Getting Office Visits More Impersonal and Costly

The bureaucracy in medicine has made the job of being a physician extremely difficult.  There are so many ways to fix it but one is now being touted as the key:

A new study in JAMA found that the use of scribes can directly and positively impact the amount of time physicians spend on EHR documentation and bring significant improvements in productivity and job satisfaction.

Yes, another layer of cost added to the office visit.  Instead of stripping away the garbage the powers that be are supporting studies to put scribes in between the doctor and the patient.

Results showed that compared to periods where scribes were not used, periods where they were showed less self-reported after-hours EHR documentation, also sometimes referred to as ‘pajama time.'”

Listen, patients are not getting a choice here.  I guarantee they don’t want someone loitering in the exam room.  As a patient myself I found it…weird.

If the industry is to address the growing relationship between EHRs and physician burnout, then a solution like using scribes to shoulder some of that burden seems a logical one, one that could keep physicians happy, healthy, and practicing longer.

Really?  If you complain of pain because you are sticking a pin continuously in your eye then why would you give pain medicine?  Why not just stop sticking the pin in your eye?  The same holds true here.  Get rid of the bogus unproven metrics and go back to plain old SOAP notes.  Strip away the useless crap.  Not all primary care docs can afford scribes.  Heck, they can’t even afford all the staff they have now for prior authorizations and chasing down insurance payments.  Now you are going to add another salary, benefits and payroll taxes to the equation?  Yeah, let’s make the cost of running a practice even more unaffordable so that either the doctor shoulders the load or the costs are trickled down to the patient.

It’s idiotic.

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Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  8 comments for “Getting Office Visits More Impersonal and Costly

  1. RSW
    September 22, 2018 at 5:14 pm

    From the JAMA article:

    “2 medical center facilities within an integrated health care system”

    Translation: $400 facility fees for a 99213 sore throat.

  2. September 22, 2018 at 2:04 pm

    I recently interviewed the co-founders of a new technology (Robin Healthcare) that combines the voice (and video) recording via a device in the office with all transcriptions edited and reviewed to varying degrees by scribes. It seems like the best of both worlds – a quick, reliable transcript of the visit that doesn’t disrupt workflow plus the human touch in creating the penultimate draft that is ported over tot he EHR- the final one, of course, is the one the doc reviews and signs. Here’s a link to the interview: One of the co-founders is a 4th-year med student at UCSF!

  3. GE
    September 22, 2018 at 1:58 pm

    I think that you guys don’t get it. It’s pretty simple. Independent doctors won’t be able to afford a scribe. More of them will have to sell to hospitals. This is the ultimate goal, destroy private practice so mammoth hospital chains will gain all the power.

  4. L. J. Sloss, M.D.
    September 22, 2018 at 1:40 pm

    … and while you are at it, examine the patient from the wrong side of the bed and apply the stethoscope to the gown, thus minimizing potential heart noise interference with the stream of formulaic drivel you are able to generate for your supernumerary amanuesis.

  5. Soccerdoc11
    September 22, 2018 at 9:38 am

    Or doctors will just hang it up (no double entendre intended)

  6. PW
    September 22, 2018 at 9:29 am

    Pretty soon we’ll have to have scribes to help the scribes when they get burned out!

  7. Gerard Mazza
    September 22, 2018 at 7:09 am

    Every time I I see a new government or insurance company regulation there is an increase in cost and a waste of time. Usually they are small increases such as the so called tamper proof prescription pads and the HIPPA compliant sign in sheets, but these small increases add up. A scribe would be a big cost increase. Government, the AMA, AAFP, insurance companies, etc. think that I have an unlimited supply of time and money to use for their latest pet project. I recently read an article in either an AAFP publication or Medical Economics, I can’t recall which, about how giving vaccines in the office can be profitable. It then went on to explain the complexity of proper coding, the need for a dedicated professional quality refrigerator, a temperature monitoring system, and of course a backup generator for the office in case of a power failure. After having a few vaccines refused by the insurance companies, some go out of date, and some patients not paying their part, I am sure this would make me a fortune after taking about 20 years to pay for the initial investment.

    • PW
      September 22, 2018 at 9:29 am

      And…the patients can get all their vaccines at the local CVS. So why get them at the family doctor

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