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Fam Pract Manag. 2021;28(5):37


Using clinic protocols is one way to leverage your medical assistants (MAs) so they can do more to support you and your patients. What your MAs are permitted to do depends on state regulations where you practice. But having formal protocols that fit within that framework can spur your staff to complete additional tasks before, during, and even after the patient visit.

Clinic protocols should include information about who authorized them (usually the clinic's medical director), the targeted patient populations (e.g., adults over age 18), the personnel authorized to perform the outlined tasks, the procedure steps, and the documentation process.

Once the protocols are written, distributed, and understood, clinic staff should recognize tasks for which protocols exist and complete them without waiting for a physician order.

Examples of tasks that MAs may be able to do with protocols include urinalysis, urine pregnancy test, rapid streptococcus test, peak flow lung capacity testing, pulse oximetry, A1C measurement (for patients with diabetes due for a reevaluation), urine microalbumin (for diabetes monitoring), urine toxicology (for chronic opioid refills), immunizations, mammogram orders, and tuberculosis skin testing.


When you've got a big decision to make about your career, answering these five questions can help you determine what to do:

  1. What are your feelings telling you? Write out the different paths you're considering and note how each one feels to you at a gut level.

  2. What matters to you? Identify your values and make sure your career choices align with them.

  3. What matters to other people? Your career choices affect your family and friends, so seek their input.

  4. What is the reality of the situation? Go beyond your gut instinct and look at the data on things like salary, time off, and decision-making authority.

  5. How do you put the pieces together? Compile all the information from the other four questions and make sure your answers are based on information, not assumptions.


Discussing patients' passions and fears, in addition to their medical issues, can make office visits more productive by building trust. Trust leads to better adherence to our medical advice.

Patients are interested in their own health at different levels. But as physicians we can empower them to make a substantial investment in their own health by knowing what matters to them. If you know your patient is a gearhead, for example, perhaps equating the annual physical to regular oil changes and tire rotations for a beloved car will motivate the patient to care a little more for the most amazing machine of all, the body. If you know your patient loves to travel, perhaps you can use increased mobility in old age as a long-term incentive to lose weight or take other steps to manage general physical fitness.

Knowing patients' desires and fears can elevate the simple office visit to an educational encounter that helps patients understand how their health factors into their goals and how they can help make themselves better between visits.

In my experience, knowing your patients in this way is not only good for them, but it's also a gratifying and constructive way to practice medicine — a balm for all the stresses that go along with being a physician these days.


Practice Pearls presents readers' advice on practice operations and patient care, along with tips drawn from the literature. Submit a pearl (250 words or less) to FPM at

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