An Unexpected Quality of Life Upgrade

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.

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Joanna Rulf, DO

Joanna Rulf, DO practices Family Medicine and Integrative Medicine in her second-home state of Maine. Originally from NJ, Joanna graduated from Rutgers University with a degree in English Literature, pursuing a career in the publishing industry in NYC before attending the University of New England College of Osteopathic Medicine from which she graduated in 2009. She completed residency in Family Medicine and fellowship in Integrative Medicine at Maine Medical Center in Portland, ME. During this time she also completed the fellowship curriculum from the University of Arizona Center for Integrative Medicine and received certification in Medical Acupuncture from the Helms Institute for Medical Acupuncture in Phoenix, AZ. Her practice blends the broad spectrum of rural primary care medicine with evidence-based management of a variety of conditions using Osteopathic Manipulative Medicine (OMM), acupuncture, and an array of wellness strategies. The mother of two young children, Joanna has journeyed hard on the quest for work/life balance, mental/physical wellness, and strives to help her patients (and colleagues!) do the same.

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7 Responses

  1. Mamadoc says:

    Computer was never more efficient, at anything except collecting information for billing and regulators. Never will be, either.

  2. arthur gindin says:


  3. Stewart says:

    Hiring more people to do work that isn’t worth doing in the first place is never a solution.

  4. Kurt says:

    So now pri care has given up on hospital practice and call.
    I had a hand held dictaphone and it was still laborious and stupid. The next patient doesn’t want to wait any much longer to be seen so the dictations get put on the back burner. A scribe? In a small town I’ve had patients complain that their medical particulars were leaked out and it was likely from the people in medical records at the hospital I worked at. They were sworn not to talk but apparently someone did. Think you can keep the scribe “sworned in” ? Yeah, yeah, yeah. I know you have to do what you have to do in order to survive. I appreciate that.

  5. Rick says:

    Makes me ponder on my childhood MD. Not a Ped, a GP. Small office. Wife was his Nurse and front desk. One patient at a time. Relaxed. And he lived a nice life.
    And I remember going to a museum and seeing a medical office from yesteryear. It was so simple, so basic, I almost cried. For what we’ve lost.
    And now, massive burnout and misery. How did we get here. Don’t answer that, I do know.

  6. Dave says:

    Or, just maybe, we shouldn’t have to document all the bull$!*t that we are only documenting to satisfy insurers, the sepsis and stroke “quality” people, and the general bean counters? What do all these people have in common? Oh yes, none of them went to medical school, and none of them actually touch patients, and none of them actually produce anything other than more BS.

  7. Martha Clark, RN says:

    Great post, Dr Rolf. Welcome back to a (relatively) normal Life!

    I couldn’t agree more – we don’t need nurses with online degrees replacing physicians.

    The practice of medicine must be modified – it needs to be compatible with living a relatively normal life.

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