Monday, December 14, 2015
Could scribes be the ultimate answer to the frontline woes of hospital care?
Statistics suggest that physicians are now spending a minimal amount of time in direct patient care, shockingly as little as 10% of their day. This proportion of time that physicians (and nurses) actually spend interacting with patients has been shrinking year by year. There's the need to communicate with other members of the expanding health care team, increased bureaucratic requirements, and over the last several years, the need to navigate and use the electronic medical record to enter notes and place orders. Of course, it's not realistic to suggest that it's possible for any doctor to spend 100% of the day in direct patient care, but 10% is, quite frankly, a little sick.
If you ask any frontline physician or nurse at the moment what 1 of their biggest daily frustrations is, they will list health care information technology at or near the top of the list. It's not that IT isn't the future (because it definitely is). It's just that the current crop of systems are largely slow, clunky and inefficient to navigate. They are not reconciled correctly with frontline clinical workflow and are turning physicians into “type-and-click-bots”. Unfortunately too, this problem particularly affects the generalist specialties including primary care, emergency, and hospital medicine. These are the specialties where interactions with patients matter the most. For example—over a dozen clicks and a couple of minutes of time just to order a Tylenol? 5 minutes with a patient and then 30 minutes documenting it on a computer? Come on!
Having been in clinical practice for the best part of a decade and seen first-hand in several hospitals this huge problem unfold, I am increasingly coming to the conclusion that medical scribes may be the ultimate answer to the problem of taking doctors back to where they belong. In direct patient care. For anyone reading who is not familiar with what a scribe is, as the name suggests, it's basically an individual who takes care of all the documentation requirements for physicians. They usually shadow the doctor who then tells them what to document, later co-signing the note after they've reviewed it. I've personally seem them working with emergency room physicians but am yet to use them myself (although am very keen to try). Scribes are becoming more popular, and a recent article in a major hospital medicine journal discussed them in detail. Here is a summary of why they could be a win-win solution:
• Physicians have more time to engage in direct patient care;
• Physicians can see more patients and be more productive;
• Increased physician job satisfaction, retention and lower burn-out rates as they spend more of their day doing what they were trained to do and less time staring at a screen;
• The scribes themselves are often college age students who want to get into a healthcare profession. They are paid an hourly rate and are very happy to be there learning about medicine; and
• Hospitals benefit from happier staff, patients and higher productivity.
In fact, I'm sure many physicians would gladly pay $10-15 an hour out of their own pockets if it meant more overall productivity/RVUs, efficiency and a happier time at work. But it shouldn't come to that, because if used correctly, they are an asset to any hospital or clinic.
The job of being a scribe is an ancient one, and has its roots in ancient Egypt, where a scribe was considered 1 of the most important professions. Back then, they were used primarily for copying texts and making records using hieroglyphics. They were part of the royal court and did not have to pay taxes. With the advent of printing over the next few millennia, the scribe profession became obsolete. Wouldn't it be interesting if 5,000 years on from ancient Egypt, the scribe profession came to the rescue of frontline health care?
Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care. This post originally appeared at his blog.
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Ira S. Nash, MD, FACP, is the senior vice president and executive director of the North Shore-LIJ Medical Group, and a professor of Cardiology and Population Health at Hofstra North Shore-LIJ School of Medicine. He is Board Certified in Internal Medicine and Cardiovascular Diseases and was in the private practice of cardiology before joining the full-time faculty of Massachusetts General Hospital.
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Robert M. Centor, MD, FACP, contributes short essays contemplating medicine and the health care system.
Suneel Dhand, MD, ACP Member
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