Even when doctors are listening to a patient, they might have their heads buried in charts. Using a scribe frees physicians to focus completely on the patient, and enables them to be more productive in the long run.
A chief concern among patients is that they feel as if their doctor doesn’t give his or her complete attention during in-office interactions. Judy Bee, a practice management consultant with Practice Performance Group, says that’s not surprising.
Physicians are listening, of course, but Bee points out that with their heads buried in paper charts or, more recently, focused on a computer screen and the patient’s electronic medical record (EMR), physicians are neglecting an important element of the patient-doctor exchange.
“You miss physical cues,” Bee explains. “You’re not interacting with the patient. And that breaks the patient bond.”
Using a scribe, however, frees a physician to focus completely on his or her patient, and enables them to be more productive in the long run.
In the dark
Bee says that the first time she saw a scribe was in an ophthalmology office. And in an ophthalmologist’s exam room, the lights are usually off. The doctor is eyeball to eyeball with the patient, making it challenging at best to continue rotating back to a piece of paper or a brightly lit computer screen to write down what he or she sees.
What Bee witnessed was a doctor who could stay face to face with the patient while a tech wrote down what the doctor said during the exam. By the time the patient was done, so was the note.
“The doctor was very efficient, because the entire time that she was in the exam room was face-to-face with the patient saying ‘here’s what I think.’ And they could move on,” Bee says. “And so in terms of productivity, [doctors] might be able to see one or two more patients in a morning, let’s say, if someone else is doing the documentation. And so the increase in production easily paid for the price (of the scribe).”
Bee says that the physicians she has spoken with believe that using a scribe enables them to pay full attention to the patient and get back to actually practicing medicine. Once the physician completes the exam, the scribe or nurse can review the information with the patient, and the physician can move on to the next patient.
There is the argument that patients may not be used to having a third person in the exam room, and that the physician-patient encounter is now less private and confidential. While Bee doesn’t believe most patients will mind, she suggests giving them an option.
“Say to the patient, ‘Mrs. Jones, you now have an electronic medical record, but I’m not going to be staring at the machine. I’m going to be talking to you. And Pat, here, is going to be recording the stuff that we need to have in your records. Is that okay with you?’” Bee uses as an example. “And if they say ‘Yes,’ then tell them, ‘If there is anything that you would rather say privately, that would not be put in a record necessarily, I can ask Pat to leave the room.’”
A scribe believer
Charles Crutchfield III, MD, is the principal of Crutchfield Dermatology based in Eagan, Minn. He has been using scribes for the past 10 years, and says doing so has had such a positive impact on his practice that, “If I were told I could not use scribes, I’d leave medicine. That is how much of a difference they make.”
Crutchfield began using scribes shortly after opening his own practice. He attended a seminar called One Nurse Per Exam Room, and thought, “Why not be a scribe also?” He started with three high-level trained assistants — medical assistants, registered nurses or LPNs — and now has a staff of 16.
“They all work as scribes,” Crutchfield says. “They do all my electronic medical record notations, write the prescriptions when I tell them what to give the patients, and educate the patients on how to use the medication.”
There are naysayers who believe EMRs will eliminate the need for scribes, but Crutchfield simply believes those are just people who haven’t tried it.
As for quantifying the cost of hiring and/or training staff to work as scribes, Crutchfield says it’s an easy dollars and cents decision.
“I have a staff of 35 employees, full- and part-time,” he says. “And I would say that from my other practice [where scribes were not employed], my overhead has doubled, but my income has tripled. And I’m not sitting around doing paperwork. I’m doing people work, patient work. And I love it.”