Some doctors choose medicine because of the medicine, and some doctors choose medicine because of the people. I veer towards the latter: Medicine is my tool to help the person sitting across from me.
However, I am finding more and more stuff getting in between me and my patients, primarily my computer. The increasing burden of gathering coded health data in the EMR, especially in light of the impending MACRA, MIPS regulations and the various private insurance compliance requirements, has proven generally ineffective in improving patient care and health outcomes. If you compare health IT to other major industries, the medical field is still analog. It is no wonder that, for many of us, the human element of primary care gets lost among the codes, screens and checkboxes.
While most providers agree that the introduction of technology into patient care has game-changing possibilities, the path forward is about as clear as, well, navigating an EMR. We are just not there yet.
Operating within the current confines of insurance companies and regulatory structures, though, a medical scribe might just be the accidental blessing borne out of overburdened necessity.
Too often the job of medical scribe is presented as a shadow in the corner, typing away; a perhaps fleeting vocation easily replaced by future voice recognition technology. But that overlooks how having a medical scribe on your team can be an asset and an opportunity: one that helps you maintain your humility, your compassion. Your scribe is a human being, and reminds you to be one, too.
Scribes change the dynamic in the room. While we can definitely let them fade into the background, we could also welcome that extra person in the room into the conversation. A playful banter based on a trusting, friendly and efficient relationship with our scribes, focused on providing better patient care, helps put the patient in a relaxed frame of mind, ultimately enhancing the quality of the conversation about their health. A patient might even laugh a little.
But even more important than promoting a more relaxed atmosphere in the exam room is the opportunity my scribe affords me for self-reflection as we review together post-visit. “That was a little fast, Dr. Mink. I think the patient felt rushed.” Or, “I think that went really well, she seemed calmer today,” are helpful forms of feedback that you can’t get anywhere else. Well, maybe in the form of a negative ZocDoc review — but your scribe can help you avoid getting there.
The templates, the smart phrases and the potential monotony of primary care can lead to a quick burnout, leading our thoughts adrift to side projects, dinner plans, and family needs. We may find ourselves just going through the motions. Patients can tell when you’re distracted, but you may not realize until it’s too late.
My scribes don’t need to be administrative geniuses or the fastest typists in the world. Above all, they need to be present with me and the patient when they’re in the room, and help keep me honest.
Physician burnout continues to plague the U.S. health care system, but my scribe keeps my emotional barometer engaged and holds a mirror up to my patient care. Cultivating a relationship of respect and trust with my scribe helps me avoid slipping into box checking, and may prevent me from checking out altogether.
Jonah Mink is a family physician.
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