Time has changed the interaction between patients and physicians drastically. With the increasing presence of computers in healthcare, the electronic factor has modified the doctor patient relationship. While many benefits come with the age of electronic records, it comes with its own downsides. One drawback has been sacrifices to patient satisfaction, which can disrupt the doctor patient relationship. Many patients have become increasingly dismayed by the reduced time their physicians get to spend interacting with them since the widespread utilization of computers in healthcare began. Medical scribes provide many benefits including improved physician-patient relationship.
Documentation Interferes with the Doctor Patient Relationship
With the increased documentation demands, many doctors may run behind. When patients finally do get to see their provider, many are left feeling like the physician sat across the room the entire time looking at the computer, typing and clicking, while paying little mind to the patient’s concerns. Provider and staff difficulties with the computer can upset patients further if lagging note completion and clerical errors lead to delays in services and treatment. Unfulfilling experiences can have negative effects on any type of relationship, and the doctor patient relationship is no different.
Different Approaches to Managing EMRs
Different approaches have been used to manage the documentation burden presented by electronic record keeping while also taking full advantage of it. Physicians doing it themselves is one approach that has been used, and is probably closer to the intended result of the mandates requiring computer documentation. Another solution to the electronic medical record (EMR) problem is medical scribes, which are increasing in popularity and productivity. Like the nature of transitioning to EMRs itself, the use of healthcare scribes comes with potential for great improvements, but there are also challenges that must be overcome.
The chief concern when making considerations in healthcare is the patient, and the transition to electronic records makes no exception.
The burden presented by the growing multitude of requirements for documentation makes it important to analyze the impact of these clerical and administrative burdens on patients, and more specifically in this case, how these new responsibilities affect the doctor-patient relationship. Each of the options discussed here, physicians handling documentation themselves and medical scribes, has a different impact on the patient’s care and the physician-physician relationship.
Doctors Filling Out EHR Decreases Communication
Doing it yourself is the go-to route for many people, especially when it comes to saving money. Some healthcare providers feel confident enough in their computer abilities to at least try documenting on their own. This is carried out with mixed success, but regardless of the quality and timeliness of the documentation, time spent directly with the patient is often reduced as an inevitability to maintain an efficient pace. Rather, Mittler, Banerjee, and McDaniel (2016) found that psychosocial and emotional information sharing was compromised when providers were responsible for documenting in an EHR. This reduction in communication of critical information has a negative impact on the doctor patient relationship, which can detract from patient care. While the perks of self-documentation in the EHR may be alluring for physicians and facilities, the potential drawbacks can be detrimental, especially if a serious complaint is withheld by the patient because the physician seems too preoccupied.
Scribes Increase Patient Comfort Level
The introduction of medical scribes is a possible solution to issues such as doctor-patient interactions in the electronic age, but using scribes is not a remedy without obstacles. A cornerstone quality of the patient-physician relationship is its exclusivity. Since the information discussed is of the most personal nature, there is an understandable apprehension by all parties to include additional people in this company outside of family and necessary healthcare personnel. Despite this, Koshy, Feustel, Hong, and Kogan (2010) found that patients in a urology clinic reported feeling comfortable disclosing information in front of a scribe. This is especially notable considering the likelihood urology complaints will be more “personal” than complaints in some other specialties. Earls, Savageau, Saver, Sullivan, and Chuman (2017) found similar results in primary care.
In this study, fewer than 10% of patients refused the presence of a scribe during their visits. The patients who did participate in the study with a medical scribe in their visit reported a high level of comfort and no inclination to modify what they told their doctor.
Yan and colleagues (2016) had similar findings in a primary care setting regarding patient comfort level. In this study, patients also reported the perception of increased attention from their provider. Maintaining this comfort level and patient-centricity is essential to the integrity of the patient-physician relationship, which makes these findings regarding how scribes affect that comfort very useful in analyzing the effect of medical scribes on doctor-patient relationships.
In my own experience, scribes are trained to use their judgement and leave the rooms, or omit themselves from visits altogether, for particularly sensitive topics. Prior to certain visits, providers have told me to sit a certain patient out while they take down their own notes for me to put in after the visit. At other times, when a sensitive issue comes up during the visit, the scribe will likely have had some sort of sensitivity and HIPAA training, and therefore be able to exercise good discretion when deciding if they should quickly and quietly excuse themselves.
The Patient's Perception of a Medical Scribe
Speaking of patient apprehension with scribes reminds me of some of my early scribing experiences. My initial reception was not always warm, and how I was received by patients seemed to vary depending on the population. For instance, one of the first providers I worked for in primary care was an older physician whose patient population had been with him for decades. Many of these patients were greater than 70 years old, and several made it clear they were distrustful of computers and the federal government. Given this, you can probably imagine how they felt when the doctor told them I was there because the federal government was forcing computers into their healthcare.
Early on, it wasn’t uncommon for patients to scoff at me and say something along the lines of, “Oh, Big Brother, huh?” Other reactions would relate to the current president at that time, and I often felt as if I was perceived as his personal spy.
With time, many of these patients came to recognize me as a member of the healthcare team they regarded so highly and started to appreciate me, but it would be insincere to say that acceptance of scribes by patients has been absolute. Nonetheless, I eventually found myself developing the same relationships with patients that other members of the healthcare team developed, and even started to be included when patients would bring in gifts and treats, which really made me feel included. Yan and colleagues (2016) found this same type of outcome, where scribes became integrated into the healthcare team to the extent that they began to develop their own relationships with the patients. This finding and my own experience show the way scribes are able to integrate into the healthcare team without disrupting the doctor patient relationship.
How Does a Medical Scribe Help a Physician
Satisfaction can be lost in the objective numbers that tie more closely to the bottom line. While business may rely more heavily on such measures, it is imperative to consider the satisfaction of patients and employees alike, especially physicians. With the inclusion of a scribe, the experiences of both patients and providers can be vastly improved. When scribes were included in a urology clinic, physician satisfaction with office hours increased to 69% compared to 19% when they were without scribes (Koshy et al. 2010). Another study by Earls and colleagues (2017) found that physicians felt their administrative burden and the encroachment on their personal lives improved with a scribe. Anyone who’s ever had a miserable boss knows the effects it can have on the entire team. Such a great improvement in provider morale is likely to benefit the rest of the healthcare team, and more importantly, the patients! With healthcare scribes bearing the burden of EMR, a doctor has more time to spend with their patient and are more satisfied themselves, which makes maintaining the patient-physician relationship easier.
Patient Satisfaction Increases with Medical Scribes
Everyone wants the doc to be happy, but the patient’s satisfaction is the most important measure. Patient satisfaction has been shown to improve in several settings with the presence of a scribe. In urology clinics, patient satisfaction increased from 87% without a scribe to 93% with a scribe (Koshy et al. 2010). Similar results have been found in several studies in primary care, a specialty in which scribes are being found more frequently. While maintaining a near-perfect patient satisfaction average (4.9/5.0), one physician saw an average of 35 patients a day after utilizing a medical scribe. In addition to the high patient satisfaction and probably in contribution to it, gaze analysis found that this physician spent 93.7% of each patient encounter in direct interaction with his patients after a scribe came on board (Shehata, Amparan, & Hizon, 2017). In a cardiology clinic, Bank and colleagues (2013) found that patient satisfaction was unchanged by the presence of a scribe, which is notable because it was high at baseline. These results show that scribes are likely to improve patient satisfaction, but even if they do not improve patient satisfaction that is already high, scribes do not appear to compromise patient satisfaction. Considering the importance of satisfaction in the physician-patient relationship, the realization that scribes’ effects on satisfaction do not jeopardize this crucial bond.
Medical Scribes Help the Doctor Patient Relationship
In an industry with stakes as high as they are in healthcare, it’s important to have faith and a good relationship with your physician. This stands whether you see the same provider frequently, or you’ll never see them again. The doctor-patient relationship is one of many factors to consider when implementing a medical scribe program. The introduction of EMR systems has brought many burdens with it, although there is now exciting potential to improve several domains of healthcare. The weight of the EMR may be too great for some physicians to perform alone without compromising patient interaction, which can make the benefits of EMR out of reach for them. Introducing a clinical scribe into a medical setting is showing to be a proven way to handle the documentation requirements while allowing doctors to focus on their relationship with the patient and maintain high patient satisfaction.
Bank, A. J., Obetz, C., Konrardy, A., Khan, A., Pillai, K. M., McKinley, B. J., Gage, R. M., Turnbull, M.A., Kenney, W. O. (2013). Impact of scribes on patient interaction, productivity, and revenue in a cardiology clinic: a prospective study. ClinicoEconomics and Outcomes Research, 5, 399-406.
Earls, S. T., Savageau, J. A., Saver, B. G., Sullivan, K., & Chuman, A. (2017, April). Can scribes boost FPs' efficiency and job satisfaction? The Journal of Family Practice, 66(4), 206-214.
Koshy, S., Feustel, P. J., Hong, M., & Kogan, B. A. (2010). Scribes in an Ambulatory Urology Practice: Patient and Physician Satisfaction. The Journal of Urology, 184(1), 258-262.
Rathert, C., Mittler, J. N., Banerjee, S., & McDaniel, J. (2017). Patient-centered communication in the era of electronic health records: What does the evidence say? Patient Education and Counseling, 100, 50-64.
Shehata, H., Amparan, A., & Hizon, G. (2017). Use scribes to shift your focus from computer to patients. Medical Economics, 38(4), 68-69.
Yan, C., Rose, S., Rothberg, M., Mercer, M. B., Goodman, K., & Misra-Hebert, A. (2016). Physician, Scribe, and Patient Perspectives on Clinical Scribes in Primary Care. Journal of General Internal Medicine, 31(9), 990-995.