Medical Scribes are a Solution, Not a Symptom

The wider medical community is beginning to wake up to the benefits of medical scribes. Articles in The New York Times, the Wall Street Journal, and NPR are just the most recent evidence of this awakening. “With a scribe, I can think medically instead of clerically,” says Dr. Marian Bednar in the Times. “I am now seeing over 30% more patients per hour than my colleagues who are not using scribes,” writes Dr. Alan Bank in the Journal.

But it is not the well-documented benefits of scribes that have prompted me to write this inaugural Precision Scribes blog post. Rather, it is a typical reaction to medical scribes I see from some colleagues, exemplified by Dr. Art Kellermann on Twitter:

This school of thought says that medical scribes are not a solution, but rather just a symptom of the underlying disease of poorly designed EMRs. An absurdity that will evaporate when EMRs are (inevitably, it is implied) done “right”.

The problem is, I don’t think that’s true.

I say this not because I am a fervent proponent of EMRs. In fact, I consider them just one more government-mandated intrusion into our already beleaguered professional lives. It is fair to say that for most of us the EMR is an awkward and time-consuming “de-provement.” EMRs take our attention away from our patients and force us to focus on a computer screen, pecking and clicking away to enter in the details of the patient encounter, and trying to fit square pegs into round holes by clicking on a series of symptoms, time frames, physical findings, therapeutic options, and discharge instructions. It’s exhausting to even describe it, much less to use it.

But today’s EMRs, while sometimes poorly designed, are not the only reason medical scribes add value. Because until we get to a “Star Trek” future where we possess medical computers that listen to us and perfectly comprehend what we say, medical charting will require human effort and remain a burden.

Medical charting has always been a nuisance. Over the years various paper systems were introduced to streamline the process and improve the capture of data items needed for proper billing. But regardless of which system you were using it was necessary to spend a significant amount of the workday completing your documentation. Even so every one of us has had charts returned from the billing company asking for additional information, or even any information on those patients who got by us without a chart being completed at all. A technological solution to these problems may arrive some day, but it’s still well over the horizon.

But medical scribes are a solution that’s here today. And when working with a scribe, the practitioner can focus entirely on the patient. The charting is done in real time, and it is thorough. Results of lab and imaging studies are brought to your attention when they are available. You are able to see more patients in a workday and spend more time with each of them. When the last patient leaves you are actually done. There is no need to stay late to complete your charts. As an additional bonus, your hourly billing has increased, offsetting the cost of the scribe often to the point of additional revenue to the practice.

This is true no matter how adept you are at data entry. There are physicians who claim they can work as fast or faster by themselves. They may be right, but they are working with one eye on the patient and the other on the computer. Patients are aware they are getting only part of the doctor’s attention. While you’re feeling proud of how terrific you are at multitasking the patient feels slighted. This isn’t good for patient satisfaction and if there is an unfavorable outcome, regardless of fault, the patient is going to wonder whether or not you were actually listening to what was being said during the evaluation.

Medical scribes are not a luxury or a crutch for the technologically challenged. They are bona fide members of a new, modern medical team. They make us more efficient, and allow us to do what only we can do: practice medicine. As the EMR evolves it will doubtless become more user-friendly. It’s practically impossible to imagine otherwise. Great, I can’t wait. But no matter how good it gets it will be better with a scribe. When you’re working, stick to what you do best—taking care of patients. Save the writing for your creative projects.