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Rick's Rant: "You mean you don't have a scribe?"

Rick Bukata, MD
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Nurses Edition Commentary

Kathy Garvin, RN and Lisa Chavez, RN
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EM:RAP 2020 02 February Written Summary 257 KB - PDF

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Dallas Holladay, DO -

In my experience, a quality scribe is worth their weight in gold.

However, scribing is not a career. Scribing is a transient position occupied by students applying for advanced medical programs to improve their application. This means a lot of turnover (less than one year usually in my experience). When working with a new scribe or a poor performing scribe, I spend more time correcting the chart than it would take me to write it myself.

I find it far more reliable to customize the EMR so I can complete a low level chart in less than two minutes, a complex chart in 3-5, depending on how many phone calls I end up making. Epic can also send alerts when imaging and labs are back.

Find me a career scribe and I will happily pay them $25/hr.

W. Richard B., M.D. -

Dallas, thanks for writing. Yes, there are issues of scribe turnover and quality and maybe EHRs are getting easier to use. With the ability to integrate free-text dictation into the EHR it would seem that charting would get even easier and better. But, if a scribe can be viewed as a personal assistant that can facilitate your work beyond just charting by chaperoning all your exams and acting as a facilitator / fixer, sounds like there is value. My bottom line -- for must EPs working the ED is a 30+ year job and there are so many people who are not tolerating it very well. Facilitating physician work has to be a very high priority for all those who employ EPs. It is a very hard job and we need to work smarter -- scribes will definitly help most EPs / 8 hour shifts / waterfall shifts / casino shifts / appropriate use of APPs / learning how to sleep during the day -- there are a slew of ways that physicians can work smarter -- and enjoy their work more and last longer. Would welcome your thoughts.
Rick

Sean V. -

Rick, I respectfully disagree with your advocacy for scribes in the ED.

If your car had a broken windshield, the solution would not be to hire a premed student to sit on top of the car and tell you which way you are driving. Yet, this is exactly the reasoning that has birthed the scribe industry. I understand that EMRs are not perfect and can be hard to use. But it really is possible for EVERYONE to learn how to be proficient and fast with their EMR.

To my physician colleagues who are technically challenged, I would kindly give some tough love. You memorized the Kreb's cycle once. You have passed the most difficult exams on the face of the Earth You understand the complex interplay of human physiology, pathology and pharmacologic treatment. Surely you can figure out a computer program, if you put your mind to it. It is the year 2020 and it is time for all of us to move toward technology and not away from it.

I am 44 years old. I'm no spring chicken, but I'm lightning fast with my EMR. Using carefully created macros and dictation, my charts are thorough, easy to understand by others, and bill well. I have worked both with scribes and without scribes. Scribe notes are always inferior to physician notes. They are time consuming to proofread for errors. I can dictate to Dragon just as fast as I can say it to my scribe. What's worse is I've seen others suffer during a lawsuit when their note, which was written by a scribe, is full of contradictions and missing critical information.

We will always hate the EMR. But I'm confident that anyone who has the ability to practice the challenging profession of Emergency Medicine, has what it takes to conquer their EMR.

W. Richard B., M.D. -

Sean,
Sean,
Scribes are an interim solution largely focusing on the bad EMR experiences. EMRs have long left the station, but some were (are) really not physician-friendly. Times changes and maybe EMRs are getting better -- all software gets better over time. And Dragon has gotten very good now. So I would agree that a careful reconsideration of the ROI with scribes is appropriate in any particular ED as physicians and the EMR become more compatible. One other thing -- scribes are just not about charting. They offer an additional pair of hands to facilitate the many aspects of the doctor-patient process.
Rick

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