Scribes and lawsuits

Kohn, Michael Michael.Kohn at UCSF.EDU
Wed Jan 29 04:56:00 UTC 2014


 I explain the scribe's function to the patient.   Then, as I obtain the history, the scribe listens and takes notes.  I  dictate examination findings unless  saying something  aloud might offend the patient,  in which case  I tell it to the scribe later or type it in myself.   As I review  X-rays, I dictate my readings to the scribe.  Most of the time,  the  radiologist's reading  will come back while the patient is still in the department, and the scribe will alert me.  I also dictate my interpretation of  cardiograms and lab results.   If it looks like I might forget, the scribe will prompt me to read a cardiogram or review a lab result.

Using scribes has made my job easier and more enjoyable in many ways, but for this  email list,  the  question is how using scribes  might reduce diagnostic error.    As mentioned above, they can remind me to check a lab or an x-ray.  Taking an accurate history is important to making the diagnosis; the scribe writes down what the patient says in real time,  both providing a second pair of ears and decreasing my reliance on my memory.   Certain physical findings are also important to making the diagnosis; in the process of seeing as many as 30 patients on a shift, I might forget which patient had which finding, but the scribe made notes as I examined the patients. By decreasing  the time I spend typing, the scribes free me up to  focus on the patient,  think harder,  and use online decision-support tools.

I read every word that the scribe has written.   I add a lot, change a lot, and always write a section of the note on differential diagnosis and medical decision-making,  as do all of my colleagues and all ED physicians who use scribes as far as I know.  It's my note, not the scribe's.

We haven't had any  patients complain about our use of scribes or about an individual scribe.   They know it's important for us to get an accurate history.   Scribes have no medico-legal liability.  Having them  improves our documentation  and possibly reduces diagnostic error;  I'm sure that risk managers and malpractice insurers are very happy that we are using scribes.

MAK

Michael A. Kohn, MD, MPP

 emergency department

 Mills Peninsula Hospital

________________________________
From: Peggy Zuckerman [peggyzuckerman at GMAIL.COM]
Sent: Tuesday, January 28, 2014 1:26 PM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
Subject: Re: [IMPROVEDX] Scribes and lawsuits

I am curious how the doctor who uses a scribe differs in his thinking process, as he obviously must change as he makes a conscious effort to dictate one finding/impression/note and ignores the others.  Also, how does this scribe capture or fail to capture the patient input?

Does having a scribe help or hinder the relationship between the patient and physician?  Can the scribe catch any errors that the doctor might make as to the info given by the patient or in the electronic record, assuming the scribe may see some data that the doctor does not.?

Peggy Z


On Tue, Jan 28, 2014 at 1:16 PM, Vic Nicholls <nichollsvi2 at gmail.com<mailto:nichollsvi2 at gmail.com>> wrote:
The $64K question is if someone gets sued or complained about, who is liable? The scribe (who isn't a doctor) or the doctor? What about complaints?

Victoria

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