Reception is the area particularly in urban surgeries where, most of the administrative work, pertaining to patients for the surgery is done.
Receptionists are the key to the good name of the surgery as their approach and communication reflect on patient’s perception and judgment of the surgery.
All good work done the GP’s and the Nurses may be totally eclipsed by one bad receptionist.
It is all the more important that they are suitably prepared mentally, dress sensibly and communicate clearly to meet the patients and respond sensitively to their queries and concerns.
For the first few days’ new receptionists are advised to do clerical work away from meeting the patients.
They can understudy other receptionists, observe and make notes of procedures to follow.
2.3.1. Opening letters / Posting.
These tasks used to be in the domain of Medical Secretary but due to the Med. Sec’s working shorter hours or few days a week only, the responsibility has fallen to the receptionists.
This job may take about 30 min. or so daily and to do this effectively the receptionists given this responsibility have to be trained by the Practice Manager. To do this job effectively, surgeries usually train a receptionist who had been working for 3-6 months and also allow that person to be understudy for the Medical Secretary to find out what she expects when letters are opened and before being posted in relevant boxes.
Criteria to bear iCn mind for posting letters:
To place in relevant boxes e.g. GP’s, Nurses, Healthcare Specialists, Medical Secretary, Practice manager (PMgr), Journals and Miscellaneous.
All Hospital, Private Clinics, insurance letters etc. to be posted to Med. Sec. even if addressed to GP’s. She will then forward to respective GP’s by internal mail.
Personal confidential letters to GP’s alone should be posted to their respective boxes unopened.
Non-clinical staff should be instructed not to give surgery address for their correspondence.
If any mail comes as confidential to any non-clinical staff, such mail will always be opened and then kept in Miscellaneous Box for collection
In exceptional circumstances, with prior permission from Practice Manager, can such mails be not opened for non-clinical staff.
2.3.2 Patients Responses
- Differ considerably when they see a receptionist as opposed to a Medical Secretary.
- They perceive the Medical Secretary would do lot more for them in terms of copies of letters from Hospital, insurance queries and the like.
- Also, when they see a youngster their attitude is different to seeing an older person.
- These aspects of perception can never be regulated by rules or procedures, however, well meant they might be. It had to be accepted as part of day-to-day reactions and the surgery has to deal with it in the best way they could.
2.3.3 Receptionists Demeanour
The importance of appearance, dress, etiquettes, tone and manner of speech along with non-verbal communication must be stressed at the outset.
All these affect the response they get from the patients.
At all times, even under intense provocation, they should remain courteous and should a situation were to deteriorate, they should refer the patient to the senior receptionist or the Practice Manager.
Reception area is not for shouting or animated arguments with the patients.
The patients in waiting room and other staff should always be treated to a quiet and professional atmosphere at all times.
If patients become violent or abusive then bring to the attention of the senior receptionists or the PMgr for immediate attention.
2.3.4 Dealing with GPs and Nurses
Receptionists’ dealings with the GPs and Nurses are crucial for the smooth operation of the practice. Receptionists have to know their responsibilities and diligently carry it out without being reminded often. GPs, Nurses, and other clinical staff want the surgery sessions to run smoothly and do not want any unnecessary delays. Their expectations would include:
- Their desks are in tidy state and any records from previous sessions were not still left lying around.
- Records for the current session are kept in readiness for them to refer, if necessary.
- The patient arrivals are notified by logging in the computer but these days’ patients log in on arrival and computer is updated.
- Receptionists or other staff should not disturb GPs during the surgery sessions. It is expected of them not to refer calls to them during surgery hours except in case of emergencies, when even the PMgr is not able to sort out.
- The paper roll used to put over the bed, to examine the patients, is clean and a spare roll available, if needed.
- Receptionists are in presentable outfit fitting in with surgery and clinical conditions.
- Receptions are not heard shouting at the patients even if the patients are shouting and expect PMgr to sort out these issues.
- Receptionists behave in such a way that the GPs and Nurses do not ever want to hear complaints from the patients about the reception area personnel or facilities.
- They expect the receptionists to contact hospitals or other people, as GPs and Nurses require, so that they can complete their queries when dealing with the patients.
- Receptionists should always address them with professional respect and do not allow any familiarity to influence their behaviour. It is not the time and place for jokes and laughter.
- Receptionists should ensure that there is an adequate supply of forms that the GPs and Nurses may need during their consultations.
The errors due to receptionists will not only affect GPs performance but also earn the surgery a very bad reputation. Not all surgeries use computer only and gone paperless. Inner city surgeries rely still on paper records and it means old issues still apply on patient arrival and waiting, paper records not given for appointments etc.
The types of errors are detailed below:
- Very serious errors – liable for giving warnings to Receptionists on reaching a count of three.
Prescriptions – incorrect dosage, quantity, drug, wrong patient , not checked prior to seeking signature from GP; immediate supply not conforming to 48 hours notice without prior approval of a GP; wrong dosage information recorded in notes/computer.
Records – patient present but records not found; lab results/letters not filed; filing incorrectly another patients details.
Service – not booking ambulance pick up for patients thereby causing delays/inconvenience; arguing with patients; being rude; any issues where patient has been proved to be correct and has a very justifiable grievance.
- Less serious – still receptionists must watch out for not making persistent errors.
Appointments – multiple appointments for one appointment slot of 10 min; appointments for clinics in normal surgery hours; unregistered patient given normal appointment; more than 4 appointments for clinics ( max 4 each for 30 min).
Records – Patient present but wrong records given to GP causing delay; not providing hospital results/letters; not giving emergency patient records to GP on time.
Service – not informing GPs about patient’s arrival and waiting for booked appointment.
- More training to be given to the receptionists.
- Appointments – admitting patients after closing hours for the session; more than the stipulated emergency patients for each session; unregistered/not yet approved/removed patients given appointment with or without Temporary Services forms; emergency appointments for non-emergency reasons; giving appointments for insurance, passport related work during normal surgery sessions.
- Records – not filing records / letters; not having records in time for GP to start the surgery.
- Forms – Not having set of forms for GPs to deal with various requests from he patients’ not entering patient details in the computer within 48 hours of health check and GP seeing and approving the patient; giving incorrect payment amount details for vaccinations.
PMgr from time to time could do a status evaluation of receptionist’s performance by giving GPs the above list and requesting GPs to circle those where errors had occurred with date, day and time of surgery session.
Receptionists should collect these forms and give to the senior receptionists to put the names of the receptionist responsible for appropriate action.
Action points to be notified to the GPs during monthly or at other meetings as appropriate.
With favourable changes that have taken place in surgery operations in recent years:
- online path lab reporting
- patients registering arrivals to surgery by logging details in the entrance hall
- more use of computers by GPs, Nurses, HCPs etc. have minimised issues due to wrong paper records given to them
Life had now become a lot easier for all concerned in the surgery.
2.3.6 Path Lab Test and Results
It is not uncommon in surgeries a trained receptionist to see the Pathlab report and then log these into respective patients records so that the GP during the consultation can access the results easily. The receptionists is expected to come 15 min. or so early in the morning and do this important work, saving GPs time. When the results are outside normal, then they have to highlight these in the records and also make special note in the pad and let the GP know about the result to take immediate action.
2.3.7 Various Tests.
Receptionists will come across various requests for blood test, Diabetic Checks etc. and it is useful to have some rudimentary appreciation of some of the diseases and a brief outline is given below. For any detailed study they have to access via Google for further relevant information. Whereas some details are given, receptionists are warned that they should not second-guess ailments by looking at ranges only. Please leave it to the GPs and Nurses for the diagnosis and corrective action.
Blood test results, made possible by the taking of Blood samples, are one of the most important tools that your doctor uses in evaluating the health status. It is important to realize that a blood test result may be outside of what is called the ‘normal range’ for many reasons.
A large number of laboratory blood tests are widely available. Many blood tests are specialized to focus on a particular disease or group of diseases. Many different blood tests are used commonly in many specialties and in general practice
Most blood tests fall within one of two categories: screening or diagnostic.
Screening Blood tests are used to try to detect a disease when there is little or no evidence that a person has a suspected disease. For example, measuring cholesterol levels helps to identify one of the risks of heart disease. These screening tests are performed on people who may show no symptoms of heart disease, as a tool for the physician to detect a potentially harmful and evolving condition. In order for screening tests to be the most useful they must be readily available, accurate, inexpensive, pose little risk, and cause little discomfort to the patient.
Diagnostic Blood tests are utilised when a specific disease is suspected to verify the presence and the severity of that disease, including allergies, HIV, AIDS, Hepatitis, cancer, etc. (For further details refer to NICE publications).
If a person suffers from anemia their haemoglobin level will always be less than normal.
Full blood count (FBC)
A full blood count (FBC) is probably the most widely used blood test. It is used to assess your general state of health and to screen for certain conditions, such as anemia.
During an FBC, a small sample of blood will be taken from a vein in your arm. The amount of different types of blood cells in the sample will be measured.
On its own, an FBC cannot usually provide a definitive diagnosis of a condition, but it can provide important “clues” about possible problems with your health.
Low haemoglobin indicates anemia, which has a number of possible causes, including internal bleeding or a poor diet.
High haemoglobin may be due to an underlying lung disease or problems with the bone marrow.
A low white blood cell count may be due to problems with your bone marrow, a viral infection or more rarely, cancer of the bone marrow. However, a low white blood count can also be genetic and of no significance.
A high white blood cell count usually suggests that you have an infection somewhere in your body. Rarely, this could be a sign of leukaemia.
A low platelet count may be due to a viral infection or an autoimmune condition (where the immune system attacks healthy tissue).
A high platelet count may be due to inflammatory conditions, infection or a problem with the bone marrow.
An electrolyte test is used to measure the levels of electrolytes in blood. This is sometimes known as electrolyte balance. Electrolytes are minerals that are found in the body.
There are three main electrolytes that can be measured with an electrolyte test:
Sodium; potassium; chloride.
Raised or lowered levels of any of these electrolytes can have various possible causes.
A raised sodium level (hypernatremia) could be the result of dehydration, uncontrolled diabetes or persistent diarrhoea.
A low sodium level (hyponatremia) is usually due to certain types of medication, such as diuretics. Rarely, it could be due to a condition such as diabetes insipidus.
A raised potassium level (hyperkalaemia) could be the results of kidney failure. Certain medications can raise potassium, for example ACE inhibitors, which are used to treat heart failure and high blood pressure.
A low potassium level (hypokalaemia) could be the result of heavy sweating or persistent vomiting or diarrhoea. It can also be caused by certain medications.
Erythrocyte sedimentation rate (ESR)
An erythrocyte sedimentation rate (ESR) test is a blood test that is used to check whether there is inflammation in the body.
Blood glucose (blood sugar) test
A blood glucose test is used to help diagnose diabetes and to monitor the health of people who have been diagnosed with diabetes.
Diabetes develops either because the body cannot produce enough insulin or because the insulin doesn’t work in the right way. Insulin is a hormone that the body uses to convert glucose (sugar) into energy.
People with diabetes often have high levels of glucose in their blood. Reducing the glucose levels is an important part of the treatment of diabetes. This is because if the blood sugar levels become too high, a range of serious complications, such as kidney disease or nerve damage, may occur.
Therefore, most people with diabetes will need regular blood glucose tests. Blood glucose test kits may be available to use at home. These only require a small “pin prick” of blood for testing.
People with type 2 diabetes usually don’t need to check their sugar at home, it will be tested every three-to-six months at your GP surgery or hospital. The test shows the average blood sugar level over the past three months.
Some types of blood glucose test require one not to eat anything for several hours before the test. GP or diabetes care team can tell whether this is the case.
A blood-typing test is used to identify your blood group. Your blood group is determined by two specialised proteins, known as antigens, which are found on the surface of your red blood cells.
Blood typing is used before a blood transfusion is given (or before you provide blood for donation). This is because it’s important that anyone who receives blood is given blood that matches his or her blood group. If you were given blood that did not match your blood group, your immune system may attack the red blood cells, which could lead to potentially life-threatening complications.
Blood typing is also used during pregnancy as there is a small risk that the unborn child may have a different blood group from the mother. This could lead to the mother’s immune system attacking the baby’s red blood cells. This is known rhesus disease.
If testing reveals that there is a risk of rhesus disease developing, extra precautions can be taken to safeguard the health of your baby. For example, a blood transfusion can be given to the baby when it is still in the womb to increase their number of red blood cells.
Blood cholesterol test
Cholesterol is a fatty substance known as a lipid. It is mostly created by the liver from the fatty foods in your diet and is vital for the normal functioning of the body.
Having too many lipids in your blood (hyperlipidaemia) can have a serious effect on your health because it increases your risk of having a heart attack or stroke.
Blood cholesterol testing is usually recommended if you are at an increased risk of developing cardiovascular disease (CVD). A cardiovascular disease, such as a stroke or heart attack, affects the normal flow of blood through the body.
Things that increase your risk of CVD include:
- being over 40 years old
- being obese
- being a smoker
- being male
- having high blood pressure (hypertension).
Blood cholesterol levels are measured with a simple blood test. Before having the test, one may be asked not to eat for 12 hours (which usually includes when one’s asleep). This will ensure that all food is completely digested and won’t affect the outcome of the test.
GP or practice nurse can carry out the blood test and will take a blood sample, either using a needle and a syringe or by pricking your finger.
Liver function test
A liver function test is a type of blood test that is used to help diagnose certain liver conditions, such as:
- hepatitis (infection of the liver)
- cirrhosis (scarring of the liver)
- alcoholic liver disease (liver damage and related loss of function which is caused by excessive alcohol consumption)
When the liver is damaged, it releases enzymes into the blood and levels of proteins that the liver produces begin to drop. By measuring the levels of these enzymes and proteins, it’s possible to build up a picture of how well the liver is functioning.
Tests that Require Fasting
Blood cholesterol, triglyceride and glucose levels are the most common tests that require fasting. Vitamin levels, such as vitamin E or A, also need to be drawn when the patient is fasting.
Typically at least a 12-hour fast is required for cholesterol and triglyceride screenings. Vitamin levels and glucose tests usually only require an eight-hour fast. Following the guidelines is important to make sure your blood sample is not influenced by food or drink.
What is allowed?
Water is allowed even when fasting. Usually your regular dose of medication can be taken, although some medicines do affect test results, so check with your physician first. Black coffee or tea may be allowed, but again, check with the laboratory or your physician, because caffeine can alter some test results.
What is Not Allowed?
No food at all is allowed. Gum chewing, especially of gum with sugar in it, is forbidden. No liquid, other than water, should be consumed without the express permission of your physician.
Results may be inaccurate if fasting was not done prior to the test. This might lead to treatment for a disease such as diabetes or a condition such as high cholesterol that you do not have. The specimen will need to be repeated because an accurate result is necessary.
If GP informs of abnormal test results, ask if fasting was required. If one did not fast as needed, GP must be told immediately.
These tests are carried out to screen for metabolic and kidney disorders and for urinary tract infections. During a routine physical or when one has symptoms of a urinary tract infection, such as abdominal pain, back pain, frequent or painful urination; as part of a pregnancy check-up, a hospital admission, or a pre-surgical work-up, these tests are initiated.
A urinalysis is a group of chemical and microscopic tests. Urine is generally yellow and relatively clear, but each time someone urinates, the colour, quantity, concentration, and content of the urine will be slightly different because of varying constituents.
Many disorders can be diagnosed in their early stages by detecting abnormalities in the urine. Abnormalities include increased concentrations of constituents that are not usually found in significant quantities in the urine, such as: glucose, protein, bilirubin, red blood cells, white blood cells, crystals, and bacteria.
Urine for a urinalysis can be collected at any time. The first morning sample is considered the most valuable because it is more concentrated and more likely to yield abnormalities if present. As you start to urinate, let some urine fall into the toilet, then collect one to two ounces of urine in the container provided, then void the rest into the toilet. This type of collection is called a “midstream collection” or a “clean catch.” No sample preparation is needed.
A urine sample will only be useful for a urinalysis if taken to the doctor’s office or laboratory for processing within a short period of time. If it is longer than an hour between collection and transport time, then the urine should be refrigerated or a preservative may be added.
Thyroid Blood Tests
- Thyroid Disease
- Under Active Thyroid
- Underactive Thyroid Gland
- Thyroid Testing
Diagnosing thyroid disease is a process that can incorporate numerous factors, including clinical evaluation, blood tests, imaging tests, biopsies and other tests. In this article, you’ll learn more about the blood tests that are used as part of thyroid disease diagnosis and management.
The most common thyroid test is the blood test that measures the amount of thyroid-stimulating hormone (TSH) in your bloodstream. The test is sometimes called the thyrotropin-stimulating hormone test.
TSH that is elevated, or above normal, is considered indicative of hypothyroidism. TSH that is “suppressed” or below normal, is considered evidence of hyperthyroidism.
As of 2003, the normal range run from 0.3 to 3.0, versus the older range of 0.5 to 5.5. So, according to the new standards, levels above 3.0 are evidence of possible hypothyroidism, and levels below 0.3 are evidence of possible hyperthyroidism. Keep in mind that there is disagreement among practitioners, and some follow the older range, others use the newer range.
Free T4 / Free Thyroxin
Free T4 measures the free, unbound thyroxin levels in your bloodstream. Free T4 is typically elevated in hyperthyroidism, and lowered in hypothyroidism.
Total T4/Total Thyroxin/Serum Thyroxine
This test measures the total amount of circulating thyroxin in your blood. Thyroxine, a hormone produced by the thyroid, is also known as T4. A high value can indicate hyperthyroidism, a low value can indicate hypothyroidism.
Total T4 levels can be elevated due to pregnancy, and other high oestrogen states, including use of oestrogen replacement or birth control pills.
TSH = approx. reference range for this test is 0.4 to 4.5.
TT4 = approx. reference range for this test is 50 to 160.
FT4 = approx. reference range for this test is 10 to 24
The thyroid is a gland found in the neck. Its main function is to make hormones.
Hormones are chemicals, which are released into the bloodstream. They act as messengers, affecting cells and tissues in distant parts of your body. Thyroid hormones affect the body’s metabolic rate and the levels of certain minerals in the blood.
The thyroid makes three hormones that it secretes into the bloodstream. Two of these hormones, called thyroxin (T4) and triiodothyronine (T3), increase your body’s metabolic rate. The other hormone helps to control the amount of calcium in the blood.
In order to make T3 and T4, the thyroid gland needs iodine, a substance found in the food we eat. T4 is called this because it contains four atoms of iodine. T3 contains three atoms of iodine. In the cells and tissues of the body most T4 is converted to T3. T3 is the more active hormone; it influences the activity of all the cells and tissues of your body.
2.3.8 Job Rota
This has to be prepared for each week, about at least a week in advance. The receptionists should check and correct if they have any issues about the rota.
Ideally it should be laid out for the whole month or longer, with notes to include, which cover whom in case of holidays, sick leave, absences etc.
The PMgr should ensure that there is no favouritism in assignment of tasks or times while preparing the rota.
A typical rota with comments on tasks is attached. The requirements had changed due to improvement in use of computers by the GPs and this format can be modified to suit present circumstances.
2.3.8a Receptionists Rota: