What impact do scribes have on medical errors?
Dr. Murphy: Having documentation take place in real time reduces error. If physicians do their charting at the end of the day, how can they remember details of every patient? In the event of a malpractice suit, these missing or incorrect details can become crucial. Additionally, details are important if the patient is transferred to the care of another practitioner.
Do patients feel scribes to be an intrusion?
Dr. Murphy: There are many options for addressing this concern. One is a legacy scribe—the physician dictates the notes and the scribe subsequently enters them into the EHR. Or the scribe is outside the room and the physician verbally dictates the notes and moves on to the next patient. Telescribes do their recording remotely through a built-in microphone in the room. A chaperone during an examination may also serve as a scribe.
How do you see the future role of scribes?
Dr. Murphy: We currently do not have prospective trials demonstrating long-term patient outcomes, but these studies are underway. I believe we will see reduced morbidity and mortality rates. Subjectively, I am sure that physicians and patients will both continue with increased satisfaction and that the incorporation of scribes into medical practice will continue to grow.
Dr. Ami Schattner
What is your experience of the use of medical scribes?
Dr. Schattner: I am affiliated with Hadassah Medical School in Jerusalem. We do not use scribes here. But I have been in the United States on sabbatical, and I have seen the pressure physicians experience as a result of regulatory and charting requirements. I have also observed the role that scribes often play. I keep up with the literature and research from the United States and England, and I speak to many US-based practitioners.
What are your perspectives on the role of scribes?
Dr. Schattner: I have serious concerns about the impact of scribes on the tender dynamic and intimacy of the physician-patient encounter. Perhaps the word “sanctity” is not too strong when talking about the physician-patient relationship. Historically, physicians and patients related directly to one another, with a nurse to assist when necessary. A secretary handled administrative tasks.
But two trends have been taking place over the years. One is that physicians have less time to spend with patients. The other is that an increasing number of professionals are becoming involved in patient care, including dietitians, social workers, pharmacists, behavioral counselors and physician assistants. The introduction of medical scribes further dilutes the relationship with the physician. The few precious moments a patient has must be shared with yet another professional, potentially reducing trust, support, and adherence. Patients may also be reluctant to divulge personal information because an outsider is present, which can be harmful to the patient.
How do you suggest that administrative tasks be accomplished by physicians, given their time constraints?
Dr. Schattner: I believe scribes will not eliminate a physician’s need to gaze at the computer and make notes, as there are crucial details of the clinical history, medications, and tests that the physician in particular will need to extract and assimilate. I recommend that the physician take time to study the EHR prior to the patient’s entrance, and then focus entirely on the patient, entering the information into the computer toward the conclusion of the encounter.
Do you have any other concerns regarding the role of medical scribes?
Dr. Schattner: One potential concern is that, as physicians become increasingly overburdened, scribes might end up taking on many of the interviewing and personal talks with the patient, and the physician may substitute this documentation for directly asking these questions of the patient.
It is a challenge in modern medicine to avoid making the computer a “third party” in the physician-patient relationship. However, I do not believe a scribe is the solution to this problem, and may create more distance and take on a potentially greater role that further complicates and compromises the physician-patient relationship.
- Shultz CG, Holmstrom HL. The use of medical scribes in health care settings: a systematic review and future directions. J Am Board Fam Med. 2015 May-Jun;28(3):371-81.
- The Joint Commission. Standards FAQ Details. Scribes-definition. Available at: https://www.jointcommission.org/standards_information/jcfaqdetails.aspx?StandardsFAQId=1206. Accessed: April 6, 2017.
- Yan C, Rose S, Rothberg MB, et al. Physician, scribe, and patient perspectives on clinical scribes in primary vare. J Gen Intern Med. 2016 Sep;31(9):990-5.
- Koshy S, Feustel PJ, Hong M, Kogan BA. Scribes in an ambulatory urology practice: patient and physician satisfaction. J Urol. 2010 Jul;184(1):258-62.
This article originally appeared on MPR