Scribes and diagnostic error

Kohn, Michael Michael.Kohn at UCSF.EDU
Sat Jan 25 19:36:30 UTC 2014

 dear colleagues,

I am  an emergency physician who has worked with scribes for three years now, after 20 years doing my documentation  unassisted.  After initial skepticism, I am completely converted. The link between using scribes and reducing diagnostic error is indirect.  They provide a second set of ears to listen to the patient's  symptoms and decrease the  probability of missing something important to  making the diagnosis.   Anything that gives us more time to focus on the patient will also decrease the number of diagnostic errors that we make.  Also,  I agree about the utility of computerized decision support tools to reduce diagnostic error.  So scribes can help by allowing us more time to consult  the computerized support tools.   I do not ask the scribes to log into and use the computerized support tools for me.   They are not sophisticated enough for that.

Michael A. Kohn, MD, MPP

From: Dr Wil [dr.will at FUSE.NET]
Sent: Thursday, January 23, 2014 7:09 PM
Subject: Re: [IMPROVEDX] [EXTERNAL] [IMPROVEDX] The right dx

That is why scribes are necessary in the era of EMR so clinicians might be able to use decision support tools and spend more time with the patient and be able to bill for the medical service in order to stay in business.
What does everyone else think?
Will Sawyer MD

Sent from my iPad

> On Jan 21, 2014, at 12:36 PM, "Graber, Mark" <Mark.Graber at VA.GOV> wrote:
> This is an important comment, and thanks Victoria for both sending the note to your physician and mentioning it on this forum.  In an ideal world, care would be both patient centered AND knowledge-based.  These goals come into conflict a lot these days - many physicians don't take the time to take advantage of decision support resources, and some believe that their patients will perceive them negatively for doing so.
> Hopefully someday we will get to the point that physicians use decision support routinely, and patients see the value in this, as you did.  The trick is to somehow maintain the patient-centered focus, and not spend so much time at the keyboard that the patient feels neglected.

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