Medical assistant is an unlicensed multi-skilled health professional who offers administrative, clerical and technical support to the physician. Medical assistant provides services for front office, back office and other clinical laboratory areas. Medical assisting is a versatile career for men and women.

Medical assistant provides services in the offices of physicians, podiatrists, chiropractors and other health practicians to work smoothly. Medical assistants are not like physician assistants who diagnose and treat patients under direct control of physician. Duties of medical assistants depend on the specialty of practitioner. Medical assistants work under the control of department administrator.

They do several administrative duties like answering telephones, greeting patients, updating medical records of patients etc. Medical assistant plays significant role in the medical offices or clinical environments. They don’t make any decisions, about diseases, treatment or emergency plan of patients, independently. They are not allowed to perform independent practice.

Medical assistants perform administrative as well as clinical duties. Their clinical duties include explaining treatment procedures to the patients, preparing patients for medical examination, and supporting physician during examination. Sometimes they perform vital laboratory tests and disinfect medical instruments. They give instructions to the patients about medications or special diets.

Sometimes they purchase medical supplies for the clinic and examining room equipments and instruments. They usually work in clean and well-lighted environments. Some medical assistants work part time and many on regular basis.

In the 1960s, a physician named Lawrence L. Weed first described the concept of computerized or electronic medical records. Weed described a system to automate and reorganize patient medical records to enhance their utilization and thereby lead to improved patient care.

Weed’s work formed the basis of the PROMIS project at the University of Vermont, a collaborative effort between physicians and information technology experts started in 1967 to develop an automated electronic medical record system. The project’s objectives were to develop a system that would provide timely and sequential patient data to the physician, and enable the rapid collection of data for epidemiological studies, medical audits and business audits. The group’s efforts led to the development of the problem-oriented medical record, or POMR. Also, in the 1960s, the Mayo Clinic began developing electronic medical record systems.

In 1970, the POMR was used in a medical ward of the Medical Center Hospital of Vermont for the first time. At this time, touchscreen technology had been incorporated into data entry procedures. Over the next few years, drug information elements were added to the core program, allowing physicians to check for drug actions, dosages, side effects, allergies and interactions. At the same time, diagnostic and treatment plans for over 600 common medical problems were devised.

During the 1970s and 1980s, several electronic medical record systems were developed and further refined by various academic and research institutions. The Technicon system was hospital-based, and Harvard’s COSTAR system had records for ambulatory care. The HELP system and Duke’s ‘The Medical Record’ are examples of early in-patient care systems. Indiana’s Regenstrief record was one of the earliest combined in-patient and outpatient systems.

With advancements in computer and diagnostic applications during the 1990s, electronic medical record systems became increasingly complex and more widely used by practices. In the 21st century, more and more practices are implementing electronic medical records.

Animals continue to be extensively used as research specimen in almost every major medical breakthrough. Utility of animals in medical research has been widely acknowledged. A wide variety of animal species are used for research that range from fruit flies to non-human primates. Research using non-human primates is required for testing drugs, clinical trials, neurology studies, evolution, genetics, behavioral aspects, reproductive biology, cognitive science and even in Xenotransplantation. An estimated 65,000 non-human primates are used annually for research purpose in UK and USA alone.

Use of non-human primates is significant as their brains share structural and functional similarity with the human brain. Most commonly used non-human primates for research purpose include apes, gorilla, chimpanzee, macaques, marmosets, baboons and orangutans. However, the use of non-human primates has always been controversial as it is related with ethical issues.

As per the United Nations Universal Declaration of Human Rights, human interests are protected by the law as they are considered legal persons. Non-human primates do not enjoy any such privilege. However, this status has always been a continuous topic of debate. Considering research on primates as unethical, various countries including Australia, Sweden, New Zealand and Netherlands have prohibited doing any kind of experimental using great apes, a biological family that comprises of gorillas, chimpanzees, bonobos, orangutans and humans. Considering the fact that animals do have a similar sense of pain and trauma as like humans, several organizations, animal rights groups, philanthropists, animal lovers, researchers, philosophers and primatologists are advocating for a world wide prohibition over the use of primates in research.

Are you a California resident who is need of medical insurance? If your employer doesn’t have a health insurance plan or if you are self-employed, you may need to purchase your own health insurance. When purchasing your own California medical insurance plan, you will see that you have a number of different options. There are a relatively large number of medical insurance companies that offer numerous plans to California residents like you. For that reason, you will want to make sure that you thoroughly research and examine a California medical insurance plan before choosing it.

When it comes to thoroughly researching and examining all California medical insurance plans, before purchasing one, there are a number of individuals who wonder why they should go about doing so. Unfortunately, many of those individuals mistakenly believe that all California medical insurance plans are the same, but they are not. To save yourself money and to make sure that you have the adequate amount of medical coverage, you not want to fall victim to the previously mentioned misconception. That is why it is advised that you thoroughly research and examine each California medical insurance plan that you are interested in, before deciding which one you would like to retain.

When it comes to examining California medical insurance plans, there are number of points that you will want to examine. One of those points is the coverage available. When getting a California medical insurance plan, you will see that plans come in all different formats. For instance, it is possible to purchase a California medical insurance plan that includes prescription coverage or one that doesn’t. If you are also looking for prescription coverage, you will want to make sure that the California medical insurance plan of your choice includes it.

It is also important that you examine the healthcare providers that you could visit. A large number of California medical insurance plans involve a network of healthcare professionals, like a doctor or OBGYN. In fact, a large number of medical insurance companies will give you information on the doctors that you can see, should you purchase their health insurance coverage. With this feature, you should be able to tell right away whether or not your current healthcare provider would accept the California medical insurance plan that you are interested in buying. If not, you will want to examine the alternatives; are there quite a few of them?

After you have thoroughly examined a California medical insurance plan, by focusing on the above mentioned points, as well as coverage limitations, deductibles, and co-pays, you can begin to examine the cost of coverage. To do this, you will need to request a California medical insurance plan quote. This can often be done over the phone or online. Should you take the time to thoroughly examine your preferred California medical insurance plan first, you will not only get a California medical insurance plan that you can afford, but one that can adequate supply you with the correct amount of coverage.

Medical research is essential for progress. However, conducting research and developing treatments at the cost of making an animal suffer is not acceptable to several people. Apart from growing humane concerns and mounting economical pressures, availability of limited funds from funding agencies have facilitated a marked decrease in the irrational use of animals in research. As per a study conducted by a medical research group, the number of animals used in medical research annually has decreased significantly during the last 20 years.

Researchers are now looking towards finding better alternatives to animal research. Latest scientific advancements and technological breakthroughs have now made it possible to reduce the use of animals in medical research. Science has developed valuable non-animal research models such as cell cultures, human tissue sections and computer-simulation models. Cell and tissue culture experiments are being used extensively in identifying the medical benefits or toxicity associated with a medical compound.

Inspite of all these developments, there would be certain situations such as blindness where the use of a complete animal model for research is inevitable. In these circumstances, proper awareness programs should be conducted for researchers regarding the handling of animals while conducting research.

Animal Ethics Committee should overview every miniature details in experiments involving animal use, including approving all research, teaching and testing procedures, supervising experiments, providing training to personnel about animal handling and maintaining proper animal care facilities. Ethics committee must ensure that the experiments being conducted do not harm the animal. Persons doing any research, teaching or experiment that is not approved by the Animal Ethics Committee should be prosecuted.

Research directed at an understanding of medical expertise is about 30 years old, and many developments in this literature parallel progress in cognitive psychology. Over the past 15 years or so, this research became much more closely identified with particular psychological theories. Initial forays into medicine were essentially direct applications of methods developed in the psychology lab to the more natural domain of medicine, with varying degrees of success. These attempts were followed by a second wave that took the psychological theories themselves more seriously in a more thoughtful application of psychological methods to the medical domain. I will argue in the present paper that the methods and theories used in the study of medical expertise have advanced to the point that there is some reverse flow and they are providing a unique and valuable perspective on the nature of thinking.

Medical diagnosis has considerable potential interest for psychological investigation. Specific diseases can often be described according to a formal rule-like structure, which is exemplified in the extreme by the . DSM-IV approach to psychiatric diagnosis, but in less extreme form in textbooks of clinical diagnosis (e.g., “myocardial infarction (heart attack) is associated with retmsternal chest pain with radiation down the left arm. Patients may be tachycardie, and diaphoretic. The blood pressure will be below normal. ECG changes include…”). Mastery of these diagnostic rules is a formidable learning task for all students. These list-like rules are complemented by causal models, rooted in physiology, biochemistry, etc., which comprise the first two years of most medical school curricula. After mastery of the formal knowledge in medical school, students enter an apprenticeship period (clerkship, internship, residency) lasting from 4 to 10 years, during which they acquire a wealth of examples to draw on. Thus, in contrast to the experimental psychology lab, where category rules are learned during a one hour session, these rules are acquired over years and shared by all. And in contrast to the causal rules that may emerge from the social psychology lab (”John struck out at the stranger because he is an aggressive person”), the causal mechanisms are a shared form of knowledge in medicine, expected of all practitioners. Finally, the fact that expertise takes many years gives the experimenter an additional variable, expertise, to be explored in situations where experts may use a qualitatively different strategy than novices.

Perhaps because of these characteristics, clinical reasoning has proven an intriguing area for testing cognitive theories, a pursuit that has preoccupied Lee Brooks and me ever since our collaboration began in the 1980s. I view it as an auspicious coincidence that led me to Lee, and my research has been incalculably enriched by Lee’s conceptual insights.

From Psychology to Medical Education

Early History

Early research conducted in the 1970s was essentially atheoretical, and was directed at understanding the “problem-solving process” of expert physicians. The goal was simply to improve teaching in medical schools, not to advance any theory of reasoning. Methods used in this first generation of studies were observational, and almost at the level of job task analysis. Expert physicians and students were placed in a setting very similar to their normal work environment, with some consistency imposed by using standardized patients (people trained to simulate a disease instead of real patients). Participants were told to approach the patient as they would in their normal practice, and were encouraged to think aloud or subsequently reviewed a videotape ol their performance and commented (stimulated recall; Neufeld, Norman, Barrows, & Feightner, 1981).

Implicit in the research strategy was the assumption that a general problem-solving process that discriminated experts from students would emerge from the observed performances and introspective comments. Such was not the case. Whatever characterized the problem-solving process - generation of early diagnostic hypotheses, focused search for data, etc. - did not look any different between experts and novices (Neufeld et al., 1981). Experts had better hypotheses but they went about the problem-solving process the same way. Further, being correct on one problem was a poor predictor of success on a second problem: a phenomenon labeled “content specificity” by Rlstein (Elstein, Shulman, & Sprafka, 1978), which casts doubt on the possibility of a general process acquired with expertise. The consequence was that a new generation of researchers began to more critically examine the nature of expertise from the perspective of knowledge organization, using methods derived from various domains of cognitive psychology. Some examples of these second-generation methods:

* Patel and Groen (1960, 1990) examined clinical reasoning using methods borrowed from text processing. They had doctors and students read a written case and “think aloud.” The transcription was then analyzed using the prepositional analysis methods of Kintsch (1974). Patel’s major finding was that medical experts, like physics experts (Larkin, McDermott, Simon, & Simon, 1980), tend to use “forward reasoning,” from data to hypothesis, whereas novices use “backward reasoning.” However, this finding has been challenged by more recent evidence (Eva, Brooks, & Norman, 2001a).

Between 1954 and 1973, more than 2,000 men entering military service as conscientious objectors participated in Project Whitecoat as medical research volunteers for the Army’s biological warfare defense program. An assessment of self-reported, current health status among 358 “exposed” individuals and 164 unexposed control subjects found no conclusive evidence that receipt of investigational agents was related to adverse health outcomes. No differences in current overall health, current exercise levels, self-reported symptoms, and self-reported medical conditions were seen between the study groups. Possible associations were seen between exposure to antibiotics or other biological agents and self-reported asthma (13.0% vs. 2.4%, relative risk [RR] = 6.00, 95% confidence interval [CI] = 1.03-34.90, p = 0.050), as well as between receipt of tularemia vaccine(s) and self-reported asthma (13.3% vs. 2.4%, RR = 6.15, 95% CI = 1.03-36.70, p = 0.049) and increased frequency/severity of headaches (35.6% vs. 18.3%, RR = 2.46, 95% CI = 0.99-6.15, p = 0.074). However, the size of the population under study was insufficient to assert with confidence that these statistical associations are real.

United States government efforts to counter the threat of biological weapons have their genesis in the War Bureau of Consultation, a commission of the National Academy of Sciences that was formed at the request of Secretary of War Harold Stimson in 1941.1,2 This group recommended the urgent creation of a program of research to address the problem of biological warfare and, in 1942, President Roosevelt authorized Mr. Stimson to establish the War Research Service as a unit of the Federal security Agency for this purpose. The War Research Service, headed by George Merck (president of Merck Pharmaceuticals), immediately undertook a program of study of biological agents, conducted with “utmost secrecy.”3

With increasing appreciation of the scope and complexity of a large-scale program of research and development in this area, the War Research Service requested that the U.S. Army Chemical Warfare Service assume responsibility. The initial site selected for the program was Edgewood Arsenal, near Aberdeen, Maryland. In 1943, a small National Guard airfield (Derrick Field) just outside Frederick, Maryland, was purchased by the War Department, and the hub of the operation was moved to the renamed Camp Detrick.

The Office of the Army Surgeon General was involved in the biological warfare research and development program from the time of its inception in 1941, but it was not directly responsible for any activities until 1956, when the U.S. Army Medical Unit at Camp Detrick was activated with a mission to evaluate the threat of biological warfare and to develop appropriate counter-measures.4 During the same year, Camp Detrick became Fort Detrick. From that time to the present, Fort Detrick has been the home of the nation’s biological warfare defense program. The Army Medical Unit was redesignated the U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID) in 1969. The contributions of USAMRIID and its predecessor to military medical research and national security are legion, and the planned integration of USAMRIID with National Institutes of Health and Department of Homeland security programs through the formation of a national biodefense campus at Fort Detrick5 ensures its future leadership role in this area.

Project Whitecoat was the title given to an Army research program “to use human volunteers in medical studies to evaluate the effect of certain biological pathogens upon humans in an effort to determine the vulnerability to attack with biological agents” (W.S. Augerson, 1976, cited in Ref. 4, p 20). The objectives of the studies involved were to develop medical defenses against biological warfare and included techniques for rapid diagnosis, improved therapeutic and prophylactic agents, and development of vaccines against biological weapons and endemic disease threats. The program evolved after a series of meetings in 1954-1955 between representatives of the Army Surgeon General and the Seventh Day Adventist Church. With the background of the Church’s philosophy and practice of medical service and encouragement of noncombatancy and its longstanding cooperation with the military in health and medical practice, Project Whitecoat became an accepted and respected vehicle by which conscientious objectors could serve the nation.4 From its inception in 1954 to its termination in 1973, approximately 2,300 individuals participated in this program, more than 90% of whom were Seventh Day Adventists. The group participated in more than 135 clinical research studies involving exposure to live agents, receipt of investigational vaccines, and studies of metabolic and psychological effects of environmental- and infection-induced stress.4,6 Most volunteers participated in at least one project, whereas some participated in several. The current study was designed to assess the long-term effects on the health of these men resulting from their involvement in this vital program.

In December, the House of Delegates of the American Medical Association (AMA) unanimously approved a resolution aimed at eliminating from agreements between physician researchers and pharmaceutical companies restrictive clauses that interfere with sharing scientific information. The resolution calls on the AMA to work with other organizations to develop guidelines to accomplish this goal, and for the AMA itself “to protect the right of physician researchers to present, publish, and disseminate data from clinical trials.”

The AMA’s resolution is in line with steps taken in recent years by other professional organizations, research universities, and the federal government to deal with conflicts of interest and bias in scientific research. These include several reports issued by the Association of American Medical Colleges starting in 2001 on individual and institutional financial conflicts of interest in human subject research; regulations adopted or revised by universities to prevent conflicts of interest especially in studies involving human subjects; and new rules announced by the National Institutes of Health (NIH) in February 2005 that, with very limited exceptions, prohibit its employees from receiving compensation of any sort from a company or organization that is an NIH funding applicant, grantee, or contractor.

The AAUP’s 2001 Statement on Corporate Funding of Academic Research, published in the May-June 2001 issue of Academe, emphasized the continuing importance of universities’ having conflict-of-interest policies, and the faculty’s role in their formulation and review of their effectiveness. “Research universities have long collaborated with industry to their mutual benefit,” the report points out, but the relationship “has never been free of concerns that the financial ties of researchers and their institutions to industry may exert pressure on the design and outcome of research.”

STANFORD, Calif. — California Gov. Arnold Schwarzenegger has proposed setting up a universal health coverage system, arguing that caring for the uninsured has prompted health care providers to shift the burden to private payers as a type of “hidden tax.”

Citing a study by the New America Foundation, Schwarzenegger argues that private payers are handing over 6 to 11 percent more in order to cover the cost of caring for those without health insurance.

Not so, counters Stanford Graduate School of Business economist Daniel Kessler. The higher premiums are being driven by the decreased funding for public insurance programs such as MediCal and Medicare, not by the cost of caring for the uninsured.

In a recent paper, titled “Cost Shifting in California Hospitals: What Is the Effect on Private Payers?” Kessler, a professor of economics, law, and policy, concludes that the impact on private insurance premiums is much less significant than critics are arguing.

“At least for hospital care in California, the costs of caring for the uninsured or indigent patients do not impose a heavy burden on private health care costs,” Kessler says. “However, the burden of uncovered Medicare and MediCal costs is substantial.”

Health care costs for those without insurance led to a 1.4 percent increase in private premiums, compared to a whopping 10.8 percent escalation due to uncovered costs of MediCal and Medicare, Kessler writes.

“Assessing the extent to which doctors and hospitals cost shift is an important policy issue,” Kessler writes. “State health policy reforms that seek to cover the currently uninsured are unlikely to lead to significant reductions in private insurance premiums, at least due to decreases in cost shifting. In contrast, increases in public program reimbursement rates could have an economically important impact on premiums.”

The study was based on hospital data from the California Office of Statewide Health Planning and Development from 2000 to 2005.

It was commissioned by the California Foundation for Commerce and Education, a private, nonprofit organization affiliated with the California Chamber of Commerce.

Federal rules and regulations exist to ensure the protection of human subjects involved in research (Belmont Report 1979; Tire 45, Code of Federal Regulations, part 46 2001); but it is the institutional review board (IRB) that interprets, implements, and applies these guidelines in a given health care or research facility (Moreno, Caplan, and Wolpe 1998; Title 45, Code of Federal Regulations, part 46 2001). Additional federal research regulations, the Health Insurance Portability and Accountability Act (HIPAA) “Privacy Rule,” and the requirement for federalwide assurances have recently been implemented with the intent of further protecting patient privacy and standardizing institutional research standards (Title 45, Code of Federal Regulations, part 46 2001; Title 45, Code of Federal Regulations, parts 160 and 164 2002).

The Privacy Rule, as applied to research, requires strict confidentiality and limited access to individual protected health information unless informed consent is provided or the research qualifies for a waiver. Federalwide assurances serve as a document or agreement that defines an institutional obligation to comply with federal research regulations (Newgard and Lewis 2002). Such “assurances” have existed for many years, being provided to centers for multiple studies or for a single study after central (i.e., federal) review of a given research protocol. In 1998, the Office for Human Research Protections began a paradigm shift of decentralizing responsibility for protocol review, changing accountability, “simplifying” assurances, and promoting the concept of accreditation and education with a single, broadly applicable federal assurance (i.e., the federalwide assurance) for all institutions participating in federally supported or federally conducted research (Newgard and Lewis 2002). While the Privacy Rule and federalwide assurances are only strictly applicable to federally supported or federally conducted research and to hospitals receiving federal funds, they have been broadly applied throughout the health care system.

Whether these regulations confer any additional protection for human subjects involved in research is unclear, and concerns have been raised about the potentially negative effect of these regulations on research, particularly on population-based health services research (Kulynych and Korn 2002). In the case of federalwide assurances, there is no evidence to suggest that such an assurance further improves the protection of human subjects, particularly for minimal risk research conducted in nonacademic institutions where the individual tasked with obtaining and signing the assurance often has no involvement in or direct supervision over such research activities.

Including patients from many different practice settings (e.g., academic, tertiary, and community) in health services research is important to produce valid results with broad generalizability. Regulatory burden may threaten broad participation (Kulynych and Korn 2002), especially among centers that would rarely, if ever, participate in research activities. Policies that effectively restrict the selection of research subjects to those in academic centers may have the unintentional result of reducing the generalizability of subsequent study results and raise concerns about whether important findings truly apply to the vast majority of patients who receive care in nonacademic centers. Finally, such restricted selection of research subjects potentially violates the principle of justice in research (Belmont Report 1979).

The objective of this study was to describe (1) the institutional variability in study approval and willingness to obtain federalwide assurance documents for a federally supported, minimal risk health services research project conducted during the implementation of the Privacy Rule and federalwide assurances, and (2) the potential impact of such policy on selection of research subjects and generalizability of study results.

MATERIALS AND METHODS

Study Design

This is a descriptive analysis of data from a prospective, observational research study.

Study Setting

From 2001 to 2004, we conducted a federally supported, prospective, multicenter, emergency medical services (EMS) study to validate a previously derived clinical decision rule intended to identify children seriously injured during motor vehicle crashes (Newgard, Lewis, and Jolly 2002). We selected 20 fire stations in Los Angeles County, California, and identified 27 pediatric receiving hospitals that received pediatric patients from these squads during the previous year. These 27 hospitals represented 47 percent of the pediatric receiving hospitals in Los Angeles County.

Data Collection

In July 2001, all 27 potential receiving hospitals were sent an identical research protocol requesting approval of a retrospective chart review to determine outcome information (i.e., injury severity and hospital resource use) for children transported to their facility by participating EMS personnel. Fire fighters and paramedics prospectively identified children at the scene of a crash, and completed a standardized data form. The research protocol included strict confidentiality protections, was noninterventional, did not alter the standard of care either at the scene or at the hospital, and met requirements for waivers of both informed consent and HIPAA regulations (the Privacy Rule).