Case Studies

As a medical assistant, you will have to multitask, perform triage, educate patients, document findings, and think critically. Improving these skills takes a wealth of experience gained over multiple patient and provider encounters. Throughout your education, you likely learned about these skills individually. Putting them into practice together, in a clinical setting, is the next step.

The case studies presented in this section allow you to test your knowledge across multiple aspects of medical assisting at once. Each scenario gives you the opportunity to use critical thinking skills and to incorporate your legal, professional, medical, and administrative knowledge.

Read each case study and the questions that follow. On a separate sheet of paper, write your best answer to each question. At the end of the section, detailed answer explanations will enhance your knowledge about handling real-life situations such as these. As you review each answer explanation, take note of medical assisting content areas in which you missed any questions. You may need additional study time in those areas to prepare for your credentialing examination.

Case Study #1: Did I Do That?

Sally Carter is a 60-year-old woman with a family history of melanoma. She takes daily doses of Synthroid and Minipress, plus a daily vitamin. Ms. Carter is scheduled to come to the office for the removal of a mole located inferior to the left mid-scapula. The day before Ms. Carter’s 9:00 a.m. appointment, the medical assistant calls to instruct her to have nothing to eat or drink after midnight, avoid taking all medications, and wear loose clothing. The MA also reviews instructions and checks all chart documentation.

When Ms. Carter arrives at the office, the MA sets up the sterile field and then accompanies Ms. Carter from the waiting room to the treatment room, where the MA obtains her TPR, BP, and weight. The MA then provides Ms. Carter a gown, instructs her to put the opening in the back, and leaves the treatment room. Once Ms. Carter is gowned, the MA returns and assists her into a supine position. Dr. Iacono enters the room and undertakes the scheduled procedure.

Based on this scenario, answer the following questions.

What is melanoma?
Evaluate the MA’s instructions when reminding Ms. Carter of the appointment. What could be improved?
The MA put Ms. Carter in the supine position. Why was this the incorrect position, and what position should have been used?
What principle of sterile procedure did the MA violate?
Who is responsible for obtaining informed consent from the patient?

Case Study #2: See No Evil, Hear No Evil, Speak No Evil

Gabby McGowan has been an established patient at Dr. Vladich’s office for many years. Ms. McGowan knows all the medical assistants and loves to stand at the front desk and socialize when she arrives for an appointment. The office is arranged so patients sign in at the front window on a sheet listing their name and time of arrival. When a patient signs in and is checked in by the front desk MA, her name is crossed off. Also located in the office area are the telephones where two MAs manage incoming calls. Finally, there is a sliding glass window at the front office.

Ms. McGowan stands at the desk chatting with the front desk MA when she overhears a phone MA state, “Ms. Jackson, it sounds like you may have an infection, and you should see the doctor as soon as possible.” Ms. McGowan asks, “Was that my neighbor Judy Jackson? I know Judy doesn’t do a good job of washing her hands, and I bet she has food poisoning! Is Judy a patient at the office?” In response, the front desk MA states, “That really isn’t any of your business.” Ms. McGowan walks away from the window and sits next to another patient, complaining about how rude the office staff was to her.

Based on this scenario, answer the following questions.

What parts of this front desk setup are means of protecting patient confidentiality?
Evaluate the phone MA’s interaction with Ms. Jackson. How might it be improved to enhance patient confidentiality?
Evaluate the front desk MA’s response to Ms. McGowan’s inquiry about Ms. Jackson. How might it be improved?
What is white noise? What impact might it have in the office setup described in the scenario?
Knowing that Ms. McGowan likes to stand at the desk and socialize, what strategies could the MAs incorporate to minimize the risk of sharing information while accommodating her desire to chat?

Case Study #3: This Won’t Hurt a Bit

Suzy Stick is a medical assistant working in a medical office laboratory. She collects blood specimens that are sent to the reference lab and CLIA-waived testing. Last week, she asked her supervisor for the day off, but her request was declined due to limited staffing on the day she requested. She reports to work but is not happy. Suzy proceeds to her station to take care of the first patient, Jane. Jane is a 40-year-old woman who hates to have her blood drawn but has agreed to have all the testing done at one time as requested by her provider. She needs specimens drawn for a CBC, lipid profile, and evaluation of clotting factors.

Suzy calls Jane to the lab, prepares the equipment, and asks the patient to extend her right arm. She finds a vein and starts the procedure, following standard precautions. After running into trouble filling all the tubes, Suzy moves the needle. Jane complains of pain and reports feeling weak and sweaty. Suzy responds that it will just be another moment and continues with the process. After filling the tubes, she removes the tourniquet and needle and applies pressure to the site. She applies a bandage within 30 seconds of finishing the draw, dismisses Jane, and continues with her work. At the checkout desk, Jane asks for a release of information form. She wants to transfer to another provider.

Based on this scenario, answer the following questions.

Jane is having several lab tests done. What tubes should be used, and what order of draw should be used?
What key step did Suzy neglect to do after calling Jane to the lab?
What should Suzy have done when Jane reported feeling weak and sweaty?
What should the medical assistant at checkout do when Jane asks for a release of information form?
What role does a medical assistant serving as the lab supervisor or office manager have when approaching Suzy about this incident?

Case Study #4: A Slip and Fall

James has been a medical assistant in a provider’s office for many years. He is considered a leader and mentor for many of the other MAs, and he prides himself on ensuring that the office runs smoothly through preparation and anticipation of provider needs.

Upon arriving at work on a snowy day, James opens the office by disarming the alarm system, turning on the lights, and heading to his workstation to prepare for patients. As patients are escorted to the exam rooms, James notes that the floor is getting wet. Because it is clear this will be an issue throughout the day due to the snow and because he doesn’t want the schedule to fall behind, James decides to continue with his usual program of work. Later, James is walking ahead of an elderly patient to show her to the examination room when she slips and falls, complaining of hip pain. James tries to help her up to walk to the room but cannot get her to stand. James summons the provider, and an ambulance is called. It is later determined that the patient has suffered a hip fracture.

Based on this scenario, answer the following questions.

What should James have done when he noticed the floor was wet?
When calling the elderly patient to the examination room, what else could James have done to ensure her safety?
Who is held liable for injuries sustained in the office?
What document must James complete to address the accident?
James made several mistakes throughout this scenario that endangered patient safety and welfare. Which error was in violation of first aid training?

Case Study Answers and Explanations

Case Study #1: Did I Do That?

What is melanoma?
Answer: Melanoma is an aggressive form of skin cancer that can be life-threatening if left untreated. It is mainly caused by ultraviolet radiation and is commonly associated with exposure to the sun’s rays and tanning beds.
Evaluate the MA’s instructions when reminding Ms. Carter of the appointment. What could be improved?
Answer: The following aspects of the MA’s instructions could be improved:
- Instructing the patient to avoid all food is unnecessary because a mole is removed under local anesthetic. Instead, it would be advantageous to suggest a light breakfast or liquids to help the patient avoid nausea.
- Instructing the patient to avoid taking her regular medications is incorrect. This patient’s medications are necessary for thyroid function and blood pressure control and should be taken as usual.
- Although instructing the patient to wear loose clothing does no harm, it has no benefit either. Since the patient is getting undressed, loose clothing really has no effect on the procedure or preparation.
The MA put Ms. Carter in the supine position. Why was this the incorrect position, and what position should have been used?
Answer: In the supine position, the patient is lying on her back. Since Ms. Carter’s mole is inferior to the left mid-scapula—that is, on her back—she must be placed on her abdomen in the prone position to allow easy access to the treatment site.
What principle of sterile procedure did the MA violate?
Answer: A sterile field that is left unsupervised cannot be guaranteed as free of contamination. Do not turn your back on a sterile field. Although the assistant should gather items together in advance, setup should not occur until the field can be supervised continuously—which is usually immediately before the procedure.
Who is responsible for obtaining informed consent from the patient?
Answer: The provider is always responsible for both informing the patient about the procedure’s risks and benefits and obtaining signed consent. The MA is able to sign the form as a witness, but this only documents that the MA saw the patient sign his name. The MA is an important member of the team with regard to consent: MAs make sure the patient has had all questions answered and assist in clarifying information as needed.

Case Study #2: See No Evil, Hear No Evil, Speak No Evil

What parts of this front desk setup are means of protecting patient confidentiality?
Answer: The privacy window is a good way to prevent unwanted information from being shared outside the administrative area. The medical assistant must ensure that it is kept closed except when a patient is checking in. The sign-in sheet is an acceptable means of checking patients in, as there is no personally identifiable information being shared on this document. Additionally, crossing the name off of the sign-in sheet with a solid marker serves as a means of avoiding sharing patient names.
Evaluate the phone MA’s interaction with Ms. Jackson. How might it be improved to enhance patient confidentiality?
Answer: It is important to avoid divulging any personally identifiable patient information when speaking on the phone around other patients. The phone MA appropriately addressed the patient and did not use her full name. But because MAs are not qualified to diagnose, telling Ms. Jackson “you may have an infection” was inappropriate. It would have been better to say, “It sounds like you need to see the doctor. I can offer you an appointment.”
Evaluate the front desk MA’s response to Ms. McGowan’s inquiry about Ms. Jackson. How might it be improved?
Answer: “That is none of your business” is a confrontational statement that angered Ms. McGowan, who went on to complain to another patient. It is an unprofessional response that reflects poorly on the practice and the MA. When communicating with patients, it is important to present yourself professionally at all times. A better answer to a question like Ms. McGowan’s is something like, “I’m not allowed to share that information; we do our very best to protect the privacy and confidentiality of all our patients.” This response is less intimidating and could even comfort the patient asking the question, because it shows that the office will protect her privacy as well.
What is white noise? What impact might it have in the office setup described in the scenario?
Answer: White noise is background noise, such as soft music, that can be used in an office to obscure the conversations held in patient areas. Used in combination with other security measures (such as keeping the window closed when not working with patients), white noise can help minimize breaches of patient confidentiality.
Knowing that Ms. McGowan likes to stand at the desk and socialize, what strategies could the MAs incorporate to minimize the risk of sharing information while accommodating her desire to chat?
Answer: Scheduling strategies are often beneficial. For instance, scheduling Ms. McGowan at the end of the day or at a time when her wait will likely be short may be helpful. Offering a nice greeting to Ms. McGowan, having a short conversation when she arrives, and then inviting her to have a seat while waiting presents an expectation and overall positive direction that doesn’t lead to intimidation and defensiveness. It is also beneficial to acknowledge Ms. McGowan and wish her well as she leaves the office. This shows concern for her as a patient and leaves her with a good feeling about the practice.

Case Study #3: This Won’t Hurt a Bit

Jane is having several lab tests done. What tubes should be used, and what order of draw should be used?
Answer: Three tubes will be drawn. The CBC requires a lavender tube, the clotting factors require a light blue tube, and the lipid profile requires the tiger-stoppered tube (also known as serum separator tube). The order of draw should be: first, the light blue–stoppered tube; next, the tiger-stoppered tube; and finally, the lavender-stoppered tube.
What key step did Suzy neglect to do after calling Jane to the lab?
Answer: Patient identity must always be confirmed. The MA should have asked the patient to state her name.
What should Suzy have done when Jane reported feeling weak and sweaty?
Answer: Jane reported symptoms of syncope; she was at risk of fainting. Suzy should have made the patient’s health and safety the top priority and immediately removed the tourniquet and needle to care for her. Moving the needle around in the arm is not an acceptable practice, and it is possible that the resulting pain caused the patient’s reaction. Responding to patient signs and symptoms are the priority in this situation. Finally, before dismissing Jane, Suzy should have ensured that Jane was feeling better.
What should the medical assistant at checkout do when Jane asks for a release of information form?
Answer: While it is important to comply with the patient’s request, the medical assistant also needs to consider what may be the underlying cause of this request. In this situation, the MA should tell Jane she is sorry to see her leaving the practice and ask if there is a concern she can help with. If Jane is willing to share the reason for her frustration and sudden choice to transfer to another provider, the MA should refer her to the office manager for a more detailed conversation.
What role does a medical assistant serving as the lab supervisor or office manager have when approaching Suzy about this incident?
Answer: All health care professionals must take care to prevent personal issues from interfering with their work duties. Suzy was obviously unhappy about being required to work; her attitude might have affected her customer service. It is the supervisor’s responsibility to counsel Suzy on her actions and issue a verbal warning if this is Suzy’s first performance incident. If a similar incident has occurred in the past, a written warning may be required—or even suspension or dismissal, depending on office policies and procedures.

Case Study #4: A Slip and Fall

What should James have done when he noticed the floor was wet?
Answer: The medical assistant is responsible for maximizing patient safety. James should have cleaned up the wet floor, placed a “Caution: Wet Floor” marker at the site, and also placed a wet floor marker at the door to alert patients. These actions make sure safety is maximized. Clearing outside sidewalks of snow would also reduce the amount of snow tracked into the office.
When calling the elderly patient to the examination room, what else could James have done to ensure her safety?
Answer: Again, safety is the key issue. Any patient who needs assistance should receive it. James failed to recognize that an elderly person may need an extra arm to hold on to or a device such as a cane or walker. A family member may also help if warranted. Simply asking the patient if she would like assistance or offering his arm for stability may have prevented this fall.
Who is held liable for injuries sustained in the office?
Answer: The provider or owner of the office is held liable for negligence under the doctrine of respondeat superior (“let the master answer”). This incident could possibly be considered an act of nonfeasance, or failure to do something to prevent injury.
What document must James complete to address the accident?
Answer: James will need to fill out an incident report that objectively describes the incident without adding anything personal. It should clearly state the date, time, and location of the incident and an objective account of what happened.
James made several mistakes throughout this scenario that endangered patient safety and welfare. Which error was in violation of first aid training?
Answer: One should never move a patient who may be injured before determining the potential extent of the injury. James tried to get the patient to her feet. Instead, he should have instructed the patient not to move until help arrived or an evaluation was completed. Always stabilize the injury before trying to move the patient. The appropriate action in this scenario would be to instruct the patient not to move, then bring the provider to evaluate the patient.