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This is what I was trying to hit upon when I said "intern" or "page" earlier. What I really need is a "gofer" to go get me EKGs, results, tacos, etc.
Do your scribes suck? Do just mine suck? Do I suck? Am I doing it wrong? You tell me.
- Thread starter RustedFox
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This is what I was trying to hit upon when I said "intern" or "page" earlier. What I really need is a "gofer" to go get me EKGs, results, tacos, etc.
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This is a really good and informative thread. I understand some tensions involved but the underlying concerns about having scribes slowing down the work because of their incompetence are definitely something to consider. I'm more concerned about scribes messing up what they write in documentation, which could get the supervising physicians into serious trouble if they missed it. It's why I don't really like scribing, since it's an overused activity that lost its flavor and puts the physicians in way too much risk.
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deleted836128
As a PA, we had some scribes for a few months to help us increase our volumes - and then we got rid of them because we found they weren’t cost effective. No one really ended up seeing more patients. It was just a waste. I am relieved we don’t have scribes anymore.
The only pros:
1) They brought me water
2) They delivered EKGs and prescriptions
3) They helped me remember dumb details that don’t matter ultimately, like Sally with the knee laceration had a mastectomy in 1999
4) They helped with transfers
The cons:
1) I was always distracted.
2) So many damn typos, bad spelling, bad grammar... “Patient is a sexual male with a history of...” NO! “John is a six year old male...” How do things like that get missed? You had ONE JOB. I just rewrote everything.
3) Clicking stuff I didn’t want clicked. Is the newborn truly alert and oriented times three? Really?
The only pros:
1) They brought me water
2) They delivered EKGs and prescriptions
3) They helped me remember dumb details that don’t matter ultimately, like Sally with the knee laceration had a mastectomy in 1999
4) They helped with transfers
The cons:
1) I was always distracted.
2) So many damn typos, bad spelling, bad grammar... “Patient is a sexual male with a history of...” NO! “John is a six year old male...” How do things like that get missed? You had ONE JOB. I just rewrote everything.
3) Clicking stuff I didn’t want clicked. Is the newborn truly alert and oriented times three? Really?
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I have had a generally good experience with my scribes, now at two different gigs.
Yeah they miss stuff here and there, whatever. I always document my own MDMs.
They mentally offload me so that I can deal with doctor stuff.
When I first became an attending, I was REALLY anal about my documentation. Since then I have become way more relaxed about it. I just don't think an "iron clad" chart does much to deflect a law suit, medical board issue, admin issue. If someone wants to get you, they will get you. I don't have the time/energy to make sure every chart is sparkly clean. I would rather be able to go home on time and not spend time at home documenting.
Things I will spend more time charting on - as in I am dictating my own paragraph or two:
1) Significant "non-medical" issues:
-Elopements
-AMA
-Patients' bad behavior including yelling, swearing, threatening (basically anytime I sense a potential patient complaint issue cause I didn't give them narcs, antibiotics, admission, CT scan, their dx for years of chronic nonsense, whatever)
-Consultants' bad behavior including delays in evaluations, inappropriate dispo recommendations, ICU rejecting patients, etc.
2) Some critically ill patients
-Usually the ones that are requiring intubation (especially rationale for intubation, which the ICU always loves to question), titration of advanced drugs like pressors or anti-hypertensives, goals of care discussions
3) Some discharges
-Chest pain (HEART, Wells, PERC)
-Pedi fever sometimes
Yeah they miss stuff here and there, whatever. I always document my own MDMs.
They mentally offload me so that I can deal with doctor stuff.
When I first became an attending, I was REALLY anal about my documentation. Since then I have become way more relaxed about it. I just don't think an "iron clad" chart does much to deflect a law suit, medical board issue, admin issue. If someone wants to get you, they will get you. I don't have the time/energy to make sure every chart is sparkly clean. I would rather be able to go home on time and not spend time at home documenting.
Things I will spend more time charting on - as in I am dictating my own paragraph or two:
1) Significant "non-medical" issues:
-Elopements
-AMA
-Patients' bad behavior including yelling, swearing, threatening (basically anytime I sense a potential patient complaint issue cause I didn't give them narcs, antibiotics, admission, CT scan, their dx for years of chronic nonsense, whatever)
-Consultants' bad behavior including delays in evaluations, inappropriate dispo recommendations, ICU rejecting patients, etc.
2) Some critically ill patients
-Usually the ones that are requiring intubation (especially rationale for intubation, which the ICU always loves to question), titration of advanced drugs like pressors or anti-hypertensives, goals of care discussions
3) Some discharges
-Chest pain (HEART, Wells, PERC)
-Pedi fever sometimes
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That’s how I think too. I heard at one point there is 1 lawsuit / 40,000 ER visits. That sounds about right, give or take a few thousand here and there.
All documentation is crappy, I read all sorts of notes all the time where there are inconsistencies. People with severe AS and they have no murmurs. Neurological findings with a negative neuro exam. Those ICU patients often have the worst exams. They are intubated and have about 5 lines with all abbreviations.
I do not spend an incredible amount of time doing charting. I make sure that 1) there is generally enough info in the HPI section to get credit. Rarely I’ll edit it, and sometimes trim back, if it’s too lengthy. 2) there are no glaring inconsistencies in the exam section, and 3) the MDM. Which I right myself.
I think after awhile you get a sense of the high risk charts, and do spend more time on those, as you wrote.
There are some complaints here about bad charting from midlevels...I see worse from docs. There is one doc I work with and all he does is click on buttons in cerner and never puts in a single written line of text. As far as i know he has never been personally sued. His charts suck too. I can never tell what he is thinking.
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I'm having one of those shifts right now where I'd be so much better off without a scribe.
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My last shift, my scribe literally started crying because I was seeing too many patients. Like she just broke down and started sobbing uncontrollably. I think I am going to start just requesting to only work with specific scribes, as this is now the second scribe that I sent home because she couldn't handle my patient load and was slowing me down. I was literally being a doctor, doing procedures, and writing (better) notes faster than this scribe could do her singular job.
A good scribe makes my job so much easier and way less stressful. A bad scribe you could not even pay me to take on.
A good scribe makes my job so much easier and way less stressful. A bad scribe you could not even pay me to take on.
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Can't spell. Can't get the history done by the time I dispo. Can't write sentences. Gets the facts wrong. Holy sh-t.
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You big meanie! How can you not be sensitive to the needs of a scribe? After all; they ARE the future!
lolololololol.
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Um, not documenting an ED course or ECGs either.
Some things require on the spot correction. This one is just an email to their manager and make it someone else's issue.
Some things require on the spot correction. This one is just an email to their manager and make it someone else's issue.
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Can't spell.
Boom. Hard stop.
When I review the MLP charts, there are two or three "offenders" that I really... really can't sign their charts in good conscience.
When you can't spell, I doubt your ability to do ANYTHING beyond that grade-level.
I should log-on right now and copy-paste some of the HPIs from my last shift that I need to sign. Its so awful.
*scream*
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We're waiting....
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deleted836128
Speaking of bad charts... this was literally one of the charts I saw my favorite doc write last week.
HPI:
Abd pain fever
10/10
Tylenol
Hyst 1999 right knee surg
MDM: patient looks well, CT negative, will DC home with tramadol
HPI:
Abd pain fever
10/10
Tylenol
Hyst 1999 right knee surg
MDM: patient looks well, CT negative, will DC home with tramadol
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Yup that is terrible. I wouldn’t reimburse that doc a penny for that chart
This is the reason why people expect testing done, and don’t really care for our opinions as docs. It’s because we have none, and all we do is order tests and give pills.
Test’n’Pills
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classic whataboutism.
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See "other thread".
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All scribe services were terminated August 6th at my home site.
Things are so much better.
The MLPs that are/were documentation problems have nobody to point the finger at.
Nevermind the fact that: "You are supposed to read the chart and certify it before it comes to me."
They didn't like that.
It has been a rude awakening for several MLPs that are not up to snuff.
Lazy.
Lazy.
Lazy.
Things are so much better.
The MLPs that are/were documentation problems have nobody to point the finger at.
Nevermind the fact that: "You are supposed to read the chart and certify it before it comes to me."
They didn't like that.
It has been a rude awakening for several MLPs that are not up to snuff.
Lazy.
Lazy.
Lazy.
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deleted109597
So the scribe thing has been present long enough that I now know friends that have their old scribes as residents. Which makes it funny because the residents know exactly what the attending wants to hear.
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Sorry buddy...our scribes are pretty good and generally worth it. Wish your experience was better.
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Still going strong without mine though I'm one of only 3 docs that don't use them. I honestly thought it would have been a more painful transition but it really hasn't. I love that at the end of the day, my charts are 100% my own. No more mis-typed, embarrassing words or phrases. No more having to repeat or enunciate medical phrases 4-5 times with the scribe STILL typing it wrong. No more butchered HPIs. No more speed reading charts at the end of a shift and just closing my eyes and clicking "OK" hoping that everything I dictated made it in there.
It's been really smooth for me especially with dragon dictate. Sure, I don't have a fetch gopher anymore, but...whatever. Now, I'd still be using them probably if my CMG hadn't made the decision to pass on the cost of the scribes to the docs @$15/hr. It was costing me 25K a year. Screw that.
It's been really smooth for me especially with dragon dictate. Sure, I don't have a fetch gopher anymore, but...whatever. Now, I'd still be using them probably if my CMG hadn't made the decision to pass on the cost of the scribes to the docs @$15/hr. It was costing me 25K a year. Screw that.
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I was a scribe before med school and it is a damn tough job, especially for freaking minimum wage. You get what you pay for. Keep in mind that these scribes have considerably less medical experience than even an MS1. The scribe company wants cheap labor and gives a few basic powerpoints on "how to do an H&P" and some basic acronyms. That's it. Now go have fun in the ED trying to navigate Epic and keep up with the busy, seasoned attending who is seeing a boatload of patients quickly with a variety of medical problems. Without knowing the medical lingo and having the adequate background to somewhat understand what is being said, even directly transcribing things as dictated is very hard. Simple, simple things like "abrasion" and "laceration" are the edge of their vocabulary/understanding. You also have no idea what is and is not important to write down. I would liken it to having an ED attending with a basic Spanish vocabulary try to scribe, completely in spanish, for a complex presentation, with a brand new EMR. That's the feeling. Very intelligent college graduates with ambitions of medicine are scribes and STILL end up struggling. I think some attendings are so far removed from not having a lick of medical knowledge that they genuinely forget how little the average non-medical person has and thus their expectations do not align with the capabilities of a scribe.
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Worked at a bunch of sites and I really like working with scribes. I guess I've been lucky running into good ones wherever I go. When it's busy they allow me to see a bunch of people rapidly, when it's not they allow me to tinker with my fantasy team.
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I just use them to write the "garbage" parts of the chart like the HPI, ROS, and PE. I find most scribes can handle that. They're also great for documenting which doctor called back and when. I leave all the MDM portions to myself.
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Agreed. I feel like you can't really expect them to take down a good MDM.
I don’t even trust them to do those parts. How many times do patients casually mention little unrelated symptoms that are potential landmines.?
Like a patient who comes in for a toe injury and blabbers on about the chest tightness they had that one time 2 weeks ago, or the subjective fever and mild headache they had yesterday. I just pretend I didn’t hear them say that, but I don’t need a scribe polluting my chart with those things.
The 2 sites I work at that have scribes stopped putting scribes on my shifts after 1 or 2 shifts because they just sat there and didn’t do anything and were probably bored out of their minds. I wouldn’t mind having them to document EKG reads, conversations, etc, but overall not worth having a shadow. Give me Dragon with any EMR over a scribe.
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deleted109597
I mentioned this to some people at breakfast the other day. I don't need a scribe. I need a personal secretary to follow up on labs, get the consultant paged/repaged, answer the phone when I'm in a patient's room, etc. I can write all the rest of the stuff.
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Mine actually do those other things you mentioned. It's pretty nice.
Yeah as a former scribe this was expected and we did this, and of all the things we did I feel that this actually made some of the biggest impact on dispo times and minimizing interruptions to the docs. Now as a medical student in sub-I' and observing some EM attendings working with scribes, I feel the scribe is underutilized because they are only writing the chart. Your scribe can essentially be your personal clerk.
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deleted109597
My good one did. That's when I came to this epiphany. I don't need them to write. I only need them for the other stuff.
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I scribed too and you definitely get an "amen" from me. Though the real issue is the companies' provision of training. I don't think the docs should have to dial it down...the companies need to step it up. Unfortunately, they won't until medical groups stop hiring them for overall decreased productivity. This likely would never happen since most docs just revert back to doing things solo even with a scribe so as not to lose efficiency.
I'd be curious to take a cursory peak at the cost-benefit analysis of hiring these scribing companies.
