Send in the Scribe
So, welcome to the new normal. I had heard of scribes before but thought they were Monks who helped write things down centuries ago because there was no printing press. Well, now scribes are back as discussed in this NYT article:
Without much fanfare or planning, scribes have entered the scene in hundreds of clinics and emergency rooms. Physicians who use them say they feel liberated from the constant note-taking that modern electronic health records systems demand. Indeed, many of those doctors say that scribes have helped restore joy in the practice of medicine, which has been transformed — for good and for bad — by digital record-keeping.
The end game seems interesting – that is being an authentic doctor again – but can any of you afford to have a scribe? Companies typically charge $20 to $25 per hour for scribes so probably not. So instead of deconstructing this terrible healthcare model and going back to our roots (direct primary care) we now have to adapt with more money coming out of our pocket. Sounds like a terrible idea to me. It’s called giving in.
They are fictional or employed physicians who have no quota to fill.
I would still prefer to dictate into a hand held recorder and have the note transcribed. I used to see 30-40 patients per day vs the current 20. Guess what that did to my cash flow. I do not know more about medicine from an EMR or EHR as some call it. I spend more on computers and techy stuff than I did on transcription and my cash flow became a trickle.
Why not go back to paper?
No PCP can afford a scribe in their office. This is for employed physicians (like ER) or specialists (like neurosurgeons).
A specialist has only one series of questions to ask. And add another procedure or two to cover costs. Another prudent use of health care dollars.
The problem here is that electronic health record (EHR) systems that collect oodles of data for health care researchers to mine later are having that data entered at our expense. Also, the EHR converts us, who are trained to be “executives” (we gather information and make educated decisions) into data entry clerks. So the expense to build this big data base is put on our backs, but if we don’t add scribes, the EHR will slow down our productivity as we will be able to see and treat less patients per hour without a scribe than with one. Either way, we lose. More importantly, patients lose when our attentions are not on them and are on a computer screen. And all of this productivity killing innovation is occurring right when more patients are obtaining health insurance, so will want to be able to obtain primary care. The EHR will constrain access to primary care by limiting primary care doctor productivity. This will lead to more patients seeking care in emergency departments, which won’t “help bend the cost curve”. I’m just sayin….
And when the scribe makes a mistake?? The compassionate attorney will sue both the doctor and the hospital via the miracle of vicarious liability. This will now give lawyers an additional path to get hospital/corporate money once the doc and scribe start squabbling in dueling depositions about who wrote/said/ordered what. Mark it down gang, this will increase the chance for medical errors and if anything will increase the likelihood of lawsuit.
Yesterday I returned to one of the hospitals my company staffs, my first visit since the got EHR’s. Not a bad system, really, but it was busy with a lot of acuity – and I spent far, far more time staring at the screen than I did the patient. No I’m not a tech-tard, I actually mastered it pretty quickly, but there are so many elements that must be recorded so that we can be paid properly by honest insurance companies, satisfy a benevolent government, and prove to the legal system that the patient is protected from our incompetence. Through mass societal neurosis we have determined that data collection IS care, so…I’m delivering the “care” that society demands, and no, I don’t care. No mister, I don’t have time for your amusing anecdotes from the Depression, no lady I don’t have the energy to help you find a dentist…Click…click…click, click…click, click, $&%#£¥@ click!click, click! click! click,click … Bet all you budding med students can’t wait to join this happy clique 🙂
Give me a scribe, and it will only add more hours to the day, reviewing and signing what it wrote. Do I owe the patient that exta time at the end of shift, so that I can spend more face-to-face with them? Nope.
One hospital here says they use Dragon Naturally Speaking with a headset.
Sorry Doug,
I’ve been one of your many silent admirers for over 10 years now. I can’t wait to open your newsletter every week, and I forward it to other docs in my town. The solution to our health care crisis is outside the system. It can’t be fixed from within. Medical tourism is siphoning off the elective surgery market already. Many are trained in the U.S. and even Board Certified in the U.S. but return to their home country where they can actually practice what they have learned, without lawyers, insurance companies and administrators sucking the system dry. We have to emulate that right here, outside the system. Larry Foster, MD
I agree with much of what you said. I have even toyed with creating a company where I, as a doctor, could be a Medical Tourism ambassador/consultant/advocate. The country/hospital could pay me. No kidding
You know the scribes are employees of the same hospitals as the doctors are. This is not for us old-fashioned doctors who actually try to pay office rent and make payroll. Vanishing like the dinosaurs…
You are probably correct but, trust me, the hospitals are not just giving out scribes to doctors without something in return (more volume of patients, less pay, etc)