Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Scribes put humanity back into the practice of medicine

Jim Pagano, MD
Physician
August 2, 2014
Share
Tweet
Share

In a recent posting Dr. Kaylan Baban mused about the ubiquity of scribes and some of the reasons behind this growing phenomenon. Among them were the usual suspects: increasing patient loads leading to decreased visit times with the provider, increasing non-clinical demands monopolizing time that would be better spent actually practicing medicine, and improved legibility of notes, which are now the patient’s property and are used for a number of things other than merely jogging the physician’s memory ahead of the next visit. These are all valid, but I think there’s more to it. I think that perhaps technology has gone too far.


Until recently most of us (and by “us” I’m referring to clinicians working in fast-paced environments like a busy ER) have embraced the technological advances that have made our diagnostic challenges easier and our therapeutic choices more robust. Ultrasound is replacing the stethoscope and its use is becoming the standard of care for certain invasive procedures. Bedside testing can give us lab results in minutes that we used to wait an hour or more to receive. CTs and MRIs have — and I’m a bit queasy about this — rendered certain elements of the physical exam almost irrelevant. Hooray for technology.

Then came the EMR. It was inevitable, really. Our handwritten notes had become the butt of stale jokes and even if they were more or less legible they were not easily portable. The various template solutions weren’t much better, given their checkbox nature and multiple pages. Plus the amount of documentation required in order to get paid became absurd. I mean, a full review of systems on a sick ER patient in order to get the government to reimburse you at an appropriate level 5? Even if the patient can’t speak?

Dictation was always a good solution. A reasonable chart in a reasonable amount of time. But dictations cost money. In the case of the busy ER that usually means money the hospital has to spend for something it views as the ER group’s problem. Since the hospital has to have an EMR system, and since there is a significant financial incentive for it to achieve meaningful use, our hospital partners would prefer we forego the telephone and stick to the computer.

Fine. We’re team players. So we gave it a shot, and guess what? A lot of us found it to be one technologic step too far. It made us realize we were allowing technology to come so completely between us and our patients that the encounter was bordering on robotic.

There is little in this world more personal or intimate than the doctor-patient relationship. That human interaction is why many of us chose the profession in the first place and is the source of much of the satisfaction we derive from our practice. Scribes allow us to focus on our patients. Completely. We can speak to them, lay our hands on them, and look them in the eye without doing simultaneous data entry, or wasting time between patients sitting at the computer. We can keep it personal.

I don’t care how fast you can type or how great you are at multitasking. Any time spent working on your chart is time you could be spending doing what you signed up for: practicing medicine. Besides, a well-trained scribe is going to produce a better chart than you can, in real time. It’s just the way it is.

So yes, the current iteration of EMR’s is dysfunctional and time consuming. They will inevitably get better. It doesn’t matter. Until we reach the point at which the entire treatment area is one giant computer, in which the doctor-patient interaction is recorded as it happens, we will still be faced with filling out a chart. We will still be wasting time and giving our patients less than they deserve.

Scribes put some humanity back into the practice of medicine. This is what health care providers are beginning to realize. This is why scribes are becoming mainstream. In the not-too-distant future many of us will wonder how we managed so long without them.

Jim Pagano is an emergency physician and chief medical officer, Precision Scribes.

Prev

The ethics of trainee-patient encounters: Are we practicing on the poor?

August 1, 2014 Kevin 24
…
Next

Are vasectomies a risk factor for prostate cancer?

August 2, 2014 Kevin 1
…

Tagged as: Emergency Medicine

Post navigation

< Previous Post
The ethics of trainee-patient encounters: Are we practicing on the poor?
Next Post >
Are vasectomies a risk factor for prostate cancer?

ADVERTISEMENT

More by Jim Pagano, MD

  • Solving the mid-level dilemma: Call them what they really are

    Jim Pagano, MD

More in Physician

  • How to handle chronically late patients in your medical practice

    Neil Baum, MD
  • How early meetings and after-hours events penalize physician-mothers

    Samira Jeimy, MD, PhD and Menaka Pai, MD
  • Why medicine must evolve to support modern physicians

    Ryan Nadelson, MD
  • Why listening to parents’ intuition can save lives in pediatric care

    Tokunbo Akande, MD, MPH
  • Finding balance and meaning in medical practice: a holistic approach to professional fulfillment

    Dr. Saad S. Alshohaib
  • How regulatory overreach is destroying innovation in U.S. health care

    Kayvan Haddadan, MD
  • Most Popular

  • Past Week

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Why timing, not surgery, determines patient survival

      Michael Karch, MD | Conditions
    • Why health care leaders fail at execution—and how to fix it

      Dave Cummings, RN | Policy
    • How digital tools are reshaping the doctor-patient relationship

      Vineet Vishwanath | Tech
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • The hidden health risks in the One Big Beautiful Bill Act

      Trevor Lyford, MPH | Policy
  • Recent Posts

    • Why point-of-care ultrasound belongs in every emergency department triage [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why PSA levels alone shouldn’t define your prostate cancer risk

      Martina Ambardjieva, MD, PhD | Conditions
    • How to handle chronically late patients in your medical practice

      Neil Baum, MD | Physician
    • Reframing chronic pain and dignity: What a pain clinic teaches us about MAiD and chronic suffering

      Olumuyiwa Bamgbade, MD | Conditions
    • How early meetings and after-hours events penalize physician-mothers

      Samira Jeimy, MD, PhD and Menaka Pai, MD | Physician
    • Why medicine must evolve to support modern physicians

      Ryan Nadelson, MD | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 67 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Why timing, not surgery, determines patient survival

      Michael Karch, MD | Conditions
    • Why health care leaders fail at execution—and how to fix it

      Dave Cummings, RN | Policy
    • How digital tools are reshaping the doctor-patient relationship

      Vineet Vishwanath | Tech
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • The hidden health risks in the One Big Beautiful Bill Act

      Trevor Lyford, MPH | Policy
  • Recent Posts

    • Why point-of-care ultrasound belongs in every emergency department triage [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why PSA levels alone shouldn’t define your prostate cancer risk

      Martina Ambardjieva, MD, PhD | Conditions
    • How to handle chronically late patients in your medical practice

      Neil Baum, MD | Physician
    • Reframing chronic pain and dignity: What a pain clinic teaches us about MAiD and chronic suffering

      Olumuyiwa Bamgbade, MD | Conditions
    • How early meetings and after-hours events penalize physician-mothers

      Samira Jeimy, MD, PhD and Menaka Pai, MD | Physician
    • Why medicine must evolve to support modern physicians

      Ryan Nadelson, MD | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Scribes put humanity back into the practice of medicine
67 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...