Physassist scribes to Virtual Medical Scribing: My Story

Imagine a physician running towards a patient’s room in a busy hospital. Now imagine a younger college-level student hot on their heels, desperately trying to multitask: typing on laptap computer, listening, and dodging others running in the opposite direction. Sounds like a madhouse, right? Well, this is the typical hustle and bustle of an onsite medical scribe and what my life was like when I worked for Physassist as an ER hospital scribe. After a short time, I changed jobs and worked at ScribeMD as virtual scribe. Each of these work environments have their own set of challenges. As I delve deeper into the life of a medical scribe, you will gain an understanding of just how tedious and challenging a scribe’s job can be.

What Do Medical Scribes Do?

​A medical scribe, or medical transcriptionist, is a physician’s personal data entry clerk who enters real-time interactions between the patient and the physician in the electronic medical record (EMR), virtually or onsite. A medical scribe’s responsibility is to document the encounter the physician has with each patient, and is at no time obligated to impart medical advice. A medical scribe decreases a physician’s clerical tasks so that he/she can focus solely on and give undivided attention to the patient. Large hospitals to small private practices are employing clinical scribes to decrease a physician’s data entry burden. The use of scribes as data managers is an ingenious practice. This way, the physician can see more patients in the same amount of time.

Scribe duties include:

  • Documenting physical examination results, family, social and past medical histories and procedures
  • Generating referral letters for patients
  • ​Searching for relevant past medical records
  • Keeping track of imaging results and entering the results into the chart
  • Bringing tests results to the physician’s attention
  • Typing progress notes
  • Inputting the patient’s disposition

A scribe dutifully performs their job in order to produce a well-written EMR that is reviewed and signed by the physician.

Physassist Scribes Training

As an international student, I was determined to enhance my knowledge of the American health system before medical school. Prior to college graduation, I decided to take time off from school to pursue avenues that would be beneficial for my resume. I was eager to gain extensive clinical experience in the health sector before matriculation. I first learned about the medical scribe role as a junior in college from a classmate, who was a seasoned scribe trainer with PhysAssist Scribes, one of the leading companies in the scribing industry. I was intrigued by the opportunity it presented and I was more than willing to experience it for myself. I became an onsite medical scribe soon thereafter.

​I underwent an extensive 5-day scribe training session at Physassist’s secondary headquarters in Chicago before moving to onsite training at an emergency department in Florida. Training was inclusive of vast amounts of medical terminology, learning to write history of present illnesses (HPIs), noting review of systems (ROS), methodology, and enhancing our typing skills and speed. At the end of it all, we were given a comprehensive exam and after successful completion, moved on to the practical portion in our respective medical settings.

We had consistent, ongoing online training during our probationary period. It was nerve-racking to say the least. Shadowing physicians throughout their 8-12 hour shifts along with a scribe trainer was not easy. Although I am a night person by nature, working overnights and early mornings simultaneously was, initially, challenging. While I was very grateful for the opportunity, I could see the toll it was taking on my body and mind.

Typical Day of an Onsite ER Medical Scribe

Let us take a typical day for example. I reported to work 15 minutes before my scheduled time of 7pm. I used this time to log in and familiarize myself with the first patient’s chart and get up to speed on the expectations of my trainer for the shift. The physician would update me on any information that needed to be added to the chart beforehand. I also utilized dot phrases to auto-populate the chart. This is a time-saving technique to prevent unnecessary, repetitive typing.

For each encounter, I followed the physician into the examination room. As the two individuals interacted, I would be standing mainly in the corner of the room and documenting, utilizing the technique taught. If I was unsure about a term, I would highlight it and bring it to my trainer or physician’s attention at the end of the dialogue. At that time, if a physical examination had to be carried out on the patient, I would leave the room. Any pertinent findings were relayed to me after the encounter back at the physician’s station.

This would continue throughout the rest of the shift – constantly moving between examination rooms, keeping abreast of any lab results, if any, and the occasional emergency run to check on a patient that presented to the ED with cardiac or breathing complications. During all this activity, there were instances of limited lunch breaks. There were also instances of returning from breaks and almost immediately being told that the patient’s chart needed to be appended.

In addition to dealing with the changes your body undergoes while working as a scribe, I also had to deal with multiple physicians and nurse practitioners. Each medical practitioner is different and there are varying personalities to deal with. Some are willing to take you under their wing and mold you to be an aware and proficient medical student while others were more preoccupied with their job and had little or no time to speak one-on-one with their scribes.

Virtual Medical Scribe for a Nephrologist in Private Practice

After a brief stint with PhysAssist, I moved on to virtual scribing with ScribeMR, a role which I held for a year. Because of the comprehensive training I previously received, my transition to remote medical scribing was an easy one. I scribed virtually for a nephrologist in a private practice. Working onsite as well as virtual gives me the perspective of the pros and cons of working remotely.

The Pros of Telescribing

  • The ability to work from the comfort of my own home without being seen by the physician and patient.
  • Utilizing the short downtime between patients to stretch and/or eat.
  • ​More comfort for the patients, who were sometimes uncomfortable with the physical presence of a third person in the examination room.

The Cons of Virtual Scribing

  • Scribing onsite involved constant movement, whereas virtually you’re being sedentary for hours at a time. Personally, this caused increased strain and discomfort for me. Although, everyone will have a different perspective so depending on your circumstances this can be a positive.
  • While the patient is unable to see or hear you, there are times the audio quality is poor, creating difficulties in hearing the patient as he/she confides in their primary care physician (PCP). Hence, writing a precise HPI and filling out the EMR can be difficult. This was a major setback.
  • Also, there may be loss of phone or Wi-Fi connectivity during patient interactions. Behind the scenes, note taking was done in any form. In contrast, onsite note taking was restricted to the EMR.
  • I recently trained with another scribe company, ScribeAmerica, who had some slight differences in their Telescribe department. Scribe America utilizes both audio and visual so the physician can see the scribe at all times via Skype. Scribing onsite involved constant movement, whereas virtually you’re being sedentary for hours at a time. Personally, this caused increased strain and discomfort for me. Although, everyone will have a different perspective so depending on your circumstances this can be a positive.

Virtual scribing has its pros and cons. However, I believe the cons outweigh the pros.