Scribes and diagnostic error

Goodson, William, M.D. GoodsoW at CPMCRI.ORG
Tue Jan 28 20:56:45 UTC 2014

Dear Dr. Slater,
I live in San Francisco.  They employ scribes in the emergency room (accident ward) of several hospitals.e.g. the SF General Hospital and occasionally at CPMC.  They are typically persons who are interested in health careers but they are not trained physicians, physician assistants, nurses, or paramedics.  They have an introductory course of a week, or it may be two, that teaches medical spelling, for example the "double rr" words such as menorrhagia, diarrhea, etc.  They are in the room and take notes, but they do not observe GYN exams, breast exams, rectal exams or other times of very personal exposure. Usually they work with an attending physician.
I hope this helps,
Bill Goodson

William H. Goodson III, MD
Senior Clinical Research Scientist
California Pacific Medical Center Research Institute
2100 Webster St, #401
San Francisco, CA 94115
FAX 415.776.1977

From: Slater, William [WSlater at PHCN.VIC.GOV.AU]
Sent: Monday, January 27, 2014 2:48 PM
Subject: Re: [IMPROVEDX] 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

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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