A recent article by Dr. Art Caplan of the Division of Medical Ethics at the New York University Langone Medical Center really hit home for me. In his article, “Would a Scribe Repair of Destroy the Doctor-Patient Bond,” Dr. Caplan hypothesizes about how adding a third-party to the doctor-patient relationship would affect each party.
He begins by noting some common patients complaints; that doctors are often buried in their computers or cell phones while patients list their symptoms, and he supposes how adding a scribe to record the patient information could allow the doctor to focus solely on what the patient is saying without having to take notes. He later offers a counterpoint, saying that scribes could introduce more opportunities for error. He concludes by saying he doesn’t believe scribes would be a good fit, and he thinks we ought to pursue other avenues to improve the doctor-patient relationship.
My Take
I respect Dr. Caplan and I believe it is well worth investigating other ways to improve the doctor-patient relationship, but, having recently introduced a scribe in my practice, I want to share my experience. Not only has it improved patient relationships, but it has also improved my relationship with my family.
I introduced a scribe in the last month after spending over a year with a new Electronic Health Records system. I refused to let the EHR interfere with my relationship building. I would listen to the patient and record their concerns in the EHR database later, and while my patients appreciated my direct attention, the method began to destroy my family life.
I would spend an entire weekend, hours upon hours, going back and dictating notes, modifying different sections, adding my reviews of MRIs and CT scans into our EHR system called Dragon. Sometimes voice dictation would incorrectly interpret what I was saying. I would always double check the dictation, and oftentimes I would catch these errors, but every once in a while one would slip through the cracks. I would catch any of these errors prior to any operation, as I know what the notes should read, but catching it at that point left me mortified because a copy of the notes were disseminated to primary care and referring providers.
I missed dozens of my boy’s hockey games catching up on work. I missed playing with my daughter and still hate remembering those moments when she said, “Daddy, let’s play,” and I had to say “after I’m done with my work.” I wouldn’t sleep as much because I was always waking up early to finish a clinic.
Well, I just couldn’t do that to my family anymore, so I added a scribe. The first week was a little tough, but the transition is going quite smoothly. Does it damage the doctor patient relationship? In orthopedics, not a chance. I can spend all the time the relationship needs and now I do without the guilt. Do I catch errors in review? Yes, but that is part of any record, dictated or scribed.
The scribe is a prospective medical student, nurse or physician’s assistant. They get to experience a medical office, and they learn tons of information that I never had the early opportunity to do in college. I would pay for an experience like that, and they are getting paid to do it!
So with little extra cost, I get my family life back, more sleep, and I am helping someone else learn the ins and outs of the medical world. I will be a mentor for them for years to come. Adding one person to my clinic has led to an exponential improvement in my life. I would recommend it to any doctor who is feeling overburdened or who is missing out on memorable family moments.
