Wednesday, May 20, 2015

Do medical scribes improve physician or patient experiences?

- Kenny Lin, MD, MPH

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 is likely to increase in the future.