Medicine
According to a national survey, a typical family physician spends nearly half of his or her working hours outside of the examination room doing follow-up care or documentation. I think most of my colleagues would agree that entering notes into the electronic health record is one of their least favorite parts of practicing medicine. After all, we went into medicine to care for patients, not to spend endless hours scrolling through screens full of check boxes to prove to payers that we are caring for patients. At the same time, patients may be unable to connect emotionally or convey subtle physical findings when their doctors spend so much of the visit looking at a computer screen.
One solution to the problems posed by electronic documentation requirements is for physicians to delegate the task to a medical scribe. As described in a recent article in Family Practice Management, this trained assistant (medical assistant, medical student, licensed practice nurse, or registered nurse) gathers initial data; documents the physician's examination, assessment, and plan; and provides patient education and implements the care plan while the physician moves on to the next patient. One of the authors reported that his increased efficiency and net revenue more than made up for cost of training and paying for an additional medical assistant functioning as a scribe. Further, the presence of the scribe seemed to have positive effects on the patients' experience:
We've also noted significant increases in our patient satisfaction scores as we've adopted this new model of care. One thing that surprised me was the relationships my patients developed with my MAs, sometimes telling my MAs things they won't tell me. Patients consider the MAs as additional advocates to whom they can go with problems or questions. I thought more patients would object to having another person in the exam room, but that has not been the case.
Beyond this suggestive anecdote, what is the evidence that medical scribes improve practice productivity, revenue, or the physician and patient experience? A systematic review on the use of medical scribes in the Journal of the American Board of Family Medicine found only five studies, none performed in primary care practices. In emergency department, cardiology, and urology settings, scribes appeared to improve clinician satisfaction, efficiency, revenue, and patient-clinician interactions, but did not improve patient satisfaction. Still, given the ever-increasing burden of documentation in primary care, the demand for medical scribes will doubtless increase in the future.
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This post first appeared on the AFP Community Blog.
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Medicine
Do medical scribes improve doctor or patient experiences?
According to a national survey, a typical family physician spends nearly half of his or her working hours outside of the examination room doing follow-up care or documentation. I think most of my colleagues would agree that entering notes into the electronic health record is one of their least favorite parts of practicing medicine. After all, we went into medicine to care for patients, not to spend endless hours scrolling through screens full of check boxes to prove to payers that we are caring for patients. At the same time, patients may be unable to connect emotionally or convey subtle physical findings when their doctors spend so much of the visit looking at a computer screen.
One solution to the problems posed by electronic documentation requirements is for physicians to delegate the task to a medical scribe. As described in a recent article in Family Practice Management, this trained assistant (medical assistant, medical student, licensed practice nurse, or registered nurse) gathers initial data; documents the physician's examination, assessment, and plan; and provides patient education and implements the care plan while the physician moves on to the next patient. One of the authors reported that his increased efficiency and net revenue more than made up for cost of training and paying for an additional medical assistant functioning as a scribe. Further, the presence of the scribe seemed to have positive effects on the patients' experience:
We've also noted significant increases in our patient satisfaction scores as we've adopted this new model of care. One thing that surprised me was the relationships my patients developed with my MAs, sometimes telling my MAs things they won't tell me. Patients consider the MAs as additional advocates to whom they can go with problems or questions. I thought more patients would object to having another person in the exam room, but that has not been the case.
Beyond this suggestive anecdote, what is the evidence that medical scribes improve practice productivity, revenue, or the physician and patient experience? A systematic review on the use of medical scribes in the Journal of the American Board of Family Medicine found only five studies, none performed in primary care practices. In emergency department, cardiology, and urology settings, scribes appeared to improve clinician satisfaction, efficiency, revenue, and patient-clinician interactions, but did not improve patient satisfaction. Still, given the ever-increasing burden of documentation in primary care, the demand for medical scribes will doubtless increase in the future.
**
This post first appeared on the AFP Community Blog.
- Can Mindful Communication Protect Physicians From Burnout?
Are mindful clinicians happier clinicians, and do they communicate better with patients? A pair of studies published in 2013 in Annals of Family Medicine aimed to answer one or the other of these questions. Mindfulness, defined as "purposeful...
- Two Types Of "scut Work"
When I was an acting Medicine intern in Manhattan's Bellevue Hospital at the turn of the century, all employees who provided the hospital's "ancillary services" went home between the hours of 5 PM and 8 AM. It was the job of the on-call interns...
- The Best Recent Posts You May Have Missed
Every other month or so, I post a list of my top 5 favorite posts since the preceding "best of" list on this blog, for those of you who have only recently started reading Common Sense Family Doctor or don't read it regularly. Here are my favorites...
- Mindful Communication, Physician Burnout, And Patient Satisfaction
Are mindful clinicians happier clinicians, and do they communicate better with patients? A pair of studies published this month in Annals of Family Medicine aimed to answer one or the other of these questions. Mindfulness, defined as "purposeful...
- Would You Like Fries Or Cheesecake With Your Family Medicine?
In "Big Med," his latest article on health care in The New Yorker, surgeon-writer Atul Gawande added the Cheesecake Factory to his running list of health care analogies (which have included, among others, farming, pit crews, and airline safety)....