This is a huge benefit, especially when it comes to med mal defense.ДЄnother 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 вЂ“ 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:ДЎ645 вЂ“ 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 вЂњteaching pointвЂќ 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. IвЂ™m learning to вЂњlet goвЂќ 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 didnвЂ™t realize its significance. To me, reading these charts are like fingernails on a chalkboard, though theyвЂ™re perfectly accurate and acceptable. There are some odd little verbal tics some of the scribes have that I would never use. ItвЂ™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. IвЂ™m facing the patient, not facing a computer screen, IвЂ™m not making notes on a clipboard, and IвЂ™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 вЂњmyвЂќ 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. IвЂ™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 вЂњissuesвЂќ such as psych, substance abuse or simply an unpleasant patient, IвЂ™ll wait till weвЂ™re out of the room to tell the scribe what I want documented. вЂњYour lungs are clear and your heart is regular without murmurs.вЂќ 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 IвЂ™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: вЂњIвЂ™m Dr Shadowfax, and this is Jenny, who is working with me today.вЂќ 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 docвЂ™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.ДЇirst, the general structure of the program, for our group.

Whats a medical scribe