Who is caring for the caregivers? A medical scribe’s perspective.

I’m not going to be a doctor. It feels more like a confession than a statement — like I’m disappointing someone. Each time I say, or even think, those words, I feel as if I need to atone for it. Survey a hundred scribes.  Ask them of their goal in becoming a scribe, and all of them will tell you about higher aspirations. They want to be surgeons, cardiologists, intensivists, or neurologists. They dream of practicing primary care, infectious disease, or emergency medicine. None of them will say they are scribing because they simply enjoy it.

That’s because working as a scribe is a means to an end, a needed medical school application item. Like the internship for the Business major, scribing is where many pre-medical students pay their dues before vying for the coveted few seats offered to the hopeful masses every year. A few months ago, I would have counted myself among that group, working my job with a defined expiration date. But it was because of the things I learned as a scribe that I turned away from the singular pursuit to which I had devoted all of my energy. I’ve been scribing for nearly three years. In that time, I’ve worked at numerous sites across several states. Regardless of the location or the specialty, there are common denominators everywhere I have been. I am grateful for them. For so long, my life was on cruise control. I would be a doctor, and I paid no mind to any alternative. I wore blinders. Many will become doctors because they were scribes, but because I am a scribe, I’m not going to be a doctor.

Physicians are underappreciated. They dedicate years — decades — to their craft. Medicine is ever-changing, and standards of practice evolve rapidly. In response, physicians never graduate from scholarship. This alone is not problematic. But after years of education and incredible sacrifice, if a physician is not punctual to a clinic appointment or will not freely write narcotic prescriptions, he is called a bad doctor. Patients who are anything but patient are quick to fly into a rage if they are late to their unquestionably important obligations.

If a seemingly insignificant lab result is missed for one patient in thousands, and if that lab result can somehow be linked to the development of a major illness years later, the doctor is labeled inept and becomes a target for a lawsuit. It doesn’t matter how many patients he successfully cared for and treated, or how long he toiled to create his previously flawless reputation. Many of the physicians with whom I have worked tell me that they can no longer practice how they would like, and are instead forced to practice defensively, always thinking of how their charts could be interpreted in a legal sense. Such is the state of affairs in our increasingly litigious culture. To err is human, but to err is to risk your career.

Physicians are overworked. The 40 hour week doesn’t exist in medicine. Providers routinely stay past the scheduled end of their shift everywhere I have been. Some only stay a few minutes after; others spend up to an extra 2 hours finishing workups and discussing cases with other doctors. I recently helped establish a scribe presence in a cardiovascular surgery clinic. On paper, those surgeons had it pretty good for themselves. They spent four days in clinic seeing patients, and every Friday was reserved for surgeries and procedures. Our clinic days started at 9 a.m. and went until 3 p.m., which is an admittedly lax workday by anyone’s measure. The reality, however, was anything but lax. In addition to the time spent in clinic, those doctors also frequently had surgeries scheduled before and after the shift. Sometimes they even got called out if a patient needed to go back into surgery. On average, they started their day in the operating room at 6 a.m. and didn’t get to go home until around 10 p.m. After all the damage, they were logging close to 70 hours per week. No wonder they wanted scribes.  I may well be wrong, but I don’t think that practice was an anomaly. In fact, I know it isn’t, according to a 2012 study.

The irony is that no provider I have worked with was actually scheduled for 40 hours in a week. Their schedules will tell you they work between 32 and 36 hours. The kind of hard work it takes to be a health care provider is not something I need to defend, but there is something to say about a person who doesn’t even consider clocking out if they reach the daily 8 hour mark and work still needs to be done. However, this is a dangerous, unsustainable cycle. Work until you can’t work anymore, then lather, rinse, and repeat until burnout is achieved. I make a habit of asking doctors what advice they would give to someone in my position. Without question, one thing is most commonly said: “If you are going to be a doctor, make sure you are satisfied with a life that is devoted only to medicine.” Frankly, that life is not a satisfying one from my perspective. Granted, specialties are different, and there are multitudes of doctors with an adequate amount of free time to spend with their families, but if the most common advice is actually a warning, I would be a fool not to put my aspirations under heavy scrutiny.

When people think of doctors, they think of their salary. They imagine a world where every doctor lives in a mansion, drives a sports car, and spends their weekends on a yacht. Maybe that’s true for some, but most people don’t know how many grueling hours physicians sacrifice to their jobs. Suddenly, a “giant” salary is not so giant when you have to work the equivalent of a job and half to earn it. Further, how valuable is a large salary when there is no time to take advantage of it? These are things that few take into account.

Doctors are told how to practice. The power to make their own decisions regarding how they care for patients is being diminished. This is especially true for those employed by large health systems. Some ERs have pathways that providers must follow, step-by-step instructions on how to treat patients in a given scenario. Now, all of that education, all of that time spent learning how to manage ailments, is reduced to adhering to an instruction manual. Out of all the instruction manuals I’ve read, none of them required years upon years of school. In some cases, the permissible treatment decisions are made not by other doctors, but by bureaucrats that care less about patients and more about profits. Our nation’s most intelligent, compassionate people are handcuffed to regulations they have no power to change.

So, I’m not going to be a doctor. To be candid with you, I don’t know what I will pursue. Until I do, I am content simply being a scribe. I have the ability to better the lives of those who have committed themselves to bettering the lives of everyone else. Sometimes my job equates to saving a doctor just an extra half hour per day, but I believe that time is meaningful. Who will care for the caregivers? Who will ease the burden of the overburdened? I will.

Jeremy Madison is a scribe trainer, Essia Health.

Image credit: Shutterstock.com

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