or Venipuncture Technician– Skilled in drawing blood from patients

• Laboratory Technician (MLT and CLT)– Skilled in testing blood, urine, lymph, and

body tissues

• Medical Technologist (MT) or Clinical Laboratory Scientist (CLS)– Directs the work of other laboratory staff – Responsible for quality assurance in the lab





Information Services Career Clusters

• Careers involved with documenting patient information

• Tasks related to this information include:– Managing – Coding – Analyzing– Maintaining– Retrieving





Health Information Technologist

• Maintains the permanent records relating to a patient’s condition and treatment

• Graduates from an accredited medical records program

• Two-year associates degree• Several years experience as a medical

records clerk• Successfully completes the record

technical examination to be an ART





Health Information Technologist

• Registered medical records administrator (RRA) requires a bachelor’s degree and successful completion of an exam





Other Information Services Careers

• Medical transcription– Enters dictation into a computer

• Office management– Supervises the entire support staff

• Unit clerk/communications clerk– Responsible for clerical duties, reception

work, and other communication duties in hospitals, long-term-care facilities, and clinics





Environmental Services Career Cluster

• Careers involved with the patient’s health care environment

• Examples:– Biomedical Equipment Technician– Central supply/sterile supply workers– Housekeeping staff– Food Service Aides





• Government agency employing over 8,600• Division of the Department of Health and Human

Services (DHHS)• Purpose is to safeguard public health by

preventing and controlling disease• Acts as a resource for the medical profession on

causes of diseases, alerts to potential outbreaks, recommendations for treatment, disease research, prevention, control, and educationTo visit the CDC, click here or go to http://www.cdc.gov

Centers for Disease Control and Prevention (CDC)





Questions?

medical science: history and practice lesson 2: the practice of medicine

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