Your Doctor's Office, Demystified

Written By Amy Sutton, Contributing Writer

While undergoing an X-ray, Holly Gage, of Bowmansville, Pa., shared details about her medical concerns with the technician and asked questions about the results, only to find out the technician wasn't permitted to answer them.

Situations like these are embarrassing because you've opened up, revealing very personal information to the wrong person, and it's not always clear who you're supposed to talk to, Gage says. The tech informed her that only her physician could interpret her images and answer questions about the test results, leaving Gage frustrated, annoyed and wondering: Who's who at the doctor's office?

Long gone are the days when all nurses sported identical uniforms and only physicians wore white coats and scrubs. Today, when visiting your doctor's office, it can be difficult to know with whom you're speaking and what role they play in your health care.

In an ideal world, your health care provider never runs late, you understand every medical term, everyone wears a nametag and the paper exam gowns are comfortable and fashionable.

But in reality, patients often report emerging from medical appointments feeling embarrassed, frustrated or intimidated. As they're shuttled from the reception area to the exam room to financial records, they encounter lots of personnel, but don't know who anyone is or what they do. After their appointments, they feel clueless about who to call about lab results or with follow-up questions.

How can you increase the likelihood you'll get the answers and care you need? Keep in mind that you're buying a service, and you're the customer of the service they're providing. If you were in a grocery store and you weren't certain what type of produce to buy, you wouldn't hesitate to ask the produce manager questions, says Jeffrey Cain, M.D., a family physician and spokesperson for the American Academy of Family Physicians. Your health care team should respect that, Cain says.

From physicians to nurses to medical assistants and front office staff, every one of the staff members in a physician's office contributes to your care in some way, and knowing who they are, what they do and how to communicate with them enables you to make better medical decisions.

Meet Your Health Care Team

In a medical office, it often seems like an alphabet soup. It's hard to know who's who, what's an M., what's an RN? 'How do I know who I'm talking to?' is a common question patients have, Cain says.

Though the process varies from practice to practice, receptionists or office staff are often the first team members you encounter at the physician's office. Typically these professionals verify your appointment details, request additional paperwork and process insurance information. In a smaller practice, the office staff might have additional roles, such as taking you to your examination room or measuring your blood pressure. If you have a health emergency when you arrive at the office, the front desk staff can direct you to the most appropriate next step in your care.

Getting to know the office staff pays positive dividends, according to Dana Marlowe, of Silver Spring, Md. At her annual visits to her primary care provider and obstetrician/gynecologist, she makes a point to meet the administrative and reception staff. This practice paid off when she needed to have blood drawn repeatedly during a three-month period. The office staff scheduled Marlowe's favorite nurses to collect the samples, making a potentially nerve-wracking experience much more pleasant, Marlowe says.

Another office staff member who plays a role in your care is the practice manager or administrator. "These are general managers, making sure the business operations for the group practice are being performed properly and in an efficient manner. They can be a liaison between a clinician and a patient," says Crystal Taylor, director of survey operations for the Medical Group Management Association. The practice manager may also handle your financial questions or direct you to the person in the billing department who can answer your concerns about spreading out payments or requests for a discount.

If you're frustrated by long wait times, fuming over an interaction with a physician or confused about a bill, a practice manager may help you resolve your concerns.

Once you're in the exam room, a nurse or medical assistant, (also called an MA), usually helps you next. Few people know the difference between a medical assistant and nurse, and if office clinicians do not wear a nametag with their credentials, it is impossible to know which level of clinician is helping you. Typically a medical assistant can only be responsible for certain medical activities that are less extensive than what a nurse is responsible for, as nurses have more clinical training, Taylor said. Medical assistants may take the patient to the exam room, get vital information that goes on office visit forms and record weight and blood pressure. A medical assistant notes your symptoms and presents that information to the physician, but isn't qualified to offer medical advice.

At your visit, a technician (or a "tech"), such as a radiology technician, phlebotomist or laboratory technician, may also provide care. A tech trains in performing a specialized task, such as taking X-rays, drawing blood or examining laboratory specimens. Like a medical assistant, these health care professionals cannot offer medical advice or diagnose health conditions. Their role is to provide vital diagnostic and treatment information to the physicians and nurses who are responsible for creating your care plan.

Though a nurse can also do the duties of a medical assistant, a nurse can give clinical advice. In certain situations, such as a wellness check or immunization appointment, the nurse may be the only health care provider you see, Taylor said.

Most licensed practical nurses, or LPNs, have a year of nursing education. In the doctor's office, they perform basic nursing skills like recording height, weight and temperature, gathering health histories and collecting tissue and blood samples. RNs, or registered nurses, spend two to four years training to care for patients and often specialize in a specific type of patient care. Advanced practice nurses, or APNs, possess a master's degree in nursing and may work on their own or with doctors. APNs treat both common and complex medical issues, and depending on state regulations, these nurses may write prescriptions, diagnose disorders and treat medical conditions. You may also meet nurse practitioners, or NPs, a type of advanced practice nurse.

Does your practice employ a physician's assistant, or PA? Don't confuse this role with that of a medical assistant. Unlike a medical assistant, a PA is licensed to practice medicine under a physician's direction. A PA can perform exams, treat minor injuries and interpret lab test results. In some cases, they may prescribe medicine. However, although both physician's assistants and nurse practitioners handle some of the routine tasks a physician performs, they aren't physicians and should not be called doctor, Dr. Cain said.

Physicians, who attend eight years of schooling and up to eight years of internship and residency, come with their own set of abbreviations. Both MDs, or medical doctors, and DOs, or doctors of osteopathic medicine, care for your health by performing exams and tests, diagnosing illnesses, administering treatments and prescribing drugs.

The difference between DOs and MDs is that DOs have been trained in osteopathic manipulation, another form of effective treatment for musculoskeletal conditions, Cain said. Both MDs and DOs may treat with a whole-body, or holistic, approach.

Can I See Some ID?

As a patient, you have the right to know the credentials of the health care professionals providing your medical care. But relying on uniform cues — thinking all nurses wear scrubs or all people in white coats are physicians, for example — often proves misleading, since uniform trends have little or no relationship to patient care responsibilities.

If your health care provider doesn't offer an introduction up front, don't hesitate to ask for his or her name, title and credentials. In Cain's office, for example, all staff members identify themselves by name and role. Everyone in the office should have a nametag that includes the letters after their name that indicate their role, Cain said.

In the course of one appointment, you may meet with three, four or even more health care professionals, all of whom have access to your personal information. The Health Insurance Portability and Accountability Act (HIPAA) protects patient confidentiality. Any information in your patient file or conversations you have with health care providers must remain private and can't be released unless you give written permission.

If you ever feel uncomfortable with discussing your personal information with someone other than the physician, or you have concerns about privacy that extend beyond HIPAA — for example, if you'd prefer office staff to call only your first name in the waiting room — don't hesitate to voice your concerns, Taylor recommends.

Who Answers Your Questions?

Though it depends largely on the practice, nurses may help solve problems and answer questions over the phone; these health professionals may also offer advice on when you should schedule an office visit and whether medication side effects you're experiencing warrant an appointment with a physician. Sometimes your physician may encourage you to email questions, though research suggests this practice remains relatively uncommon.

As you're leaving any physician's visit, ask how you'll receive lab results, whether a follow-up visit is required and where you should direct questions, recommends Todd Evenson, assistant director of survey operations for the Medical Group Management Association. You may even want to jot down the names of the clinicians you saw during your visit. Ask the office manager as you are checking out if you got the information right, and confirm that you understand who to call for specific concerns like problems with getting test results. If you'll be taking a prescription medicine, ask how the office handles refills. Some doctor's offices allow you to complete your refill requests over the phone or online.

Billing: Cracking the Code


Though their work remains mostly behind the scenes, medical coders play a key role in your care. After each visit, these professionals — who work in doctor's office, hospitals and insurance companies — review your health care provider's documentation, translate the physician's notes into codes and ensure that the appropriate services are billed to your insurance company, said Raemarie Jimenez, a certified professional coder and director of education for the American Association of Professional Coders.

The coder is making sure that physicians aren't billing for services the patient didn't receive. It's a role that reduces frustration and increases peace of mind for the patient, Jimenez said. Because inaccurate codes may affect applications for health care and insurance coverage, the accuracy of medical information is crucial.

For most visits, you won't have contact with the medical coder at your doctor's office. However, if your insurance company denies a claim or a billing error occurs, you may work with a coder to resolve any inaccuracies.

Health Professional Standards


These organizations provide information about training, certification and licensing of health professionals who work in physician's offices:

American Academy of Medical Management

American Association of Medical Assistants

American Association of Professional Coders

American Board of Medical Specialties develops and implements educational and professional standards to evaluate and certify physician specialists. Consumers can check on the certification status of their physician using the ABMS "Is My Doctor Board Certified" tool.

American National Standards Institute (this organization certifies medical technologists, laboratory technicians and phlebotomy technician certification programs)

American Nurses Association

Medical Group Management Association

National League for Nursing Accrediting Commission, Inc.



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