Lesson 2: Tour of the Medical Front Office

Learning Objectives
› Explain the five elements of phone professionalism.
› Discuss strategies for handling special situations, such as angry visitors.
› Differentiate between the various types of appointment systems.
› Describe strategies to protect patient information and privacy.

Lesson Preview
Let’s meet Gina. Gina is the administrative MA for a small, traditional medical practice. Her coworkers are Dr.
Howard; Kathleen, the nurse; and Lindsay, the billing specialist. She has worked here for 15 years and feels a strong
attachment to the friends and patients she has come to know over the years. The staff is caring and kind to the mostly
elderly clientele. Dr. Howard has seen some of these patients all of their lives. He even makes house calls when a more
fragile patient needs him. Gina is very valuable to the practice because not only can she handle the front office duties,
she can also assist with exams and minor procedures when clinical help is needed.

Gina’s day begins at 7:30 a.m. Gina first checks the office email and phone messages. At 8:20 a.m. the phone begins to
ring. Gina fields two call from patients requesting appointments, so she schedules each of them to see the doctor. Gina
then takes a call from a patient who wants Dr. Howard’s second opinion on a diagnosis she received from her
gerontologist. Gina consults Dr. Howard’s schedule and finds some open time late in the week.

It is now 9 a.m. Dr. Howard arrives with a stack of data that must be entered into a spreadsheet format. He also gives
Gina several letters to send. Since Gina helps with administrative functions, these are among her many duties. Gina
types the letters and puts them on Dr. Howard’s desk to be proofread and signed. All the while, she is fielding phone
calls and greeting patients as they arrive for the day’s appointments. She then starts to enter the data from the doctor on
the computer. However, an irate patient interrupts her. The patient demands to speak with Dr. Howard, insisting that
she was billed incorrectly for a recent visit and procedure and wants her bill fixed immediately. Gina listens and then
calmly explains to the woman that the doctor is with a patient, but Lindsay is available to help her. She buzzes Lindsay
to let her know that she is bringing the patient back to see her. On the way, she puts the patient at ease by assuring her
that the billing specialist will do whatever she can to help her.

It's 10 a.m., and Gina’s day continues until 4:30 p.m. During that time she repeatedly answers phone calls and emails,
greets patient, enters data and schedules appointments. In the afternoon she calls patients to remind them of their
upcoming appointments.
In this lesson, you’ll explore effective telephone skills, as well as the five components of a
professional phone personality. You will also discover strategies for handling special situations and
complications.

If you work as an administrative MA, you’ll spend much of your time dealing with patients’
appointments—making them, as well as canceling and rescheduling. You’ll learn how to comply with
regulations protecting patient information while completing the various tasks of a medical assistant.

Phone Professionalism
› Every time you answer the phone, you leave an impression with the caller.
› Every contact needs to be a positive one—every first impression a favorable one.
• The first ten seconds of each call can leave a lasting impression of you and your
organization.
› Your primary goal should be to create a positive impression
› When you pick up the phone, you represent your medical office, and your professionalism is a
reflection of the quality of the organization.
› The two fundamentals of effective phone skills include warm confidence and genuine concern.
When used together, these traits will help you:
• Deal with patient-service challenges effectively.
• Handle difficult callers with self-assurance.
• Reduce stress and maintain composure, even during a chaotic day.
• Improve marketing skills.
• Make a favorable impression on patients and coworkers.
• Create a sense of trust and preference in patients for your organization.
› You don’t want upset callers so when the phone rings, treat the caller as you wish to be
treated.
› Five elements guaranteed to improve your phone skills in the healthcare profession.
Answer the Phone
› When you communicate with someone in person, you convey the majority of your message
through nonverbal communication.
• Nonverbal cues help you interpret messages and understand a person’s meaning more
completely.
• A shrug of the shoulders or hand-wringing often tells much more than someone saying,
“I don’t know” or “that won’t be a problem.”
› The challenge of communicating clearly on the telephone is to make up for nonverbal cues
with a professional approach.
› Additional telephone-answering tips:
• Answer slowly and enunciate
• Never answer with “Please hold”
• Don’t eat or chew gum
• Keep background music low
• Say “good-bye” and let the caller hang up first

The following is the story of someone who learned the hard way that quality service is more than just
picking up the phone.

It was a nightmare. I had one of those mornings where everything that can go wrong did. I slept through my alarm and
woke up with a headache. The kids were hyper and wouldn’t cooperate. The dog ran through the mud outside, and his
paws had to be wiped off before letting him in. The car kept stalling. Traffic was bumper to bumper. I finally got to the
office 20 minutes late, and the phone was ringing off the hook. Nobody was at the front desk. I rushed over, grabbed
the phone and said, “YES” I didn’t think to identify the office or myself. I just wanted to stop the ringing.

On the line was a woman who wanted to make an appointment with a doctor who no longer works at this office. I told
her the doctor had switched offices, but she insisted she called the right place. She was annoyed and complained, and
my head was pounding. I answered her again, “Didn’t you hear me the first time? Dr. Bair doesn’t work here anymore.”
I cut her off mid-sentence by hanging up. Whew. That was the end of that, or so I thought.

About 20 minutes later, once I settled at my desk, my supervisor tapped me on the shoulder. She needed to see me.
Now what! We went into her office, and asked me to tell her about my morning. She said she noticed I was distracted
and wondered why. Distracted is an understatement; I said. I explained the alarm, the kids, the dog, the car and the
headache.
 Then she explained that the first call I took that morning was from someone she knew. She had asked that woman to
see how the medical staff handled a difficult situation on the phone. That caller was a mystery patient. I was so
embarrassed! I could feel my face heat up. I say perfectly still as she repeated everything I said—word for word,
including when I hung up. It was my worst patient-service nightmare!

The supervisor handed me a copy of our office’s telephone policy. She explained the policy was written that the phone
is always answered in the same way. I had forgotten all about it. Every employee receives a copy at orientation, but I
hadn’t looked at it since then.

To avoid putting yourself in a similar situation, keep in mind when answering the phone.

① When the phone rings, stop what you’re doing.

Through voice, manner and word choice, you must demonstrate that you care about the caller
and you are there to offer assistance. The most important activity you can do at that moment is
answer that call, and give the person on the other end your undivided attention.

② Answer by the third ring.

If you allow the phone to ring more than three times, it can create negative impressions.

③ Everyone who answers the phone needs to offer an appropriate greeting.

Identify the office and yourself. Offer your assistance.

④ Try to use the person’s name during the conversation at least twice.
Use their formal name (Mr., Mrs., etc.) upon initial greeting.

⑤ SMILE!
Be enthusiastic, offer help at every opportunity and convey a positive attitude. Smiling helps
the voice reflect warmth and friendship.

Listening on the Phone

› Listening is an active process. You lose the ability to see show that you are listening.
› Here is a list of professional recommendations for listening on the phone.
• Don’t interrupt
• Communication your attention
• Avoid distractions
• Take notes
• Ask open-ended questions
• Repeat key information
• Conclude the call
 › Don’t interrupt. Allows callers to speak without distraction and it helps you to respond more
precisely.
› Let the caller know they have your attention with comments.
› Avoid distractions. While multi-tasking is usually a prized ability, attempting to do two things
at once oftens means neither is done as well as it could or should be.
› Take notes. Listen for facts and important information. Help you focus on the action needed,
but it serves as a permanent record of the conversation.
› Ask open-ended questions. Encourages providing more information. Questions beginning
with the words what, why or how are open-ended questions. Let the caller elaborate and
communicate that you have an interest in what the patient as to say.
› Repeat key information. Summarize important bits, and always tell the caller specifically what
you are going to do for her. Show the caller you understand and are going to act on their
request.
› Ask yourself, “Is the caller completely satisfied?” before you conclude any call.

Speaking Skills
› Hearing someone’s voice through the telephone offers an immediate impression, but
sometimes these can be misperceptions.
• A rough, hard voice may convey a gruff personality.
• A high-pitched voice may sound immature.
• Someone who speaks in a monotone may be perceived as uninteresting; someone who
speaks too softly might convey an impression of low self-esteem; while a fast talker may
seem impatient.
› Physical capabilities, environment, emotions and skill in speech mechanics all influence vocal
quality.
› To improve the way you speak, you can train yourself to recognize areas for improvement and
take action.
› It is important to hear yourself and learn how other people hear you.
• Listen to your voice to help you identify improvements you can make in tone, volume
speech rate, timing, enunciation and other vocal qualities.
› A good speaking voice is natural, pleasant, dynamic, expressive and easily heard.
• The voice is balanced in the areas volume, tone, rate (125 to 160 words a minute) and
vocal variety.
• The most common problems are sounding nasal and tired.
› One of the easiest ways to improve speech quality is to practice a simple task—breathing.
• This technique is most vital to the production of speech.
• Breathing helps you relax, lower voice pitch and convey a more confident sound.
› Research shows that lower, smoother voices are listened to more often.
• Speak from low in the diaphragm, not the upper part of the chest.
• Using the diaphragm muscles to talk, the speaker is allowing more breath to get into the
lungs.
• Short, choppy breaths at the top of the chest lead to a less confident sounding voice.
› There are exercises you can do to increase breathing control and capacity.
• Take a deep breath and, as you exhale, count aloud from one to give on a single
breath. Repeat the exercise counting from one to ten, allowing the air to flow easily.
› There are certain phrases that block communication when spoken.
• Many of these will cause a simple concern to become a bigger issue.

› One way to better communicate is to summarize the speaker by repeating back what has been
said, but in your own words. This is also known as paraphrasing.
• As you practice this skill, you will realize how valuable it is in heading off
miscommunication.
• When you paraphrase what you’ve heard, you give the speaker a chance to clarify if
you’ve misinterpreted his message.
• Help you learn what communication mode the speaker most prefers.
• Restating also allows you to demonstrate empathy and understanding to the caller.
Take Messages
› Use phone message forms on a printed pad.
› Keep the forms by the phone and complete them while you’re on the phone.

Hold and Transfer Calls

› With the use of telephones in the modern workplace, you will inevitably have to put people on
hold. To make a patient’s wait as painless as possible, follow these three rules:
①. Hold is a temporary condition.
Try to keep a person’s wait to less than 30 seconds.
②. Ask the caller if it’s okay to put her on hold, and wait for an answer.
Some people don’t have time or inclination to wait and would rather leave a message or
call back.
③. Be courteous.
Explain any delays that would make the caller wait longer, and thank the person for
holding.
› Whether a caller is trying to reach someone in particular or needs information you don’t have,
you will often need to transfer patients on the phone.
› Make telephone transfers easy.
• Give the caller the department or employee’s name and extension number prior to the
transfer. This is useful if they get disconnected along the way. This practice is also for
the caller’s future reference and your future convenience.
• Be sure that the person you’re transferring the call to is available. If not, you can offer to
take a message or transfer the caller to the person’s voicemail.
› Successful medical assistants are sincere and confident communications.
• Conducting business on the phone—be it answering, listening, speaking, taking
messages, or holding and transferring calls—is about warmth, thoroughness, clarity and
empathy.
 Practice Exercise 2-1
Select the best answer from the choices
provided.
A. Which describes the skill of
listening?
① It’s less important than talking
clearly.
② Listening is an active process.
③ It’s most effective when you interrupt
to ask for more information.
④ Listening is a passive process.
B. Which does not influence vocal
quality?
① Emotions
② Work ethic
③ Physical capabilities
④ Environment
C. Which is a characteristic of speaking
with a lower, smoother voice?
① Using short and choppy breaths
② Allowing less breath to get into the
lungs
③ Speaking from low in the diaphragm
④ Speaking from the upper part of the
chest
Answer as directed.
D. Explain five traits of effective phone
skills that will help you as a medical
assistant.
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Handle Special Situations
Medical assistants must genuinely like people. Most of the people you meet in your job will be
pleasant. However, a few will inevitably present difficult or challenging situations. Use your intuition,
professionalism and respect for people to choose the right solution when problems arise.

International Patients
› Even the smallest medical clinical must be prepared for patients from other counties who may
not speak English or may speak with a heavy accent.
› Simple patient and tolerance, as well as taking the time to speak slowly and clearly, are
helpful.
› Be sure to watch nonverbal cues—they are a universal language!

Disabled Patients
› Treat everyone naturally, without making a fuss.
› Indicate where a disabled person might comfortably sit, or move a chair so there is a safe
place for a wheelchair.

Children
› Distract a child who is rowdy, nervous, tired, or bored if you have a few children’s books or
magazines (of varying reading levels), crayons and scratch paper and some simple toys on
hands.

Unsolicited Salespeople
› Salespeople provide information about current products, services, prices, delivery schedules
and technical data in your office.
› Doctors typically purchase from several pharmaceutical salespeople who sell drugs and
pharmaceutical products.
› Pharmaceutical salespeople acquaint doctors with characteristics of products, clinical studies
and recommended doses.
› They also provide doctors with samples and literature for new and existing products.
› As the medical assistant, you will become familiar with your regular pharmaceutical
salespeople.
› Talk to the doctor to see what she prefers regarding appoints and walk-in meetings with
pharmaceutical representatives.
 › If a pharmaceutical salesperson walks into the office and you know your doctor will not meet
with him, kindly inform the pharmaceutical salesperson of your office’s policy.

Angry or Rude Patients

› A highly valued skill is to display grade under pressure, and remain professional with an irate
patient—the first step toward calming him down.
› Try using “I” statements rather than “you” statements.
• “You” statements come across as blaming and can create conflicts, while “I” statements
allow you to flip the situation.
› Tips to deal with difficult patients:
• Remain calm. Your anger or frustration will only stoke the flames of an upset patient’s
fire.
• Let the patient know you want to help. Ask questions that will help you solve the
problem.
• Listen carefully to what the person says and what is behind the words. Listen to the
entire story whenever possible.
• Don’t criticize or be defensive. Remember, the person probably is not upset with you
personally, you just happen to be the nearest office employee available.
• In the rare instance that a patient seems highly aggressive, intoxicated or abusive, call
security or a colleague to both help and act as a witness.
› Not only are these good strategies to keep in mind with dealing with patients in healthcare, but
they are strategies that apply to everyday life.

Appointments
› As a medical assistant, you’ll schedule appointments for many patients—it will be one of your
most important duties.
› The most common time-management method in the medical world is the appointment, which
keep work flowing and give patients and your medical facility the opportunity to meet, discuss,
interview, review, sell and teach.
› You will have to schedule, reschedule and cancel appointments that patients, other healthcare
professionals or salespeople make with your organization, or that your supervisors make with
others.
 › Three basic considerations when scheduling appointments:
①. Your boss’s preferences. Does he want Mondays and Fridays free of appointments?
Will he see patients between noon and 2 p.m.?
②. Which appointments should be given priority? How are emergencies and urgent issues
handled?
③. How much time should be given to each appointment, and how many minutes should be
scheduled between appointments? Do appointment times vary, depending on the
reason for the visit?

Gather Information
› You must accurately gather information about an appointment.
› Acquire the following information before you hang up the phone or let the person leave the
office:
• Name—Be sure the name is complete, correctly spelled and as the patient would like it
written. Write pronunciation symbols next to the entry if this will help you or your
supervisor later.
• Contact Number—Record the area code and phone number of a daytime and/or cell
phone number for each patient. It will save you time and effort when you need to cancel
or rearrange appointments if you have the number handy. If necessary, record an
extension number.
• Reason for Appointment—Some offices write out the reason completely, while others
use code numbers or letters for this purpose and others may use specific phrases.
• Referral Source—It’s helpful to know how a patient was referred to a healthcare
organization. Your office can study this information to see what kind of advertising
works. Some medical professionals like to know who referred a patient, so they might
mention it in the first appointment, or they might thank the person who did the referring.

Schedule Appointments
› When you make an appointment, offer the patient a choice of days and times, when possible.
› Enter the information into the computer or neatly in pencil if your office uses a paper-based
appointment system (you may need to erase it later).
› Include the patient’s phone number or other time-saving information.
› You may be expected to print a list of appointments and reminders for your boss for the next
day.
› When you schedule appointments for a supervisor, follow the general suggestions:
• Understand your supervisor’s preferences, such as when and how appointments should
be made and what kind of reminder they prefer. You can say, “How would you like me
to remind the pharmaceutical salespeople of the meetings we’ve scheduled?”
• Place a copy of the day’s schedule on the doctor’s desk. Have your boss or the
appropriate support person review the day’s calendar for accuracy.
• Enter appointments into the computer or onto the calendar clearly.
• According to the doctors wishes, avoid scheduling appointments too early or too late—
before 9 a.m. or after 4 p.m., for example.
• Schedule appointments in blocks, if you can, instead of scattered throughout the day.
• Allow enough time for appointments.
• Allow adequate time between appointments.
• Avoid over scheduling during times of the year that are especially busy.
• Do not make an appointment if you suspect the doctor does not wish to meet with this
person. You can say, “I am only making appointments at the doctor’s request for next
week because of his schedule. Please let me call you back after I speak with them.”
• Record future appointments and events on the appropriate calendars or in the computer
as soon as they are known.
• Record any necessary, helpful or new information on the calendar or in the computer
along with the appointment.
• Keep your appointment books, computer files and calendars (for use as a tax history)
for at least one full fiscal year (the office’s 12-month financial reporting period),
depending on the doctor’s needs.
• When you start a new calendar, record the usual recurring events, such as due dates or
annual medical conventions.
› Some medical offices allow for a certain amount of time in the morning and afternoon for
emergency or urgent appointments—these are known as buffer periods.
• Many medical and dental offices, the medical assistant has to decide if the needs of a
patient justify an appointment during one of the buffer periods in a doctor’s calendar.
› The success of a system depends on its appropriateness to your office environment. The
success of an appointment system also depends how well it is used.
• If such a system is not maintained, it won’t work as a time-management tool.
• If appointments are disregarded or double-booked, the system fails.
› The best way to balance a day’s workload is to choose an appropriate scheduling system and
using it efficiently.
Open Office Hours
› Means a person can walk into an office without an appointment.
› Usually won’t work well in a medical office, but you’ll see it for urgent care centers.
› When you need to see a doctor and don’t have time to make an appointment, urgent care is
the most common option.
› Typically urgent care centers provide treatment for minor injuries and illnesses.

Scheduled Appointment Systems

› Offices that use scheduled appointment systems arrange appointments at specific times.
• These offices expect some people to be early, some to be late and some to be on time.
› In a time-specified system, each patient is assigned a specific appointment time.
• Can be as little as 10 minutes or as much as an hour, depending on need.
› This system is also called a stream system because it’s a steady stream of appointments
throughout the day.
› Usually, no one else has the same time-specific appointment.
• The advantages to this system are that a visitor who arrives on time for an appointment
won’t have to wait long, and a patient’s file or other pertinent information can be
prepared in advance.
› The main disadvantage to this system is that there is little room for error.
› If a patient arrives late or an appointment is canceled, the schedule is thrown off. To avoid this,
some offices double-book appointments, though this is not common in medical settings.
• The disadvantage to double-booking is that when two patients show up at the same
time, one patient is kept waiting.
• If there are fewer no-show patients on a certain day, the office quickly falls behind
schedule.
• With double-booking, a medical office might fall behind for the entire day.
• Each visit becomes more rushed and impersonal if a doctor tries to make up time.
› Wave-scheduling system bases appointments on the average length of a routine visit.
• Consider a medical clinic sees an average of four people an hour for about 15 minutes
each.
• With the wave system, four patients are told to come to the clinical each hour, usual on
the hour, and they are seen in the order of their arrival.
• Makes it easy for an office to adjust when patients aren’t on time.
 • Patients do the waiting instead of the staff, and, every hour, the staff begins again with a
new group of patients.
• Patients might feel that the clinic may always run behind schedule or that it’s to their
advantage to arrive late.
› A modified-wave schedule is a combination of time-specific and wave scheduling.
• Two or three patients are scheduled at the top of the hour, followed by single
appointments every 10-20 minutes through the rest of hour.

Manage Walk-ins
› While some organizations cater to walk-ins, they are common in your medical office and each
patient is a customer and should be taken care of properly.
› Give the walk-in the same courtesy as the visitor with an appointment.

Reschedule
› If you need to cancel an appointment, let the patient who is scheduled know as soon as
possible.
› Cancelling appointments, especially those made months in advance, can be stressful for those
that you’re contacting.
• They may have rearranged their own schedule to accommodate the appointment and
are now being told they will need to do it again.

› Guidelines when you have to cancel an appointment:

①. Express regret on your boss’ behalf, but don’t dwell on the apology. Do not mention
confidential or private reasons:
WRONG: “Dr. Rudolph has decided to go to her sister’s wedding after all.” OR “I am so
sorry Dr. Rudolph cannot make it. That puts you in a terrible bind, doesn’t it?”
RIGHT: “I am sorry that Dr. Rudolph will not be able to keep your appointment. She will
be out of town.”
②. Say that the appointment must be changed, and shift to a positive alternative:
WRONG: “I don’t see how she’ll be able to fit you in with her busy schedule next week.”
RIGHT: “She is expected back in town Monday. Shall I set up another appointment for
you early the following week?”
Bill for a Missed Appointment
› Most medical and dental offices tell patients that they will be billed for a missed appointment if
they do not cancel 24 hours in advance.
• The idea behind such a policy is to encourage patients not to waste a highly-trained
professional’s time.
• Billing for missed appointments is usually reserved for people who make a habit of
canceling at the last minute.
• Someone who offers a service to the public does not wish to alienate patients too often.
› Such a sensitive issue has its limits.
• The policy should not apply to emergencies, legitimate transportation problems or family
illnesses.
• The patients should be encouraged to call—even at the last minute—in these cases.
› This will help medical assistants get the day’s schedule on track again and reschedule the
patient who could not appear.
› Since this rule is typically enforced only in repeat, cases, it is a good idea to have guidelines
on this policy:
• Are one or more warnings given to a patient who doesn’t show or call?
• Who gives the warnings?
• Is it given on the phone or in a written message?
• If a patient is to be billed for a missed appointment, will there be an explanation included
with the billing?

Protecting Patient Information

› As a medical assistant, you will have access to the patient information, and it’s your
responsibility to respect patient’s rights—ensuring that the privacy of the patient and their
information is not violated.
› Medical assistants are a covered entity under the Health Insurance Portability and
Accountability Act (HIPAA), and the basic principal of the Privacy Rule is to define and limit the
circumstances in which Protected Health Information (PHI) may be used or disclosed by
covered entities.
› Incorporate basic business practices into your daily routine that keep the patient information
private:
 ①. Keep a sign-in sheet behind the desk.
Do not ask patients to sign their names on a master list. A better alternative is to keep
an appointment sheet behind the reception desk.
②. Be discrete when calling out a patient’s name.
Call them by their first name only.
③. Keep charts confidential.
Make sure to turn the chart so the patient’s name faces the wall rather than the corridor
when they are kept beside exam room doors.
④. Keep phone conversations private.
If those persons should not hear the information, move to a more private location.
⑤. Secure computer information.
Reposition your computer monitor so the screen cannot be seen by others.
› The key to respecting patient privacy is to access only the data that you have a legitimate need
to view to provide service as the medical assistant.
• Do some research on protecting patient information and write a paragraph detailing
what you found to be most interesting.
 Practice Exercise 2-1

A. What is the best way to work with a ② Time for emergency or urgent
non-English speaking patient? appointments.
① Speak loudly and exaggerated. ③ Extra time to return from lunch.
② Use written communication. E. Urgent care centers are an example

③ Speak slowly and clearly. of which type of appointment

system?
④ Refer the patient to a different
healthcare provider. ① Open office hours.

B. Which is not a tip related to dealing ② Time-specific.

with an angry patient? ③ Wave-scheduling.
① Use the I versus you perspective. F. What’s the best way to let a patient

② Listen carefully to what the person know the doctor can see them now?

says. ① Mr. Jones, the dermatologist will see

③ Ask questions that will help you you now about your nasty rash.

solve the problem. ② Barbara, the doctor will see you now.

④ Speak loudly to maintain control of ③ Jordan Borden, the doctors will see
the situation. you now.
C. Which is not a consideration when G. Which option is inappropriate for
making appointments? private phone conversations?

① Your preferences. ① Leave a detailed message when the

② How emergencies are handled. patient is not available.

③ The providers preferences. ② Identify the person on the phone

before discussing the patient
④ Time between appointments.
information.
D. What are buffer periods?
③ Move to a more private location if
① Time to allow for late arrivals.
others can hear the patient
information.
Lesson Summary
› As a medical assistant, you are the patient’s first impression of the office, and you set the
foundation for a positive and mutually rewarding relationship.
• When you assist patients, whether on the phone or in person and with or without
appointments, sincere and confident professionalism will set you apart from your peers
and help guarantee both your success and the success of your medical facility.
› Patience, empathy and a little planning will help you deal with unexpected and tricky situations.
› In this lesson, you’ve covered a lot of ground. Understanding appointment-making and
telephone personality skills follow a medical facility to run smoothly.