The medical assistant’s role in examinations, procedures, and treatments

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.

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. 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. If the provider wants to examine the anal area, have the patient turn onto the left side, bringing the right leg up. As this is done, make sure the patient remains draped. After the patient is in this position, adjust the drape on an angle so that it can be easily lifted for the final part of the examination.

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. Procedure 34.2 describes how a medical assistant should coach a patient on 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
• 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’s responsibility is to assist the provider and act as the patient’s advocate. All information discussed between the patient and the provider and all testing procedures ordered and done must remain confidential. Confidentiality and trust are closely linked, and these two issues form the basis of a sound patient-provider relationship. The medical assistant is an important part of that relationship and can strengthen 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, especially medications, are constantly changing. The professional medical assistant must be committed to lifelong learning to keep up with the rapid changes in the medical field. Maintaining a current understanding of the human body, the disease process, and how specific GI system diseases are diagnosed and treated requires a willingness to learn and adapt over time. This commitment to lifelong learning is a crucial part of becoming a professional medical assistant.