I echo Meta's sentiments. We have had a scribe program for 7 years now at
Fairfax Hospital in the DC area, both pre-EMR and post-EMR. Almost all are
graduated or nearly graduated students on their way to med school. They are
bright, eager and pick up the lingo fairly quickly. I would never go back.
Everyone uses the scribe a bit differently here. I use the scribe partly for
documentation of the history and partly as an invaluable personal assistant
that I can task throughout the shift while I stay focused on more important
Prior to the EMR, they were absolutely critical to see that I did not forget
to document before I lost track of the chart.
The computer changed things somewhat but they are still extremely useful. I
NEVER write in the room and always sit or comfortably stand next to my
patient with complete attention to the family as the scribe writes down what
the patient says. Later I drop a slightly adjusted macro in the chart that
takes a few seconds and my own attention can be focused on medical decision
making rather than trying to remember how many times a particular child
vomited or if they in fact had diarrhea (or was it a fever? cough?). It all
gets blurry at shift change (or the next day). They prevent all of that.
In addition, they can remind you of stuff, run back and ask patients
questions (who was your doctor?) without you needing to break stride. They
double your multi-tasking ability by taking the more mundane tasks.
For some, that is all they can do. Occasionally they can't always do that
and are let go early. Don't be afraid to release these well meaning kids.
Very uncommonly you will end up with someone who just doesn't get it. If you
dread working with a particular scribe, in all likelihood, they need to go.
You need to be very careful with order entry, particularly meds and unusual
orders (e.g. antibody titers or special diagnostic imaging studies). The
chances are reasonable that YOU may order the wrong thing. It is that much
higher with a scribe. We do not allow the scribes to put in meds. You may
have a policy of double checking but habit makes one lazy very quickly.
The good ones fly. They become proactive. Can anticipate what you want or
need. T up your discharges. Call the primary doc. The list is endless. By
the end of the year, they are almost all wonderful to have at your side. If
you get lucky and have one for two years, they are worth their price in gold
and you are asking THEM if you can write their reference.
In the end, I am convinced that these kids almost jump into their third year
of medical school. Remember, they have seen thousands of patients by year's
end. By the second year, thousands more. And they get it. The good ones can
identify a kidney stone from the doorway whereas your medical student has a
differential a mile long (or NOT!). I will often quiz a resident who will
give me three choices and turn to the scribe who will give me the answer.
(The good ones anyway)
What is my biggest worry?
That other EDs will grow wise to this and the talent pool will become
diluted. I would rather this be a best kept secret.
So my advice to Scott Freedman (who works across the river): DON'T DO IT !!!
Inova Fairfax Hospital
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