Scribes and diagnostic error

Kohn, Michael Michael.Kohn at UCSF.EDU
Tue Jan 28 20:17:58 UTC 2014

Dear Bill,

 I am an emergency physician at a community, nonteaching hospital. In answer to your question, our scribes are persons specifically trained and recruited for the job. We use a national company called AmeriScribe.   The scribes tend to be  recent college graduates who are taking time off  before medical school, PA school, or nursing school.

 I did not say it in my email, but we use Epic as our EHR.    We started using scribes about a year after going to Epic, but scribes would have been just as valuable before we started using an EHR.   Again, the relationship between using scribes and reducing diagnostic error is indirect but it's there.


Michael A. Kohn, MD, MPP
 Emergency Physician
Mills Peninsula Hospital

From: Slater, William [WSlater at]
Sent: Monday, January 27, 2014 2:48 PM
To: Society to Improve Diagnosis in Medicine; Kohn, Michael
Subject: RE: Scribes and diagnostic error

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
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
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

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