Never said I had done any decision making. We were discussing HPIs. And on those, I'm nowhere near 'truly great' and never claimed to be. I actually never claimed to be anything other than "not as ****ty as most M2s are." But the process was still very helpful. Our HPIs were never about transcription; the doc would have their patient interview as normal, and by the time the patient encounter wrapped up and you walked back to the desk, unless it was a complicated patient or multiple patients in a single visit, the history should be done. We would write the HPI, ROS, PE, and then when they came in put in labs and my rudimentary interpretation of them, and the radiology reports. It was also within my job description to let the doctor know when he needed to address a patient again, say, if an abnormal lab came back (meaning I had to learn what was abnormal vs what was 'important abnormal' for those pts), if he had enough to sign them out, when it had been too long and they hadn't made it to imaging and we needed to kickstart things, etc. I tracked down the docs for consults, I would comb prior medical records to get information that was needed for the history, I documented all procedures, their timestamps, which equipment and meds were used, etc. I owned every inch of that chart except for the 'Clinical Reasoning' section, which my copy didn't have. Usually I'd try to put in the anticipated Dx and what I figured the d/c instructions would be based on that (most docs had a set of instructions with some variations they used for most common Dx's). Once I signed my chart, the doctor would open a 'new' chart which would copy every bit of information from my document and give them the additional 'Clinical Reasoning' tab, where they would record their differential diagnosis and why they managed the patient the way they did and came to their final Dx. They dictated this all through Dragon, so I basically got to do a chart, know every value in that chart and what it had looked like in person, and then hear the doctor literally correct my work and then talk through their entire thought process on the patient before signing it.
If you can't see how doing that for thousands of different patients would be useful, and more useful than someone who isn't working, has no access to the charts, no reason to pay attention to which questions are specifically asked of which patients, which labs are run or given importance, and to sit there watching as nitpicky docs tweaked and edited the charts they wrote so they could see what they did poorly and what they forgot to include/included that was unnecessary...then I don't know what to tell you. It has been incredibly helpful for me, more so than anything we've done in these first two years. I get way less access to charts now, way less responsibility, way less education about clinical matters now that I'm in med school. The docs I was working with used to let me ask questions when there was downtime, and then they'd not only answer them, but print out articles for me to read on the subjects - what you should aim to do with the BP in an AAA patient while they waited for transfer, the new technique they'd found for reducing nursemaid's elbow, etc...and while I was there, I had access to all of the same sites I basically use to learn now that I'm in med school, and I used them, because it was fascinating.
It is helpful in PBLs, which is 95% of our curriculum. It is helpful anytime they have us doing patient interviews, or physical exams, because you know the language, the flow, and you've seen it done literally thousands of times with varying complaints. It is useful whenever you discuss labs or imaging, because transcribing those into the chart and adding a simple interpretation was also a part of the job. Does it replace any of that? No, but if I have to choose between a volunteering gig where you're treated like a small child and learn very little, vs a job like my scribe position where it has made these first two years of med school waayyy easier and will still be helping as I go into 3rd year, I unequivocally choose the latter, and I don't understand how that is controversial.
