Medical Assistant Graduate!

Wednesday, December 31, 2008

As of Monday, December 29th I am no longer a "Student" Medical Assistant -- I am a graduated AND gainfully employed Medical Assistant!

I am over-the-moon thrilled at continuing on at the same practice I completed my externship at. I became sad at the thought of not being able to stay there because I became attached to a number of amazing patients -- and they have become attached to me, too.

With the exception of the Office Manager and the doctors (as far as I know anyway), I was the only other employee with the knowledge that there was a good possibility I would be asked to join the practice after my externship was over. I didn't even tell the patients I was working with. Even after they expressed their disappointment if I became employed elsewhere. That was tough to do, too!

Today I performed a wound care on a delightful 80-something year old woman. In the short span of three days, approximately two weeks ago, she was involved in an automobile accident (she was driving, totaled her van and received a black eye and a cut on her eyebrow) then she slipped and fell in her kitchen and scraped up both of her shins in ways you cannot begin to imagine.

I assisted the physician in removing both of her leg bandages to confirm everything was healing properly and that there was no infection present. Thanks to daily home health care, they are healing beautifully and there is currently no sign of infection.

She also scraped up one of her wrists but I cannot remember if that was from the auto accident or the slip and fall.

Today I learned another venipuncture technique -- drawing blood from a patient's foot. This patient was a retired LPN and when I entered the exam room to draw her blood she let me know right away that she was a difficult draw. She was NOT exaggerating! Her veins are teeny tiny AND could not be palpated to at least locate them -- even if we could not see them.

I hear that a lot from patients -- "I'm a difficult draw". I instantly think, inside my head of course, "I LOVE a challenge"! Nine times out of ten (in my head, of course!) I prove the patient wrong. Several times I have been either the ONLY MA in our office, or the only OTHER MA in our office do a successful draw in ONE poke.

I almost exclusively use a "butterfly" needle when drawing blood. Mostly because the needle is smaller in diameter, shorter in length and easier to manipulate if a vein "rolls" and I need to reposition it within the patient's arm.

I like the "butterfly" needle so much so that I tell my patients it's my "Magic" needle. I try to time the delivery of that information to occur just before I insert the needle into the patient's arm. As the patient ponders on how a needle could possibly be "Magic", I'm in and out of their vein.

Almost every single time I use my "Magic" needle the first thing the patient says when I've removed the needle from their arm is "That didn't hurt a bit!" I flash them a cheesy, dimpled smile and tell them "That's my "Magic" needle!"

The "Magic" needle is not the only distraction technique I employ when drawing blood. Because the "butterfly" needle is so low-profile, I come in low on the vein. Other MAs come in high on the vein.

In my humble opinion, here's the difference:

Coming in Low: Holding the "butterfly" between my thumb and first finger, I make sure that the rest of the hand (palm and three fingers) I'm holding the needle in is lightly resting on the patient's arm. Although I do this to steady my hand, I have found it is also a simple distraction for the patient. Because I have positioned the needle to be as close to parallel as possible to the arm, I allow my thumb and finger to softly drag across the patient's skin as I head for the vein. Instead of concentrating solely on the "poke" to come, they feel the warmth of my hand and the slight pressure of my fingers on their arm while they're pondering how a needle can be "Magic". :-)

Coming in High: I saw this a lot in school. It's not an "incorrect" way by any means, it is just my personal opinion that it is much more painful for the patient. Instead of resting your hands and fingers on the patient's arm, typically only the pinkie finger of the hand holding the "butterfly" makes contact with the patient's skin. The needle is typically positioned at a 20 to 30 degree angle.

A Brand New MA!

Chronicles of the escapades of a brand new MA coming soon!

Stay tuned!

Externship: Week 7

Wednesday, December 24, 2008

Week 7 of my externship flew by!

Tomorrow is the last day of my externship and today the Office Manager pulled me into her office and offered me a permanent position! She was highly complimentary of my professionalism and abilities as a Medical Assistant. She also shared with me the feedback she received from the physicians and patients and it appears I made quite an impression on everyone in the office. Boy did hearing all that feel GOOD!

A few weeks ago I had a slight problem with one of the other MAs. I was in the hallway with a patient when the other MA behaved in a very unprofessional manner toward me -- and in front of the patient. Her comments were out-of-line in general, but she definitely should not have shared them with me in front of a patient.

I stewed for a little while about the incident with the other MA and finally decided to handle it properly -- the professional way.When I noticed the other MA had finished with her patient and was alone in one of the exam rooms, I asked her if she had a minute to talk and she said yes. I stepped into the exam room, closed the door behind me and in a business-like tone of voice I let her know that she was not only completely out of line, she should never have approached me to discuss anything like that in front of a patient.

That MA met with the Office Manager to let her know of the exchange between us and not only was the office manager completely impressed with the way I handled it, she totally agreed with what I said. Much to the dismay of that MA.

During Week 7 I assisted a different MA with an ear irrigation on a patient with impacted wax. I was not yet ready to perform this procedure on my own -- and this would only have been the second time I have observed -- so I offered to assist instead. It's not that I am not confident that I can perform this procedure, I am just a tiny bit hesitant because it takes very little to puncture an eardrum.

Our patient was a very sweet and funny, average height, but very thin, elderly woman. The MA and I took turns looking into the patient's ear with the scope trying to determine the severity of the situation. Absolutely none of those peeks prepared us for what we finally extracted from her ear.

For starters, the patient had very tiny ear canals -- similar to those of a young child -- which means it took quite a bit more water than usual.The apparatus we use to squirt water into the patient's ear reminds me of a metal cookie press with a (icing) decorating tip on the end. We also use an emesis basin (a small, odd-shaped bowl you find in hospitals) to catch the water as it drains from the ear.We draw warm water into the tube, gently insert the tip and, pointing the tip toward the top of the ear canal, begin squirting water into the ear. (Pointing the tip straight into the ear canal can severely damage -- or puncture -- the eardrum.)

We were able to dislodge small particles of wax and I think we were just finishing our third tube of water when the other MA stopped to draw the fourth. As the patient raised her hand to her ear, the other MA noticed a large object sitting right at the opening of the patient's ear canal and prevented her from touching it.The MA picked up a currette (tool) from the counter to scoop the object out of the patient's ear. Instead of successfully scooping it from the patient's ear it flopped out onto the floor near the MAs feet. By this time the three of us are giggling like crazy, the patient is thrilled she can hear again and the MA scoops the object off the floor and onto a paper towel.

Although my husband may disagree with me, I really do have a pretty strong stomach. (Baby, does last Christmas mean anything to you?) The combination of a hot, stuffy, small exam room, the marble-size, multicolored object on the paper towel, and the smell emanating from it, I quietly excused myself from the room.

The very important thing to remember is this: I did NOT vomit! I was gagging at the base of my throat, but I did NOT vomit!

After taking a few deep breaths and running cold water across my wrists, I returned to the exam room and assisted the other MA with finishing up.

Externship: Week 6

Tuesday, December 16, 2008

Well, my externship period is quickly winding down. Although most students complete theirs within the six-week time frame, mine will take a tad bit longer to log 180 hours because I am only working approximately 30 hours per week.

Today was an interesting day in the office. Not only were we wall-to-wall with patients to be seen but the incoming phone calls to our area were completely whacked! The volume of phone calls and voicemails were so high that it took one MA almost completely out of patient care to keep them under somewhat control.

My favorite elderly patient (the one who made me realize the inevitable) came in to the office today to be hooked up to a 24-hour Holter monitor. She, and her husband, are two of the sweetest people I know and I always enjoy working with them.

I was also blessed to work with a new patient (new to me) today, too. After pulling her lab requisition from the pocket on the wall outside her exam room door, I knocked on the door, then poked my head in to introduce myself and tell her I would be back in just a few minutes to draw blood from her. She had the saddest eyes I have seen in a long time and I knew it wouldn't take much for the tears collecting on her lower lid to spill over onto her cheeks.

After collecting my equipment and paperwork I returned to her room and sat down on the chair across from her. As I organized the tubes, needle, cotton balls and such, I made small talk with her.

Finally our eyes just kind of locked on each other and very quietly I said to her "You look so sad today..." As she reached for a tissue in her pocket to stop the avalanche of tears, I leaned over to her and wrapped my arms around her shoulders. After a few minutes she was able to tell me the reason for her sadness.

Her husband of 63 years fell recently and broke his hip and was in a nursing home. Because she had had one of her own hips replaced in 2004, she was no longer able to drive and had become reliant upon one of her daughters, who lives nearby, to take her to see her husband. She indicated today that the nursing facility her husband is in would be weaning him off of the trach tube soon.

As if that weren't quite enough stress for this beautiful lady, she is also trying to understand Medicare and the mumbo-jumbo that constitutes their "policy".

So, we just sat there together for several minutes. She poured her heart out and I listened. I did get around to the blood draw eventually, but at that particular moment in time, drawing blood was not nearly as important to me as it was for me to listen and to be human and compassionate to a very beautiful woman with the sad eyes.

Externship: Week 5

Monday, December 8, 2008

Today was THE busiest day I have had so far on my externship. Bar none. Every chair in the waiting room had a person in it and more than a few times every exam room had a patient in it waiting for something -- the doctor, labs, x-Rays, or EKG's. It was nuts!

I performed a chest x-Ray by myself today and boy was that an awesome feeling. I also performed a knee x-Ray -- with a little assistance from another MA.

Today a very sad realization smacked me hard in the face.

I had the honor of taking a particular patient completely through her visit to our office. From calling her out of the waiting room, through intake and vital signs, EKG, and chest x-Ray.

After calling her name from the waiting room door, I watched her husband stand up and help her to her feet. Taking her hand, they slowly crossed the waiting room floor to where I stood and that's when I noticed how frail her face and hands were.

I could not see much else of her because her head was covered with a very festive red-colored cap and her body covered with a heavy winter coat. When she looked up at me and smiled I noticed she was wearing bright red lipstick and mascara, too. I let her take my hand with her free one and her husband and I led her down the hall to the scale.

I had already looked in her chart and made a mental note of her age (80-something), height (155 cm) and previous weight, something I do with every patient, and in the dictation notes from her last visit in September there was a very prominent note stating she had gained a whopping 9 pounds and, on that day, she tipped the scale at 98 pounds.

As her husband and I helped her out of her heavy coat and onto the scale, I was almost afraid to look to see how little she weighed. Hearing their excited voices about her having gained two ounces -- the scale showed 91.2 pounds -- I became a little confused. After hearing that she weighed 91 pounds in a different physician's office the week before I began celebrating with them.

Having settled the patient in the chair in the exam room I began asking her and her husband standard questions like "what brought you in today?".

She stated she was having difficulty breathing -- which was clearly visible to me -- and when I sat down near her to obtain her blood pressure and pulse, I could also hear a whistling sound as she breathed. The patient also stated that she was having very terrible dreams and that they were waking her up at night. She stated that they felt very real to her and that they scare her badly. (This information was noted in her chart.)

When I finished with the interview I let them know that the doctor would be in shortly to see them.

A short while later I was making my normal rounds and checking the chart holders on each of the rooms to see if any lab work needed to be done when I noticed a request in the chart holder for this patient.

I knocked softly on the door and poked my head in to let them know I would be back in a few minutes to do an EKG and a chest x-Ray on her. The patient was sitting up on the exam table and I let her know she was perfect where she was and gave her and her husband instructions on removing clothing and donning a paper gown.

A few minutes later I was back at her door and I listened for a moment before knocking to determine which state of dress she was in but I could not tell so I knocked softly on the door again and was asked to enter.

Her husband had given a valiant effort in trying to remove the sweatshirt his wife was wearing but it was clear he needed a little help. She had removed her festive hat and I noticed how very little hair she had because it was sticking up every which way.

Her long, thin arms were each tangled in their respective sleeves and it appeared they were having difficulty getting the shirt over her head, too. She looked up at me with her big, bright blue eyes and my heart melted into my shoes. Her husband explained to me that she had had a stroke a few years ago and around the same time was diagnosed with Parkinson Disease.

I took a moment to assess the situation then quickly began running solutions through my head on how best to accomplish this task without hurting her. My solution was to undress her as you would a newborn.

Laying the gown across her lap, I was able to untangle and free her arms from the sleeves of the sweatshirt. The neck on the sweatshirt, however, wasn't as forgiving. I helped her slip her arms into the gown before I began working the shirt over her head. As I was concentrating on not pulling her hair she giggled that she hadn't had a problem getting it over her head earlier in the day!

I continued talking to the patient and her husband as I input information into the EKG machine. While she was still sitting upright I placed the pads on her chest. After slowly reclining the table so she was laying down I placed a pillow under her head and began connecting the leads to the pads. Once the test was complete, the EKG printed, leads and pads removed it was off to x-Ray.

Two views later we were back in her exam room and I helped her dress again. After the doctor gave the "all clear" I helped her husband escort her back to the front desk to check out.

A little while later I was standing in the lab area when it hit me. One of "my" patients was going to die.

Not in the "everybody dies someday" way, but in the absolutely, without a doubt, too soon, kind of way.

Today I was blessed to have had this very beautiful woman and her husband cross my crazy-busy path.

My heart is full.

Externship: Week 4

Tuesday, December 2, 2008

Week 4 started quietly today. Although there were fewer doctors, we still had a lot of patients and with four MAs (Medical Assistants) the day flew by.

I cannot begin to tell you how positively thrilling it is to recognize repeat patients -- by name -- or have a patient ask for me to draw their blood.

Today, I gave my first "official" TB skin test to a teeny-tiny, 90-something year old woman. The wheal was perfect!