Every Batman Needs a Robin
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 (http://www.nytimes.com/2014/01/14/health/a-busy-doctors-right-hand-ever-ready-to-type.html?ref=science?src=dayp) 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.