The medical assistant’s role in examinations, procedures, and treatments
Telephone screening for GI complaints
Many times, the medical assistant may get calls from patients or parents of patients who are experiencing gastrointestinal problems. It is important for the medical assistant to be able to screen these phone calls and gather information for the provider. This screening lays the groundwork for the in-office examination that follows, where the provider evaluates the abdomen and related structures in more detail.
Assisting with the examination
When a patient describes and points to the location of the pain, the medical assistant must know the underlying organs that may be involved. The abdomen is commonly divided into four quadrants, and each one overlies a set of key organs:
- Right upper quadrant (RUQ): liver, gallbladder, and head of the pancreas.
- Left upper quadrant (LUQ): stomach, spleen, and body of the pancreas.
- Right lower quadrant (RLQ): appendix, cecum, and right ovary in women.
- Left lower quadrant (LLQ): sigmoid colon and left ovary in women.
Record the abdominal quadrant or region in which the pain is located so the provider can immediately assess this area when the examination begins.
The provider’s inspection of the abdomen begins with noting any change in skin color, such as jaundice. Striae (silver stretch marks), petechiae (small, purple hemorrhagic spots), scars, and visible masses may be seen. The contour of the abdomen may be flat, rounded, or bulging in localized areas.
The provider uses palpation and percussion to evaluate the entire abdominal area. If present for the examination, the medical assistant should remove the drape from the area to be examined and redrape the patient once this segment of the examination is completed. In addition, the provider may want the medical assistant to document findings as the examination progresses.
Example: Positioning a patient for a DRE
The provider is ready to examine the anal area and asks you to position the patient for a digital rectal examination (DRE). What do you do?
Answer:
- Ask the patient to turn onto the left side (the Sims’, or left-lateral, position), bringing the right leg up toward the chest.
- Keep the patient draped throughout the repositioning.
- Once the patient is in position, angle the drape so it can be lifted easily for this final part of the exam, leaving the patient positioned for the provider to perform the DRE or anoscopy.
A digital rectal examination (DRE) may be done to identify abnormalities in the rectum. To do the DRE, the provider inserts a gloved, lubricated finger into the rectum to feel for abnormalities in the prostate, bladder, and so on. The provider may use an anoscope to examine the anal area. For this exam, a short speculum is inserted into the anal canal and lower rectum. This allows for the detection of hemorrhoids, polyps, fissures, fistulas, and abscesses.
Assisting with diagnostic procedures
Many tests and procedures are used to help diagnose gastrointestinal diseases and disorders. The medical assistant should be familiar with the description of these tests and the patient preparation required.
Colonoscopy
A colonoscopy is a procedure in which the provider uses a colonoscope to look into the rectum and colon. The visual inspection of the colon and rectum allows the provider to see irritation, swelling, ulcers, polyps, and potentially cancerous areas.
In the past, many providers did colonoscopies in the office setting, where it was important for the medical assistant to know how to set up and assist with the procedures. Today, anesthesia plays an important part in sedating patients for the procedure. This is one of the main reasons colonoscopies are now usually done in a hospital or ambulatory surgical center. The medical assistant’s role is preparing patients for the procedure.
As with all procedures, the patient needs to be informed of any medication changes or when to not take medications. The provider will determine when the patient needs to stop taking any blood-thinning prescriptions and over-the-counter medications. If the patient is on diabetic, antihypertensive, or heart medications, the provider will determine how these should be handled. The medical assistant needs to communicate these instructions to the patient.
Assisting with treatments
There are several common treatments for gastrointestinal diseases and disorders. Patients can also be prescribed a variety of medications. The following are some of the more common classifications of medications:
- Antacid: Used to treat gastric hyperacidity
- Antidiarrheal: Used to treat diarrhea
- Antiemetic: Used to prevent and relieve nausea, vomiting, and motion sickness
- Cytoprotective agent (prostaglandin analog): Protects the gastric mucosa; used to prevent NSAID-induced gastric ulcers (e.g., misoprostol)
- Laxative: Used to increase and hasten bowel evacuation
- Proton-pump inhibitor: Used to treat gastroesophageal reflux disease (GERD) and ulcers
Patient coaching
After the medical assistant coaches a patient on a topic, it is important for the medical assistant to evaluate the patient’s learning. The medical assistant should encourage the patient to “teach back” the preparation instructions or information so that she or he can evaluate whether the patient has an accurate understanding of the directions. Any errors or misunderstandings can be clarified. The patient should have a copy of directions or information to take home.
Legal and ethical issues
The medical assistant assists the provider and acts as the patient’s advocate, keeping all patient information and test results confidential. Confidentiality and trust form the basis of a sound patient-provider relationship, and the medical assistant strengthens it through ethical, professional conduct.
Patient-centered care
When coaching patients about diagnostic procedures, it is important for the medical assistant to give the patient a list of supplies (e.g., laxatives, enemas) required for the preparation. Patients may even need directions on where to purchase the supplies. The medical assistant should encourage the patient to call if there are questions or concerns to complete the preparation directions. If the patient is not completely prepared, the procedure may not be able to be done and may need to be rescheduled.
Professional behaviors
Diagnostic procedures and treatment protocols change constantly, so the professional medical assistant stays committed to lifelong learning to keep pace with new GI diagnostic and treatment practices.