The medical assistant's role in treating immune conditions, coaching, and professional issues

This chapter brings together several of the medical assistant’s supporting roles for immune conditions: assisting with treatment, coaching patients on prevention, and handling the legal, ethical, and professional issues that come with the job - so the topic shifts between sections are intentional, not incidental.

Assisting with treatments

When working with patients who have diseases and disorders of the immune and lymphatic systems, the medical assistant often assists with the treatment of the various conditions within those systems. The following sections discuss that role.

Treatment of allergies

The classic treatment of allergies is to encourage the patient to avoid known or suspected allergens. Unfortunately, this is not always possible, so the provider may prescribe antihistamine medications, such as levocetirizine (Xyzal), for the relief of allergy symptoms. Over-the-counter antihistamines include Allegra, Zyrtec, and Claritin. Another option is using immunotherapy, a series of injections in which minute doses of known allergens are administered subcutaneously over time to desensitize the patient’s immune system and ultimately develop a resistance to the immune response. This usually requires weekly or bimonthly injections over several years. Some patients are cured, whereas others have only a minor reduction in allergic symptoms. It is recommended only for patients with severe allergic symptoms that are not relieved by antihistamine medications.

If you are responsible for administering allergen injections, you must take great care to dispense the correct dose of each allergen; administer each subcutaneous injection at a separate site; accurately document the procedure and the exact location of each injection; record any local or systemic reactions; and observe the patient for at least 20 to 30 minutes after the injections to detect possible systemic allergic responses, including urticaria (hives), wheezing, or hypotension. If the patient shows any localized or systemic reactions, the provider should be notified.

Scope of practice: Whether you may administer allergen injections depends on the supervising provider’s delegation and the medical assistant scope-of-practice rules for the state where you work. This is not a nationally uniform task, so check your state’s rules before assuming it’s part of your role.

Patient coaching

We know that proper hand hygiene plays a key role in preventing the spread of infectious diseases. Often our patients are not aware that hand hygiene is considered to be the most important element of infection control. Coaching our patients on the when and how of hand washing can help keep everyone healthier. According to the recommendations of the Centers for Disease Control and Prevention (CDC), you should wash your hands at the following times:

• Before, during, and after preparing food
• Before and after eating food
• Before and after caring for someone who is sick
• Before and after treating a cut or wound
• After using the toilet
• After changing diapers or cleaning up a child who has used the toilet
• After blowing your nose, coughing, or sneezing
• After touching an animal, animal feed, or animal waste
• After handling pet food or pet treats
• After touching garbage

Washing your hands with soap and water is recommended, but if that is not available, an alcohol-based hand sanitizer with at least 60% alcohol can be used. Sanitizer is not a substitute when hands are visibly dirty or greasy, though - in that case, soap and water is the only effective option. When washing with soap and water, the hands should be scrubbed for at least 20 seconds. Be sure to lather the backs of your hands, between your fingers, and under your nails.

Legal and ethical issues

By law, diseases considered of great public health importance must be reported. Some diseases must be reported at the federal level to the CDC; others must be reported at the state level. Most states will have a “reportable diseases” list, and many of those diseases are also on the federal list.

It is important for medical assistants to know which diseases need to be reported for the state in which they are working. A disease’s reportable status is set by that state’s own public health law - it does not carry over from a facility’s previous state or from a state where the medical assistant was previously employed. If you work in or float between states, check the current reportable-disease list for the state where you’re actually practicing rather than relying on what a different state required.

Patient-centered care

Part of providing care for patients with sexually transmitted infections is education on the ways to prevent those infections. This education must be presented in a nonjudgmental way. Abstinence, limiting the number of sex partners, and using male and female condoms and cervical diaphragms (for cervical gonorrhea, chlamydia, and trichomoniasis) are all ways to reduce the risk of contracting a sexually transmitted infection.

Professional behaviors

When you have a strong work ethic, it becomes hard to stay home when you are sick. You may say to yourself, “I’m not that sick,” “We are shorthanded already,” “I don’t want to put more work on my co-workers’ shoulders,” and so on. If you are sick, it is best for everyone for you to stay at home and get better. The quicker you get better, the quicker you will be back at work, giving 100% again. It is also better for your co-workers and patients if you stay home rather than risk spreading your illness to others. Many of your patients are at the healthcare facility because they are already ill. You risk exposing them to another illness if you go to work when you are sick. If you have a fever or have been vomiting, it is best to stay home.