Tarzananhospital er scribe11/18/2023 I don’t need to do a Review of Systems or even a physical exam for a kidney stone patient, and over the years I may have become a little lax on this point from time to time. Once you have been working in an ER for a while, there are quite a few diagnoses you can literally make from the doorway. This is a huge benefit, especially when it comes to med mal defense.Īnother thing that this has forced me to do is be more rigorous with my H&P. Stuff that I had never before had the discipline to document and time, now 100% of the time in the chart. 1025 – Dr Shadowfax speaking with Dr Jones, who requests MRI One of the best points (and a pleasant surprise) was when I reviewed my charts and found entries like:ġ645 – patient re-evaluated. Since they are all pre-med, they really seem to appreciate it. When there is an important point I want emphasized I can simply repeat it back to the patient as a cue that I want this verbatim in the chart, and if I note an omission I review that afterwards with the scribe as a “teaching point” for them, as I would with a med student. And I think the scribes, as they learn, are getting better and better at picking out the important bits of the conversations they are documenting. I’m learning to “let go” and not spend so much time editing each chart that it negates the point of having a scribe in the first place. It is very important to proofread the charts and make sure they say what you need them to say. Sometimes a really important historical point gets left out of the chart because the scribe didn’t realize its significance. To me, reading these charts are like fingernails on a chalkboard, though they’re perfectly accurate and acceptable. There are some odd little verbal tics some of the scribes have that I would never use. It’s hard to let go of control of the chart. The quality of the documentation is a little more variable. I suspect, though I have no proof, that it also helps with patient satisfaction, which matters a lot these days. Simply put, I can focus on the patient, and I feel like that allows me to be a better doctor. I feel like I have more mental energy to spend on the patient and I can simply forget about the chart, confident that the scribe is capturing the important data points. I’m facing the patient, not facing a computer screen, I’m not making notes on a clipboard, and I’m not frantically trying to remember the necessary data points for the chart. I can take a bit longer and have more of a free-flowing conversation. I have the freedom to simply sit down and talk to the patient. But these small efficiencies are of course the whole purpose of having a scribe in the first place, so I am getting over that. Getting over the idea of someone else doing “my” work for me has been and remains probably the biggest barrier for me in fully accepting the scribe. I can also document perfectly well myself. I’ve never had a secretary or personal assistant before and have always prided myself on self-sufficiency, so it feels odd to have someone whose whole job is to do the little scut work (like putting a chart in the rack or pulling reports off the fax machine) for me. If there are “issues” such as psych, substance abuse or simply an unpleasant patient, I’ll wait till we’re out of the room to tell the scribe what I want documented. “Your lungs are clear and your heart is regular without murmurs.” This allows the scribe to document my exam in real time, and, from what I can tell, patients seem to like it, since they are getting a sense of what I am looking for and seeing. During the physical exam, I verbalize what I’m seeing/doing, as if I am talking to the patient. The scribes step out of the room for pelvics or other uncomfortably intimate exams and are generally invisible during the H&P (hidden by the large monitor of the computer on wheels they bring with them). I added another line to my standard introduction: “I’m Dr Shadowfax, and this is Jenny, who is working with me today.” Almost never has the presence of the scribe occasioned any further comment or discussion. The social aspect of having a scribe is more than a little weird, though I got used to it quick enough. The program is entirely voluntary and about a third of our docs have signed up so far, usually just for the busier shifts. The cost of the scribe is deducted (pretax) from the doc’s individual paycheck. Docs who are interested in having scribes sign up and choose which shifts they want a scribe for. The vendor recruits the scribes from a local university, mostly pre-med students, and manages all the HR functions associated with such a program. We pay a flat hourly rate to a scribe vendor. These are my thoughts and observations so far, after about a dozen shifts with my own personal scribe.įirst, the general structure of the program, for our group.
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