Most patients know what it’s like to sit in an exam room and stare at the back of a doctor’s head while they stare at a screen, typing away. It’s a scenario that’s become more common in recent years, as doctors attempt to keep up with the demands of electronic health record systems to document patient visits. Electronic records are designed to increase productivity and enhance your quality of care, but they’ve had the unintended consequence of driving a wedge between doctors and patients. After all, do you really feel like divulging deeply personal or embarrassing information when physicians are under the thrall of a complex and confusing computer program? Or when they’re so tired and burned out by paperwork that they’re scattered and irritable?
Enter the medical scribe, an assistant who works with doctors in the exam room to record their interactions with patients. Scribes allow physicians to focus on their patients by handling administrative tasks like recording notes in the EHR on a patient’s medical history, physical examination, laboratory and radiology test results, diagnoses and care instructions (a task known as “charting”), as well as making appointments.
Are scribes trained?
Scribes must have at least a high school diploma. Beyond that, they receive training — either in the medical office or through coursework — on using the EHR system, making notes in medical charts and doing medical coding and billing. Basically, scribes are part of the physician’s team, just like the medical technician who leads you into an exam room and records your blood pressure, weight and temperature. Scribes are not required to be certified or licensed, and they can only work under the supervision and direction of a physician — unless they have advanced training themselves. “You might not even notice scribes, because increasingly today they can be nurses, physician assistants or even medical residents, and they will be wearing professional attire or scrubs,” says Kristin Hagen, founder and president of the American College of Medical Scribe Specialists, a nonprofit organization devoted to educating and certifying scribes and elevating the profession.
And don’t worry: Scribes are held to the same standards of privacy and confidentiality as all healthcare professionals. That said, if you would prefer not to have a scribe in the room, you can ask to see your doctor alone. In fact, rather than have scribes present, some physicians are choosing to record their patient encounters and then send the recordings to a scribe to be entered into the EHR later.
Where do scribes work?
Scribes have been around for at least 25 years, according to Hagen. Originally they mostly worked in emergency departments, where rapidly unfolding events made them a natural fit. From there, scribes moved to other departments throughout the hospital, and now work in many private physicians’ offices across primary and specialist care, as well as in urgent care facilities and nursing homes. They can also be employed to help physician assistants and nurse practitioners with administrative tasks.
Hagen estimates that there are currently around 38,000 medical scribes in the United States working at 3,800 hospitals, doctor’s offices and other medical facilities. “The pool of scribes is doubling in size and growth each year,” she says. In fact, by the year 2020, there may be as many as 100,000 scribes in the U.S., which works out to about one scribe for every nine doctors.
The need is tremendous: Doctors are increasingly being bogged down by documentation demands, leaving them feeling stressed, burned out and discontented with their chosen profession. Research indicates that for every one hour they spend with patients, doctors need to do two hours of documentation. There’s also the issue of recording the information in real time, instead of trying to remember the details of several patient visits at the end of the day, which is what many doctors are forced to do given their workload.
No surprise, then, that research shows adding a medical scribe to the healthcare team can lead to big improvements in physician satisfaction. In one study published in the Annals of Family Medicine in 2017, researchers randomly assigned four doctors employed at Stanford University’s Family Medicine Clinic to spend one week working with a scribe and then spend another week solo. When scribes were present, doctors reported feeling more satisfied about their time at the clinic and their charting demands; they also felt they were able to spend enough face time with patients to deliver good care. Many providers also said that both the quality and accuracy of their charts were better when scribes were recording information for them. Another study published in JAMA Internal Medicine had similar findings with 18 primary care providers working at two medical centers: Use of scribes improved physicians’ efficiency and reduced the amount of time they spent sitting at computers, while increasing the time they spent interacting with patients. Overall, the doctors said they were more satisfied with their jobs as a result of using scribes.
How do patients feel about scribes?
Although the JAMA Internal Medicine study found scribes had a positive impact on how patients perceived their medical visits, surprisingly, most research shows little impact on patient satisfaction when a scribe is present. (To be fair, only a few studies have looked at this question.) But they don’t seem to be a hindrance either. An Australian study, for instance, found that the presence of a medical scribe during an ER visit didn’t affect the quality of the visit — patients didn’t feel uncomfortable or withhold information with a scribe in the room, and they reported similar levels of satisfaction as they did during scribe-less visits.
While studies may not show that scribes have a direct effect on patient satisfaction (yet), there does seem to be an indirect effect: When you’re being cared for by physicians who have good work-life balance and like their jobs, they’re more likely to be at the top of their game. And that’s good for both sides of the healthcare equation.