Seven Essentials of A Productive Physician – Medical Scribe Relationship

Technology, a double edged sword, can make life more efficient by delivering information to us instantaneously but is not without it’s negative side. The introduction of EHRs/EMRs has meant more accurate, easily trackable patient information. No one would suggest going backwards when it comes to patient record keeping, but the same technology that allows a physician to provide better care for their patients has also had negative effects on the doctor-patient relationship. Walk into any exam room and you are likely to see a physician balancing his/her focus on the laptop as well as the patient. Hiring a medical scribe can eliminate the physician’s distraction, allowing them to focus on patient care. But for many physicians, having a scribe working as their administrative right hand is a new and potentially awkward situation. If you’ve decided to take the plunge and hire a medical scribe, we applaud your decision and think you’ll find many advantages.  Once that decision has been made, we work closely with our clients to prepare them for a successful workflow with their medical scribe. It’s important to make sure your scribe knows what to expect and what is expected of them. Here are some things to consider:

1. Medical scribes go with the physician into the exam room and are responsible for documenting every aspect of the patient’s interaction with the provider. If you have any preferences in the way you track your exams, let the scribe know ahead of time. You may want to dictate to your scribe, but you’ll also want them to collect test results, anything to do with prior visits, notes from clinician assistants or nurses. You’ll develop your own procedures, along with the guidance of your scribe company which can offer a variety of workflows based on your needs.
2. If you use your scribe to the full extent of their abilities, you’ll hand off most, if not all, of the administrative work to them. They can alert you to delays, schedule follow-up appointments, get lab results, and handle so many things that slow you down. Take time to list all of the responsibilities they’ll own, and communicate this clearly in writing.
3. Make sure your scribe is aware of what input you require of them. Clinical-decision support (CDS) is built into EHRs to prompt physicians. For instance, physicians may be prompted to ask important questions related to evidence-based history. You should decide how comfortable you are with a medical scribe interrupting you and when to do so. Having a plan for how they alert you to a prompt will eliminate the danger of missing one.  
4. Give thought not only to your working relationship with your medical scribe, but also to how you and your staff will introduce them to your patients. Have a plan to communicate that your medical scribe is subject to HIPAA laws and be prepared to spend time discussing why the scribe is there and how they help you better focus on the patient.
5. Make sure you don’t put undue pressure on your scribe. The pressure for documentation caused some physicians to create “macros” that auto-populate certain parts of a patient’s chart. This was done to expedite the record keeping and not force physicians to check off obvious parts of the exam that they repeat with every visit. Your scribe’s accuracy can literally save you from malpractice lawsuits because they are records of you doing your job properly. Respect that sacred trust, and don’t ask your scribe to cut corners. The culture of respect and efficiency comes from the top down. Encouraging your scribe to skip steps may mean they do so in a record that eventually could be critical in a court of law.
6. Ensure that roles are clearly defined within your staff. Whenever human beings work together, no matter their professional title, relationships can be complex. As always, clear communication can eliminate unnecessary practice politics. Make sure everyone knows their role and understands exactly how they should work together.
7. All of the above is predicated on hiring the right skill set and personality to work with each doctor. Your scribe company can be a valuable asset if it is focused on offering a customized program for your needs. In a future article, we’ll discuss the hiring and screening process.  

Hiring a medical scribe can alleviate a lot of pressure on a physician and their practice. In order to get the most out of your scribe, and ensure your practice runs smoothly, put thought into how you will work with your scribe, and exactly what their role in your practice will be. Your scribe company should be able to guide you through that process. Photo credit: colemama Two of a Kind via photopin (license)