Scribes

[rrlpa]

Experienced PA about to start a new job in a community hospital where I will be working with a scribe. Haven't ever done that. Any experience/tips/cautions/words of wisdom? Salary plus RVU bonus pay structure. Thanks

[EMEDPA]

make sure to review all notes before you sign them. they frequently pre-populate them with "nl complete physical exam" templates that are just plain wrong.  don't let them order labs or imaging in your name until you sign off on them.

these folks have no medical training. they are mobile transcriptionists.

" So PA rrlpa, can you explain why you did a pelvic and rectal exam on this pt with a splinter in her finger?"

[Nlbs]

As a former scribe:

When working with providers (especially with providers I didn't know as well), I much preferred over-dictation. I also appreciated when a provider reads over the note to ensure it is accurate and the 'feel' they want. Constructive criticism was always welcome. I hope you enjoy working with scribes!

[jwells78]

I worked with scribes and absolutely loved having them. Not to contradict you E, but not all scribes are "untrained;" at our shop we hired only pre-med/pre-PA or nursing students, so they had a grasp on med-terminology and procedures.

 

I will echo the caution to double check your notes; but likely- they will familiarize themselves with your style and upload your pre-completed notes, so all you should have to do is check the HPI, type/dictate the Med decision making, and enter in any more complicated PE findings.

 

Let them act as your reminder for everything; did you read the xray? Did you check the labwork? Did you order the CT? Should we pick up bed 10? Ect, ect..

 

They should enable you to focus on the meat and potatoes while they keep track of the details.

 

A well trained scribe is an invaluable asset.

[EMEDPA]

Jwells- we got scribes at the place you and I used to work together. a good scribe is great, a poor scribe increases your work. the problem was that there were so many of them working part time you generally worked with a new scribe every shift , so they never learned your style.

[ajnelson]

Our scribe group has a 'master' list of what we all like and all sorts of other nuances about each of us.

I agree, some are better than others. I always read through my notes before signing (even when I do my own) to make sure it makes sense and says what I want. That note is the only thing I have to (hopefully) save my butt in case of adverse outcomes. I want it to accurately reflect me, my work, the patient and the diagnosis.

[jwells78]

E agreed re: poor scribe = more work. I actually was charged with managing the scribe program for a time and we did our best to mitigate that issue by a thorough screening, probationary period, and a laser focus on succinct HPIs.

 

The good ones are worth their weight in gold.

[EMEDPA]

JW- the daughter of one of our ER docs(A.R.) is a scribe and has plans to go to medschool. she is a rock star.

[d-wade]

Most scribes will have a macro or negative template (very common broad stuff) for the physical exam and the ROS. It is somewhat limited, but there are different macros for gender/age etc. Knowing what is on those negative templates is very important, as you will never be surprised and can dictate to the scribe what you don't want checked off as negative on your note. Let them know any preferences you have; for instance, if you have a specific negative neuro exam you like to perform that deviates from their negative template, have them make (or make yourself) a macro/dot phrase that they can access (and all scribes can access) when they are working with you. If there is something you want the scribe to focus on in the HPI, let them know!
Think of scribes as just another provider tool. If you don't know how to utilize them properly, you aren't going to save yourself any time. I think where the problem comes is providers having unrealistic expectations of scribes per their training or abilities. Of course there are going to be incompetent scribes (and the same goes for providers), but most of them are pre-med or pre-PA and are very willing to learn.