Any residencies that provide or allow scribes for residents?

[TastyCurrantJelly]

IMO, physically writing notes is like a cardiologist setting up the EKG and a colossal waste of time for physicians - not to mention how annoying it is (don't freak out - I do realize that you still have to read over the scribes notes and fix any mistakes). I would like to avoid it as much as possible starting right in residency - are there any residencies that provide scribes for the residents?

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[namethatsmell]

IMO, physically writing notes is like a cardiologist setting up the EKG and a colossal waste of time for physicians - not to mention how annoying it is (don't freak out - I do realize that you still have to read over the scribes notes and fix any mistakes). I would like to avoid it as much as possible starting right in residency - are there any residencies that provide scribes for the residents?

Is this for reals? As in, scribes for everybody including the interns? If so, bad idea.

You need to know how to do it yourself and fit it into your flow. The minority of shops currently use scribes and it'd make you a pretty poor candidate (and set up for failure) when looking for jobs at places without scribes. One of our community sites has scribes (for attendings only) and sometimes there's a gap in scribe coverage and the attending freaks...imagine how much worse it would be if the attending had never learned to chart to begin with.

Pretty sure no residency offers this, though I think some may have them for senior residents.

 

[gman33]

Every residency program has scribes.
They are called residents.
You write the chart for the attending.

Learning to write charts is a big part of your training.

 

[DreamingTheLive]

Every residency program has scribes.
They are called residents.
You write the chart for the attending.

Learning to write charts is a big part of your training.

This. You *yourself* need to learn how to effectively write your own notes, for a myriad of reasons, LONG before you can just start editing someone else's documentation.

 

[EDMD4LIFE]

Every residency program has scribes.
They are called residents.
You write the chart for the attending.
Learning to write charts is a big part of your training.

This. You *yourself* need to learn how to effectively write your own notes, for a myriad of reasons, LONG before you can just start editing someone else's documentation.

OMG!!
Yes and Yes.

Also, you better get real used to the idea that as a resident, you're going to have to do a ton of scut work that's not fun or glamorous...in addition to cranking out your own notes. You will soon be known to all the staff (docs, RNs, techs, janitor, etc) as the new master rectal examiner/fecal disimpactor. I suggest that the ONLY thing you try "to avoid it as much as possible starting right in residency" is acting like a giant a-hole. That advice will get you far, kid.

 

[DeadCactus]

Heard Davis had scribes but no idea if that's true...

 

[Akail]

My residency has scribes for attendings. The attending lets senior residents have the scribes sometimes.

 

[TastyCurrantJelly]

Umm notes are not difficult to do. It is simple data entry that you can learn in one rotation in third year. It's just time consuming. Keep thinking they are some sacred piece of work doctors should do if you want to be a dinosaur... within 20 years every hospital will have realized what a waste it is to have $200/hour employees spending their time doing data entry.

 

[DreamingTheLive]

Umm notes are not difficult to do. It is simple data entry that you can learn in one rotation in third year. It's just time consuming. Keep thinking they are some sacred piece of work doctors should do if you want to be a dinosaur... within 20 years every hospital will have realized what a waste it is to have $200/hour employees spending their time doing data entry.

<sigh>

I have YET to see a 3rd or 4th year medical student, let alone an intern, master the art of ED documentation. Whatever field you choose to pursue, I wouldn't utter the phrase above at a program you really like.

 

[Tiger26]

Heard Davis had scribes but no idea if that's true...

I did fellowship there--they have scribes for the senior residents.

In all honesty, I hate working with scribes. I'm very particular about my documentation and already have a pretty good workflow, so it takes more work for me to work with a scribe.

For me, I use a lot of carefully edited and extensively built macros, coupled with front and back-end dictation.

 

[Groove]

Scribes for residents?

Bwahahaha

 

[RustedFox]

<sigh>

I have YET to see a 3rd or 4th year medical student, let alone an intern, master the art of ED documentation. Whatever field you choose to pursue, I wouldn't utter the phrase above at a program you really like.

This.

 

[b-real]

I believe that UVa also has scribes for residents. Agree w/ above that it's generally a bad idea. Kinda like trying to drive a manual transmission only having learned automatic.

 

[brk81144]

We have scribes for 2nd and 3rd year residents

 

[link2swim06]

There are several residencies out there that have scribes for residents. I interviewed at one (Virginia tech) and have heard of others.
The way I was explained it...you must first provide your efficiency without the scribe (aka intern year and maybe part of 2nd year) then you get the scribe.

I think while your productivity doesn't really affect your pay you probably should hone the art of documenting yourself.

My logic is that it's easier to:

Go from no scribe to having a scribe
than going from a scribe to no scribe

And what if your dream job had everything except the scribe? Would you pass it over because you only trained with a scribe.

 

[Groove]

You shouldn't be using scribes in residency. Develop solid documentation skills and if you REALLY want to make your life a lot easier once you graduate... spend some extra time learning about proper coding/billing along with ways to optimize chart protection from a medmal perspective. I can't think of a worse disservice to an EM resident than having them use scribes throughout residency. If your first gig doesn't happen to use your precious scribes... get ready to watch your RVUs tank post residency while you spend 2 hours after every shift "wrapping up" while your colleagues leave on time after every shift.

I was near the top at RVU/hr and RVU/pt post residency and that wasn't because I was the fastest or ordered the most tests. I had 2 years of moonlighting with "feedback" from the coders (including critical care billing) and practiced, practiced, practiced on efficient documentation and yet I still find ways to improve to this day. We use scribes and I find that they slow me down. Don't use them as a crutch during training. I truly think that's a disservice to you though naturally it's going to make your life easier as a resident. You'll pay for it once you graduate. You don't want to start your first gig at the bottom of the productivity totem pole with poor charting and constant emails from the coders about what you "did wrong" in your chart. Trust me.

 

[Groove]

Another thing too (to the residents)... and some may disagree with me on the use of scribes, but get used to documenting succinct, sufficiently complex HPIs and MDMs. For myself, if I do have a scribe, I might use them for 4's/5's or pt's getting discharged but I tend to document everything on my admitted pt's. Not only does it ensure proper coding and complexity but you'll find that your medicine or specialty colleagues will pay more attention to your ED chart where they might completely ignore it if they are used to shoddy scribe documentation. I can't count the situations post admission where I was glad that I did my own documentation for a myriad of reasons but that's prob a discussion best saved on "scribes vs no scribes", etc..

Oh, and I think critical care billing is completely under documented on most ED charts these days. There's no way an EP should be billing for only 2-4% 99291's a the end of the month with 50% 99285 charts. That makes no sense to me.

 

[Birdstrike]

I have the option to use a scribe in my current practice setting. I personally could make more money, and go home earlier each day, by using a scribe. However, I realize that my only defense in a malpractice suit is my chart. I much prefer to do my own documentation. I'm an expert in it, much more than I could train any non-physician scribe to be.

 

[TastyCurrantJelly]

I did fellowship there--they have scribes for the senior residents.

In all honesty, I hate working with scribes. I'm very particular about my documentation and already have a pretty good workflow, so it takes more work for me to work with a scribe.

For me, I use a lot of carefully edited and extensively built macros, coupled with front and back-end dictation.

Now this sounds like a pretty good idea actually. Can these macros be incorporated into epic or do you have to add them to each computer you work on (and what program do you use for them?)

 

[MSUSpartan642]

Now this sounds like a pretty good idea actually. Can these macros be incorporated into epic or do you have to add them to each computer you work on (and what program do you use for them?)

Now I'm just a first year resident, but even macros I feel like can be dangerous. Unless you use very basic macros for both ROS/PE I think it could look very bad if you ever got a malpractice suit filed against you. Just imagine if they pulled up all of your charts and they all looked the exact same, outside of just one box or a line in the MDM. Maybe I'm just still a bit paranoid about getting sued tho.....

 

[TastyCurrantJelly]

As far as getting sued, I think having a scribe in the patient room with you - who can act as a witness to confirm exactly what you did - goes way further in court than what you wrote in a note.

 

[alpinism]

I believe that UVa also has scribes for residents. Agree w/ above that it's generally a bad idea. Kinda like trying to drive a manual transmission only having learned automatic.

There are several residencies out there that have scribes for residents. I interviewed at one (Virginia tech) and have heard of others.
The way I was explained it...you must first provide your efficiency without the scribe (aka intern year and maybe part of 2nd year) then you get the scribe.

I think while your productivity doesn't really affect your pay you probably should hone the art of documenting yourself.

My logic is that it's easier to:

Go from no scribe to having a scribe
than going from a scribe to no scribe

And what if your dream job had everything except the scribe? Would you pass it over because you only trained with a scribe.

This.

Both UVa and VT have scribes for residents. In fact, at least in the case of UVa they advertise it as a huge selling point during interviews.

 

[RustedFox]

Now I'm just a first year resident, but even macros I feel like can be dangerous. Unless you use very basic macros for both ROS/PE I think it could look very bad if you ever got a malpractice suit filed against you. Just imagine if they pulled up all of your charts and they all looked the exact same, outside of just one box or a line in the MDM. Maybe I'm just still a bit paranoid about getting sued tho.....

This has been discussed on here before. Your other charts are not discoverable, and thus no basis for comparison can be made. Plaintiff's attorneys can't just go pulling random charts of yours.

 

[MSUSpartan642]

This has been discussed on here before. Your other charts are not discoverable, and thus no basis for comparison can be made. Plaintiff's attorneys can't just go pulling random charts of yours.

Very good to know.

 

[TooMuchResearch]

As far as getting sued, I think having a scribe in the patient room with you - who can act as a witness to confirm exactly what you did - goes way further in court than what you wrote in a note.

...Trolling?

 

[Birdstrike]

...Trolling?

Yeah, probably. Either that or a foreign spy. Nothing unusual for SDN EM.

 

[Arcan57]

What scribes allow you to do is to mentally divorce yourself from documentation. On patients that don't require any MDM, that's fine. The trap comes when you get used to signing off on charting that you had minimal work in preparing. It's difficult to keep the mental connection that in many cases what you charted is as or more important than what you actually did. I mean if they let some college kid do it for $12/hr, how important could it be?

 

[Tiger26]

1) Scribes tend to have a high turnover, so you're always working with new ones. It takes a long time to teach them how you want your documentation and then they leave

2) There's nothing quite like documentation that's written in the way that you would say it

3) I incorporate a lot of decision aids in my documentation--PECARN, PERC, NEXUS, canadian head rules, etc

4) My macros are for the things I see commonly--migraines, back pain, cellulitis, otitis, etc. Macros can be dangerous, but like a few others on the forum have said before, they involve the same questions that I ask everytime and I know the text of them inside and out since I've been using them for years.

For example, for headaches, I ask a series of questions exploring things like SAH, venous sinus thrombosis, carotid/vertebral dissection, meningitis, neoplasm, trauma, carbon monoxide, temporal arteritis, etc.

On top of that, my macros are all bullet-point, so I can quickly go to a section and change it. People get into trouble when the paste in a paragraph of text and miss things. By having them in lists, I can easily see where things need to get taken out or clarified.

 

[Old_Mil]

Scribes, macros, etc are very dangerous. Although you may find yourself asking many of the same things to patients, you never ask exactly the same things to all your patients. Consider the simple Neg except for HPI statement that exsits.on every EMR. Do you really want to put yourself in the position of telling a jury why you asked that 4 year old boy with what you thought was a URI If he had vaginal bleeding. These are legal documents. Craft them as carefully as you would your will. Would you outsource the writing.of your will to a pre med or high school kid making 12 an hour?

 

[TastyCurrantJelly]

Personally I think you guys are way to anal-retentive about this. Practice good EBM and say you did in the note and you won't hurt your patients. You might still get sued and lose a bs case but who cares it's a part of life, it's never your money they are taking in a settlement.

 

[Old_Mil]

Personally I think you guys are way to anal-retentive about this. Practice good EBM and say you did in the note and you won't hurt your patients. You might still get sued and lose a bs case but who cares it's a part of life, it's never your money they are taking in a settlement.

Unless the award exceeds the limits of your policy...

 

[NinerNiner999]

I'm questioning whether or not to raise the troll flag on these ignorant posts...

Learn how to chart and defend your care in a well crafted note! If you honestly think that practicing emergency medicine is examining patients, writing a few things down, and letting the odds determine who will sue you, please don't ever treat me as a physician.

Find a scribe who can type "Pain in the abdomen was diffusely tender and not out of proportion to examination. I do not suspect that the patient has ischemic bowel because the CO2 level and lactic acid levels are within normal limits and unremarkable CT findings are consistent with my examination." That single sentence details a hands-on exam, uses specific medical jargon, defends with specific lab values, and correlates a study to the examination. I went to medical school and residency to learn these details. There is a tremendous amount of thought encapsulated in a very short time by experts in their medical field in every word that is documented - even if all the charts "look the same."

There is no way I would ever allow anyone under my supervision to learn emergency medicine without tying these points together. I would also never trust my residents (who in the scheme of things are unconsciously incompetent, at best even unconsciously competent) to place their charting in the hands of an undergraduate pre-med student who has been trained to click a few boxes on a computer.

Also, such discussion in my training erodes the core of our specialty and devalues our expertise as specialists.

 

[RustedFox]

See below.

 

[RustedFox]

Personally I think you guys are way to anal-retentive about this. Practice good EBM and say you did in the note and you won't hurt your patients. You might still get sued and lose a bs case but who cares it's a part of life, it's never your money they are taking in a settlement.

 

[Arcan57]

Personally I think you guys are way to anal-retentive about this. Practice good EBM and say you did in the note and you won't hurt your patients. You might still get sued and lose a bs case but who cares it's a part of life, it's never your money they are taking in a settlement.

This stands out for me as the least useful statement that has been posted in this forum recently. I really thought the "EM sucks, it's a decaying specialty controlled by soulless yes men, so long suckers, I'm rich b&tch!" post would have enjoyed a longer run.

 

[Birdstrike]

I really thought the "EM sucks, it's a decaying specialty controlled by soulless yes men, so long suckers, I'm rich b&tch!" post would have enjoyed a longer run.

I have to say, that's the most hilarious description of someone else's post I've seen in a long time.

That NEEDS to be a thread title. Just out of respect. Start it. Now!

 

[Birdstrike]

Personally I think you guys are way to anal-retentive about this. Practice good EBM and say you did in the note and you won't hurt your patients. You might still get sued and lose a bs case but who cares it's a part of life, it's never your money they are taking in a settlement.

Amazing troll post. It doesn't get more trollacious than this.

 

[Druggernaut]

Sadly, I don't think he's trolling. He posted a thread about scribes in the "Clinical Rotations" subforum of the medical students section. I'm on the mobile app, so I can't link to it, but apparently he'd rather not practice medicine than write his own notes...

Please don't choose EM solely because you know you could use a scribe.

Personally I think you guys are way to anal-retentive about this. Practice good EBM and say you did in the note and you won't hurt your patients. You might still get sued and lose a bs case but who cares it's a part of life, it's never your money they are taking in a settlement.

What do you mean? You think you can tell the college kid clicking boxes to write, "I practiced optimal, safe EBM on this patient and followed all applicable guidelines in a manner consistent with all the latest, high-quality literature"? Or that he'll know your thought processes and everything behind all the medical decision making you've learned in medical school and residency and spell it out for your consultants and the lawyers to see and understand?

 

[Groove]

I really thought the "EM sucks, it's a decaying specialty controlled by soulless yes men, so long suckers, I'm rich b&tch!" post would have enjoyed a longer run.

lmao

 

[Groove]

The only thing I really despise in medicine is the scut-work of writing notes and mindlessly clicking through templates. I've seen a few specialties where scribes literally do all of this and all the physician does is talk to patients and make decisions - and it seems amazing.

First of all, I see no reason why every specialty can't operate like these - there are more than enough eager pre-meds willing to work for nothing to gain clinical experience and who will work their butts off for a possible LOR. Secondly, I decided after seeing this awesomeness I am only going to work in medicine if I have a scribe... So, what specialties have these other than ER?

TastyToeJam has been on multiple forums primarily waffling between IM and Peds until he shocked himself silly with a good Step 1 score which opened a few extra doors. Then he apparently fixated on minimizing his work load with the use of scribes which led him to EM as the most suitable specialty. Wait... make that "ER" as the most suitable specialty...

Don't feed the troll.

 

[winkleweizen]

Heard Davis had scribes but no idea if that's true...

We do for second and third year residents like 16-18 hours a day. (Not allowed for interns) But we share them so we still write a lot of notes ourselves

 

[filhodeinferno]

IMO, physically writing notes is like a cardiologist setting up the EKG and a colossal waste of time for physicians - not to mention how annoying it is (don't freak out - I do realize that you still have to read over the scribes notes and fix any mistakes). I would like to avoid it as much as possible starting right in residency - are there any residencies that provide scribes for the residents?

VCU in Richmond has scribes for senior residents. I would love that.

 

[WalkingCorpse]

I think it was Central Michigan in Saginaw that was experimenting with scribes for residents. Talked about it at my interview last year. I think they said it was part of a research project but I'm not positive. Now that I finish writing this I'm not positive it was Saginaw. It may have been Western Michigan.