Scribes and diagnostic error

Dr Wil dr.will at FUSE.NET
Tue Jan 28 02:41:18 UTC 2014


The scribe is still an evolving concept in many hospitals and offices to help facilitate the process of documenting patient care and all the associated services provided to the patient for effective billing and documentation of services rendered in case of insurance inquiry or legal defense. We have not developed an effective quality based EMR yet. So the scribe as I refer is any person who has some basic computer skill sets that is not a clinician but can help in the documentation and search process for Dx support and patient data from outside sources. 
A very similar reaction of frustration is occurring with many clinicians who see this excessive documentation process in EMRs as detracting from patient care and potentially more errors. Since we need more clinicians in the US in primary care I would believe we should solve this problem NOW and scribes will be one solution.
Will Sawyer, MD
Solo practice Family medicine


Sent from my iPad

> On Jan 27, 2014, at 5:48 PM, "Slater, William" <WSlater at PHCN.VIC.GOV.AU> wrote:
> 
> I am curious about the "scribe". Is this a specific role which is filled by persons specifically trained and recruited for it, or is it a role which is undertaken by the most "junior" doctor/student attending a patient with you. Working in what American's might call a hospitalist role here in Australia - I am increasingly concerned about our interns getting by with merely performing the role of a "scribe" on a processional ward round and not actually getting to directly engage with patients themselves. There is an enormous amount of paperwork required and the person primarily expected to do this is the intern. I would find this very frustrating if I were them (and many do).
> Bill Slater
> Director Physician education.
> 
> -----Original Message-----
> From: Kohn, Michael [mailto:Michael.Kohn at UCSF.EDU] 
> Sent: Sunday, 26 January 2014 6:37 AM
> To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
> Subject: [IMPROVEDX] Scribes and diagnostic error
> 
> 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
> To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
> 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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> Moderator: Lorri Zipperer Lorri at ZPM1.com, Communication co-chair, Society for Improving Diagnosis in Medicine
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