A Morning of Screenings and an Irrigation

In practice

A nine-year-old comes in for a school physical, and the provider has ordered a vision screening. The medical assistant places the child twenty feet from a well-lit chart and confirms that he does not wear glasses. She covers his left eye and asks him to read the smallest line he can, and he reads the twenty over twenty line. With his right eye covered, he reads only the twenty over fifty line. She records each eye separately, notes that no lenses were worn, and tells the provider about the difference between the eyes. She does not tell the child or his mother what it means. On the provider's order, she then screens color vision with the Ishihara plates and records what the child reports for each plate. Later, an adult patient arrives with an order for ear irrigation because of impacted earwax. The medical assistant confirms his identity and the order and explains the procedure. She prepares saline at room temperature and has him hold a basin under the ear. She straightens the canal as trained and irrigates gently. Partway through, he says he feels dizzy. She stops at once, helps him stay seated, and tells the provider. After he recovers, the provider decides how to proceed.