Letters to the Editor - July 2015

After recently penning an editorial titled, “Medical Scribes: Red Ink or Revenue-Sustainable Innovation?” (Consultant, Guest Commentary, April 2015, pages 248-249), I was convinced that the use of medical scribes were not only a substantive step forward, but also a guaranteed road to success. Whoa, hold your and my horses! 

One of my partners has been piloting a model for general medicine/primary care and has shared his personal experience as additional food for thought. Keep in mind, my first commentary was written from a cardiologist’s perspective, not from a primary care point of view. So, here are some differing on practitioner-patient interactions:

• Time allotment. The cardiologist pointed out that a medical scribe helped offset the time needed to input data into a computer screen, thereby increasing the amount of face-to-face time he had with his patients. However, depending on the primary care model, the patient in question may actually have less time with their doctor too. 

For example, in a 2-member scribe team model approach, a scribe sees patient A, while a second scribe and physician–provider team see patient B. Once the scribe–provider team is finished with patient B, the provider moves over to join the first scribe for patient A. In other words, the provider is double-booked at the top of the hour and has 20-minute slots afterwards, leading to 4 patients per hour.

• Focus. The agenda for a patient appointment with a subspecialist is typically narrower than that of a primary care meeting. There are more issues to address when visiting with a primary care practitioner and some of these may even be mentioned after the scribe leaves the room. 

• Complex patient history. In a referral center wherein primary care patients have an expansive history with multiple comorbid conditions, a scribe may find the patient interaction complex and at times, unwieldy. When the physician returns with the scribe, there may be multiple, important points unfinished. 

• Workload. If more patients can be seen, the volume of paperwork to be reviewed and completed may be substantially increased—adding significantly to the individual physician’s total workload.

• Personnel. In order for the scribe and physician to become seamless and efficient, the scribe must stay with the practice. Frequent changeovers can be a disaster. 

What I learned is that medical scribes are not a “one-size fits all” model. Each specialty and practice may improvise and the model may differ in its design, efficiency, and financial viability. Medical scribes may not always increase your face-to-face time with patients; they may increase your “out of room” workload significantly.  

- Muhammad Ali Syed, MD, and Gregory W. Rutecki, MD

Cleveland Clinic Internal Medicine