Movin’ Meat asks for input about scribes in the ED. Since I’ve had the benefit of scribes for every shift the last 4 years, I have some information and perspective to share.
Frankly I love our scribes, and there are a number of benefits for the docs:
- legible charts done contemporaneously during the visit (and finished with the encounter)
- orders ready to go when we walk out of the room (requires familiarity with style)
- smart young people who are motivated and want to learn
- another set of eyes and hands getting labs, xray /CT’s / sonos on the chart (the right chart)
- smart ‘gofer’ for phone calls, etc
- Can push you to see another patient (good, though you might think otherwise)
- can slow you down if you let them (requires some people management)
- did I say legible charts? Bonus!
- Quicker transition between new patients
I should say a word about the scribes: they’re the hotrods from several of the local Universities, usually the pre-med types, and handpicked by the Doc who runs the program. Though I have no actual knowledge of the procedure, he’s got it down, as very few drop out or unsuitable for the job. They don’t come for the pay, they come to see if medicine is something they want to do, and for a modest paycheck.
Oh, and they’re very very sharp. They have a steep learning curve initially; the new vocabulary of medicine needs to be mastered while physically in motion, and the arcana of what chart goes where to get orders, procedures, etc. done while busy (the ED doesn’t stop to make learning their job easier). There are now, in all the Universities here, groups of students who work as scribes, so it’s not hard to recruit new ones (I’m told) when it’s training time.
We’re doing training now, in preparation for our current scribe Graduates getting on with their lives (Fair Winds and Following Seas)! Several are off to med school, some are off to PA school, one is going to Law School (!), and some are going to get Masters/post-bacs (usually those med school bound who didn’t get in this year). A few decide medicine isn’t for them during this, and go another direction (and that’s a huge benefit to them, not a loss, as now they haven’t made a 200K mistake). This scribe program has been in existence long enough some of the prior scribes are back as fully-trained Emergency Physicians (the circle of scribedom, I suppose), and there’s definitely a sense of continuity within the scribes.
Apparently there was a lot of medical staff resistance to allowing scribes in the ED (I’m not sure why), but it has resulted in the following rules, still in force today (and I’ve heard from another program that lets them do the ROS independently):
- Scribes are there to collect information obtained by the doc, not to ask questions on their own (the scribe cannot take ROS or HPI independently, etc)
- Not allowed to touch patients (not licensed or trained for that, though they do get all the healthcare shots)
Without making too big a deal about it, there are a few problems, but they’re workable:
- Nurses don’t like being asked questions by the scribes, generally, though we have an outstanding nursing staff and terrific nursing leadership, so that’s not a big problem here (your mileage may vary, different at different hospitals)
- Your chart is your chart, no matter who is writing on it, so checking it is essential
- there’s nothing wrong with taking the chart and writing on it (but this makes some of the scribes uncomfortable; like asking for help as an Intern, it’s seen as a sign of weakness, and I’ve ruffled a feather or two doing it)
- Not every scribe is equal. Oh, you’ll love them equally like your kids, but there will always be the ones you can work with and those you’re happy to see show up for your shift (and they feel the same way). (Probably).
Our scribe program routinely sends experienced scribes on what I call ‘missions’, to take the Tao of the Scribe elsewhere, teach a cadre of local people about scribing, and hand them off a turn-key product. I wouldn’t do it that way, but it’s not my program. They do it frequently, and the experienced scribes like the travel, change of scenery, and the experience.
To summarize: a lot of upside, not a lot of downside (cost isn’t that much given the usual population used) and once you try it you won’t want to go back.
Our program’s Official Website (horrible colors but good information).