Scribes

[goodvibes]

I would strongly consider using an electronic service over an in person scribe. Having used both models, I agree that many patients do not enjoy having a random young person typing away while having a delicate personal conversation. More importantly, the digital service will not call in sick and lay waste to your workday. With a digital service or human scribe, either will need training at the start, but the digital product is less likely to be fired or quit

I have really enjoyed using Saykara. I would be happy to discuss with anyone. Feel free to DM

[eyecandy]

Another scribe lover here. Getting through 30+ patients without a scribe is awful. I also enjoy having actual rapport with my patients, which doesn’t come from me looking at the computer.

consider another way scribes are a time saver... a good scribe saves you from having to do any precharting. I will quickly review last note and chart nothing, they do all the clicking, create my note (typically copy forward if my last note). With returns they chart the exam, all diagnoses, create the patient instructions, nearly my entire note. Then all I have to do review: typically make a few spelling changes, add a few details to the plan, drop charges and done. Return visits they can finish 90+% of the computer work, which allows me to practice up to my highest skill level instead of being a typist/prof clicker.

What I did was shadow an ophthal for a couple hours who is very efficient with their scribe and it opened my eyes on how much documentation we can take off our plate. A trained scribe allows me to have 100% of charts closed by 5 most days. Try it out!

[StarTrekDoc]

In primary care the trouble is the learning curve for scribes is relatively steep and variability is higher compared to specialties. This is the same challenge for RNP on a different scale but same reasons.

Our system allows for scribes but few docs maintain them after the second or turnover of scribes because of the retraining involved.

[EH]

I have not been accused of that but I take the point.

I wonder if it depends on the EMR. I do not find routine documenting all that difficult or cumbersome. I do what I can before I go in. I do the minimum needed in the room so they can check out after. I dragon in the rest either right after or after 1-2 more patients. I honestly think it would take me longer to say it then to just do it.
On my prior EMR I probably would be more willing to try because Nextgen was a piece of crap. I am currently using medent and I am quite happy with it. Some things take more clicks then I feel are necessary but overall I like it way better then Nextgen and significantly better then epic.

I think I would leave medicine if I had to use nextgen. That thing is horrendous. Perfectly happy with epic. I write the history while patient is talking. Exam is a few clicks mostly. Mix of typing and dot phrases for plan - finishing this is honestly helpful for my process and I sometimes remember to do things I miss when I was in the room. I like having control of the documentation and not having anyone else in the room. I suppose it might help a little in terms of speed but if I had to review/edit I can’t imagine it being all that helpful.

[Cubicle]

I don’t have a scribe but I can’t see how having one would be anything but an improvement. The biggest thing I hate about my clinic days is documentation. I enjoy seeing and talking to (most) patients, but then having to spend almost as long out of the room doing the paperwork as I spent in the room is painful.

Announcement everyone: MaxPower is my long lost twin. 100% echo the same sentiments.

During residency I spent time in a private office with a scribe. And in residency clinic we had medical assistants who functioned like a scribe. It was dramatically, wonderfully, absolutely, fantastically better than not having a scribe. They can be your right hand. And you keep focus on your patient. Not documenting. Highly recommended. I hope to be pursuing a scribe/assistant as long as I stay as busy as I have been.

[Lordosis]

true, but it is also difficult to say that the doctor was having an erotic/inappropriate conversation about penises when there is a witness in the room.

I have not been accused of that but I take the point.

I wonder if it depends on the EMR. I do not find routine documenting all that difficult or cumbersome. I do what I can before I go in. I do the minimum needed in the room so they can check out after. I dragon in the rest either right after or after 1-2 more patients. I honestly think it would take me longer to say it then to just do it.
On my prior EMR I probably would be more willing to try because Nextgen was a piece of crap. I am currently using medent and I am quite happy with it. Some things take more clicks then I feel are necessary but overall I like it way better then Nextgen and significantly better then epic.

[SLC OB]

We are in the middle of a trial of virtual scribes. They log in remotely, the are only on the speaker listening (they don't speak) and one scribe is assigned to each doc for consistency. There is one back up scribe too, for vacations. I think this might be better than the person sitting in the room and watching the person type while they talk about ED. And this would also document the politically correctness of the conversation. The scribe can cue up orders, to be signed by doc, and can huddle with the physician between patients or after clinic for clarification etc. I am not part of the pilot group, but I'll let you know how it goes.

[MaxPower]

I don’t have a scribe but I can’t see how having one would be anything but an improvement. The biggest thing I hate about my clinic days is documentation. I enjoy seeing and talking to (most) patients, but then having to spend almost as long out of the room doing the paperwork as I spent in the room is painful.

[G]

I'm sure everybody loves telling their doctor about their erectile dysfunction with a rando young lady in the corner typing into a computer

true, but it is also difficult to say that the doctor was having an erotic/inappropriate conversation about penises when there is a witness in the room.

[Tim]

I'm sure everybody loves telling their doctor about their erectile dysfunction with a rando young lady in the corner typing into a computer

Better than Aunt Margie!
https://www.google.com/imgres?imgurl...MygPegUIARDmAQ

[Lordosis]

I'm sure everybody loves telling their doctor about their erectile dysfunction with a rando young lady in the corner typing into a computer

[G]

Thinking about it that way I do not think I would like extra people in the room if it could be avoided.
I am a healthy person with no sensitive medical issues but I could imagine that would weigh on some of the patients.

Might suggest a counter point that having a witness in the room makes everyone feel more at ease.

[JBME]

My wife is in primary care (IM) at an outpatient academic clinic. They brought scribes in years ago. Big picture, it's been a win. From my take of what she's said over the years, it improved productivity although I don't think it improved job satisfaction. It's also hit and miss-most scribes are good but some are bad and she has to redo the whole note. She's also more of a perfectionist so she goes back and redoes a lot of notes. But the bad scribes definitely make her take up time correcting the note (though again she only usually makes minor modifications because most scribes are good)

[jacoavlu]

reminds me of residency (radiology) when we were the scribes, we had one staff who would blow through some aged person pan scan from the ER, say something along the lines of "nothing acute, put some words on it"

[White.Beard.Doc]

Our scribe group works for the ED, ortho, cardiology, primary care, neurology, and others. The primary care docs over the age of 40 greatly prefer having a scribe as it take away the pain of the EHR and improves their work flow.

However, while the cost of the scribe is easily born by the cardiology and ortho practices, in primary care it takes away a bit of profitability from the practice.