It’s new and it’s old. Old as in ancient Egypt and the scribes who kept records there. New as in a modern scribe typing into a computer in real time, recording heart rate, blood pressure and observations.
It’s new and it’s old. Old as in ancient Egypt and the scribes who kept records there. New as in a modern scribe typing patient information into a computer in real time, recording heart rate, blood pressure, and observations. To see this in action, visit Doctors Community Hospital in Lanham, Maryland.
“Room 22? Okay, let’s do it.”
Dr. Puneet Chopra is moving from patient to patient in the emergency room. His scribe, Susan Kim, is right behind him pushing a cart with a computer. She’s been trained to document everything that happens in the exam and mark the electronic form in her computer.
“It’s a list of every bodily system,” she gestures to the screen, “like neurological, cardio or respiratory- and you either circle it if they have the symptom or you cross it out if they don’t have it.”
After the exam, Dr. Chopra stops in the hallway for a moment to clarify the diagnosis. “Put sclera icterus down for her; everything else is normal. Under skin, put in jaundice.”
Dr. Chopra is 36, old enough to have seen huge changes in how doctors practice medicine. Before using scribes, he would have juggled his stethoscope and computer and would have broken eye contact multiple times while typing. Dr. Chopra says that is not the way he wants to practice medicine.
“The common saying is that now you spend more time with the computer, sitting in the room typing away, while trying to talk to a patient and examine them and the patient doesn’t feel it’s a personal encounter anymore.”
While he was still in training, Dr. Chopra designed a model scribe program at Georgetown University Hospital. It convinced him that scribes are the solution to the federal demands on doctors to keep electronic health records.
Scribes make between $10 and $25 an hour. Their job is to sit in a corner quietly and document the conversation between patient and doctor. They enter billing codes and can make appointments.
Think about it, you’re still sitting in a gown, your doctor wants to see you next week and the scribe makes an appointment and offers you a reminder card.
“It’s the doctor and the scribe will see you now,” says Dr. Michael Murphy, co-founder and CEO of Scribe America.
Murphy estimates there are about 10,000 scribes working in the country, about half trained by his company. He says in some situations, however, patients choose not to have a scribe in the room- often during sensitive exams, like ob-gyn and urology.
“What we do is put a digital microphone in the doctor’s pocket and let the patient know the encounter is going to be recorded. The scribe sits outside the room but they can hear everything.”
Some doctors are concerned that this is a lot of information in too many hands. Retired cardiologist, Dr. Joel Sherman of Connecticut worries about patient privacy and blogs about it on the health care website KevinMD.com.
“A GP is going to ask about sexual history, venereal disease, drugs, all kinds of things. Another thing about scribes is that they may just have high school training and no experience in medicine.”
Doctors who use scribes say they can cut two hours of clerical work and see several more patients. In Philadelphia, a hospital trimmed their wait time for appointments from one to two months to one week.
Medicine is not all math though. It is listening between the lines and then distilling a problem. So, hospitals and doctors will have to decide whether a scribe helps them do that, or interferes with that process and the relationship with the patient.