Slightly before spontaneously combusting due to burnout from the overwhelms of doctoring, homeschooling, parenting and merely subsisting emotionally during the initial months of COVID-19, I was finally granted something I had been vainly trying to obtain for the last seven years since graduating from fellowship: a scribe. As one who is admittedly resistant to change, it must have taken a rock-bottom level of desperation to create the surrender necessary to submit to the awkwardness, but submit I did, one-hundred percent, immediately after receiving my 30-minute training on using the transcription device. Noting with surprise my seemingly endless well of equanimity in dealing with the initial glitches, I persisted until it began to run more smoothly. At this point, I noted a sensation of generalized lightness and optimism. Consequently came the realization that a significant volume of mental real estate previously occupied by medical documentation, anxiety about medical documentation and the threat of delinquent documentation had been freed. I think I may actually be squinting less. Instead of spending multiple hours after each clinic day handling acute issues and charting, I handle the acute issues and go home to my life. In deciding to go on a long bike ride last weekend, guilt about not spending that time on my computer suddenly did not need to be factored into the equation. In the office I have begun to feel more accessible, more apt to squeeze more patients in for acute visits as needed, which I would assume increases my patients’ satisfaction, not to mention my productivity. Even though I am a fast typer, and have historically been able to type an HPI while looking at my patient, I can now actually have a conversation with them, with my body turned squarely toward them, and give them my undivided attention as they speak, something I have never been able to do. My notes read more complete/thoughtful, less minimalist/haiku. I have more time to think about additional roles fostering medical students and residents, lending my energy to committees, etc. I also sense a newfound loyalty to my organization. Is this what they call job satisfaction?
“This fix is, admittedly, a little ridiculous. We replaced paper with computers because paper was inefficient. Now computers have become inefficient, so we’re hiring more humans. And it sort of works.” – Atul Gawande, MD, “Why Doctors Hate Their Computers”. The New Yorker. 11/18/2018.
As physician burnout continues to climb, with primary care having one of the highest rates in medicine, I am left wondering why it took a crisis to implement this in my practice, and why it’s not more widespread. The limited data support increased productivity and therefore revenue that more than covers the cost of the service. As we continue to lose doctors to burnout, and to suicide, and to deepen our national crisis in accessible primary care, it continues to amaze me that efforts have turned toward giving medical decision making autonomy to non-physicians untrained in medical decision making, than to making primary care the enjoyable specialty it is for physicians, given the proper compensation and supports.