Editors’ pickMed

We Need More Medical Scribes – Op-(m)ed

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By Kunal Sindhu, MD

On the last day of one of my outpatient rotations, I was introduced to the new medical scribe who would be working in the clinic going forward. It was my first and, to date, only experience working with a scribe.

While worried at first that an additional person in the examination room might alienate my patients, I was pleasantly surprised to find that the scribe—a young man who had recently graduated from college and seemed genuinely interested in medicine—had embedded himself into patient rooms so discreetly. My patients welcomed his presence, and some even seemed to relish the opportunity to share their stories with an additional person.

I found that I was able to devote far more time to making eye contact with my patients and addressing all of their concerns since I did not have to worry as much about my notes. At the end of the day, for the first time all rotation, I was able to leave the clinic on-time thanks to the scribe’s assistance in completing the day’s required documentation.

I still remember how much better that clinic day was solely due to the scribe helping me complete my notes. As it currently stands, physicians at all levels are spending far too much time on electronic medical records (EMRs), which are driving increasingly unmanageable documentation requirements. A 2016 study of 41 medical interns found that they were spending an astonishing 5–7 hours per day on EMRs. Another 2016 study found that physicians spent just over a quarter of their day with patients, but nearly half of their time is spent completing EMRs and desk work. In other words, for every hour they spent with patients, physicians spent nearly two hours on EMR and desk work. The physicians in the latter study who kept after-hour diaries reported spending 1–2 hours of personal time each night to complete work tasks, mostly associated with the EMRs.

This is unsustainable. Patients come to see us to tell us their symptoms, express their fears, be reassured, and get better. With fewer and fewer minutes available to patients, I fear that we, as a profession, will no longer be able to sufficiently cater to their needs. Over time, this could have long-term ramifications on the all-important patient-provider relationship, undermining patients’ trust and satisfaction. The burdens of documentation associated with EMRs have become too great for physicians to handle by themselves.

That’s why a recent study in JAMA Internal Medicine got my attention. Primary care providers (PCPs) were randomly assigned to start the first three months of the year with or without medical scribes, and then alternated every three months for a year. The availability of medical scribes was associated with reduced EMR documentation after work hours and greater likelihood that PCPs spent more than 75% of a patient visit interacting with the patient. Importantly, like in my clinic, only 2.4% of the patients in this study reported that having a scribe present had a negative effect on their visit.

In other words, the use of medical scribes may hold the key to reducing documentation that has plagued the rise of EMRs and turned many physicians against such administrative processes. Perhaps most importantly, by freeing an hour or two per night for personal time and refocusing physicians’ jobs on actual patient care (the reason that many of us pursued the profession in the first place), the use of scribes may help combat the burnout crisis in American medicine. With nearly half of American physicians currently reporting burnout, this is an intervention worth considering.

While hiring new scribes would undoubtedly be associated with new fixed costs, in the grand scheme of things, they would be relatively low. One study by members of an academic Dermatology practice found that the costs of new scribes to a hospital was covered by seeing one additional patient per session. The trade-off between the number of additional patients that have to be seen to pay for the costs of new scribes would likely vary across specialties. But this is a small price to pay given the considerable potential benefits of scribes.

Medical scribes have the potential to remake American medicine. As a clinician, the possibility of being freed from the burdens of excessive documentation and having more time with my patients is tantalizing. On a systemwide level, by helping to reduce after-hours work and refocusing physicians’ time and energy on the direct provision of patient care, scribes may help fight physician burnout. Importantly, scribes may be able to achieve these objectives at a relatively low cost. Medical leaders would be wise to consider investing in their services.

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