By this title, I mean whether it is a good idea or not to hire a scribe to enter data into the electronic medical record (EMR) system.
I favor having a scribe. I came of age with paper charts, and I found the transition to EMR tricky and time-consuming.
My chief argument favoring scribes is that scribes can save doctors a lot of time. And by saving time, scribes can also help doctors’ mental health.
This is especially true in primary care or urgent care settings where doctors must collect a lot of data and rule out various possible diagnoses.
I would always do minimal charting in the usual 15-minute time slot assigned to a patient visit. I would note the salient details, including chief complaint, history of present illness, pertinent physical findings, and then assessment and plan. I wrote enough on the chart to get the patient out the door.
I would then return to the EMR at the end of the day and add further details. There are a lot of details mandated by EMR systems. This would take up to another 10 minutes per patient chart. Yes, I timed it. With 20 or more patients during the day, this could easily take another two hours. This makes for a very long day.
I was working at an urgent treatment center, where a busy Saturday in January would be overwhelming. At one point, I hired a scribe. She was a bright young woman interested in medicine and some alacrity with computers. It was a pleasant change of pace for me.
She would accompany me into the exam room under instructions to remain unobtrusive and abide by HIPAA. I found that she could record the pertinent negatives and positives on the physical exam and the review of systems. She could record the assessment and plan as well.
I was then able to give the patient my full attention during their 15-minute visit. I could even maintain eye contact and have a conversation without the distraction of a computer screen demanding my attention. I could feel like a human being instead of a data entry clerk.
So that, at the end of the day, the scribe would have filled in most of the chart. I would need to review her entries, check the assessment and plan, and sign off on everything. Voila! I even got to go home at a reasonable time.
The major downside of having a scribe? Someone must pay her salary. I paid the scribe myself. Eventually, the owner of the clinic offered to cover the expense. I am not sure how you negotiate the perk of having a scribe in other clinics. Perhaps doctors can insist on adequate staffing when they first take a job and include a scribe as part of the contract.
If doctors are pressed for time from a heavy patient load or from patients who require a high degree of mental acuity, a scribe is well worth the expense.
Janet Tamaren is a family physician and author of Yankee Doctor in the Bible Belt: A Memoir. She can be reached at her self-titled site, Dr. Janet Tamaren, and on Twitter @jtamaren.
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