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Every Batman Needs a Robin

January 14, 2014

Today we are going to talk about typing.  In most professional, higher-level educational fields the guys with the fancy degrees have clerical help.  It has always been thus.  Lawyers have paralegals and court reporters.  Businessmen have executive assistants.  Baseball players have steroids.  What do doctors have?   Umm.. residents?  Well, OK but that’s a really lousy use of their educational dollars.  Nurses?  They have their own paperwork morass to deal with.  I’m still thinking…  Oh yeah.  We do our own clerical work.

A recent article in the journal Health Affairs actually suggested that two-thirds of a primary care physician’s time is spent on the computer.  Two-thirds. Now, I have to trust Katie Hafner of the New York Times for this data ( because I’d have to pay $15 to actually read the paper myself.  Since I don’t get paid for writing this blog we’ll have to trust Katie.  Anyway, that’s a lot of time.  Similarly, the AMA asked the RAND corporation to look into the factors that lead to physician satisfaction.  Here I must digress again.  The AMA might want to know what factors these are but seems to have little interest in lobbying to effect measures that would increase physician satisfaction.  Anyway, RAND found the following:

1. Physicians who perceived themselves or their practices as giving high quality care had greater professional satisfaction.  OK, Duh.

2. The demands for greater QUANTITY of care was frustrating for doctors, because their time with patients is limited.  I’m guessing this refers to the number of inconsequential data points doctors have to collect for Meaningful Use and other nonsense.

3. The mixed blessing that is the computer.  Physicians were frustrated by lack of interoperability among systems and the amount of physician time spent on computer data entry.

So back to my original point.  Why are doctors spending so much time typing?  Why are doctors staying late in the office to complete computer-related documentation?  Enter the medical scribe.  You know how, in those legal dramas on TV, there’s always some dowdy lady with big glasses sitting at a mini-typewriter recording  everything that is said?  Can you imagine how boring those shows would be if the lawyer had to stop and write everything down him/herself?  Medical scribes can potentially do the same thing.  It sounds like a great idea, and there are thousands of these scribes out there, and a growing market.

If I were designing a scribe there are a few things I would consider.  You really need someone who understands medicine, or at least the field you practice.  Someone with the vocabulary.  Medical students would be perfect.  You can’t be turning around every 30 seconds to spell something for your scribe, nor can you spend 15 minutes outside the room explaining things to your scribe.  In fact, now that I think about it, I don’t know who would have the background to enter intelligible data besides doctors and nurses (Or PAs, NPs etc), unless all you need the scribe to do is write down everything that is said.  It seems to me if all they did was a literal transcription you’d have to spend a certain amount of time sorting out the scribes’ work into an appropriate context,  in which case maybe you’d rather do it yourself.  Scribe companies give people three weeks of training.  I’m not sure that gives the scribe the depth required.  Your scribe should also have some sort of credential and subscribe to the same set of patient privacy and HIPAA standards that everyone else has to.  If they are seen as professional by patients, patients are more likely to accept this third person in the room.

Katie Hafner’s article cites physicians who are very positive about scribes.  I would like to hear from some who are not so positive.  Still, I think it’s potentially a great idea.

  1. anne vinsel permalink

    I just had my first encounter w/a scribe + physician team. It was great! The physician could talk with me face to face, which was helpful bc my eyes were dilated. He had his entire brain free to help figure out some vision-cataract-reading symphony (rented) music, which can’t be written on.
    I work in a large academic medical center and know that physicians are just as good as the general population at multi-tasking, and have often seen them drift off my question to type into the record. Plus most of our physicians are not great keyboarders, particularly those who have grown up doing dictation. I’m a patient, not a physician, but I am very positive about this one experience (which I checked up on with MyChart, and the scribe was more accurate but still concise than most other entries).

    Btw, most people who have worked in a hospital for a reasonable period of time could scribe. I know I could, and I can spell histoplasmosis out of my head, although my job is not clinical. It ain’t rocket science. It’s pretty wasteful to pay 200+$/hr to have a physician keyboard when you could pay a reasonable clerical wage/benefits to a non-physician. Everybody wins.

  2. Fiona permalink

    Scribing isn’t as hard as you think. I used to work as a scribe in a level 1 pediatric ER before I started medical school with zero health-care training at the time, unless you count my premed courses. The doctors I worked with found me highly competent, one even wrote a recommendation letter for me for medical school! Don’t get me wrong, there is definitely a learning curve, but a few weeks of training will get you 90%+ of the day to day terminology. Plus with the advent of the internet, as long as you are close to the spelling you can look it up and spell it correctly after the fact. Also, not all doctors know how to spell well. Fact: I had a doctor yell at me for spelling “inflamed” with one m, because they were adamant it was spelled with two m’s (they were probably thinking of the word ‘inflammation.’) For most specialties I think scribing is a very viable option to be had, plus for me it was an invaluable experience. Personally I want a scribe when I’m done with my training.

    • Thanks Fiona! I’m glad you had a good experience with scribing. It’s the terminology and all the abbreviations that make me think med students would be the best candidates to be scribes. You are right to point out that competence and intelligence, with a little practice, would undoubtedly produce great scribes, as indeed, competence and intelligence do in any field. And don’t let anybody yell at you about spelling – most doctors haven’t written a complete sentence since college!

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