Medical Scribes

by admin on 06/20/2011 1:06 AM

Are Medical Scribes an innovation that improves healthcare and the doctor/patient relationship?

In the early 2,000s as we were being pushed to see more patients as health maintenance organizations (HMOs) were exerting their control of private practice in the United States, I began writing this Journal on a Quarterly basis. I utilized international conferences as one mechanism to gain a world perspective of health care.

I attended a large number of the International Conferences of my specialty organization. Our meetings were scheduled alternately on an East Coast city such as Boston or Atlanta or a West Coast city such as San Francisco or Seattle.  It was attracting colleagues from more than 40 countries. The meetings in the East attracted large numbers of European, African, and Mid-East and the meetings in the West attracted large numbers of Asian, Australian, and South American colleagues. The physicians from the UK, who were on salaries, were sponsored by Pharmaceutical firms. They usually sponsored three plane loads of physicians which comprised a significant contingent of Pulmonologist. We have been known at various times by the five names which designated our specialty. Thoracic, Pulmonary, Lung, Chest, and Respiratory.

As the quality of the meetings continually improved, the attendance from around the world matured. Foreign attendance approached the domestic attendance. Although started by the pulmonologist, it attracted colleagues in related specialties.  There were increasing numbers of pulmonary Pediatricians, Thoracic (Pulmonary) Surgeons, Lung pathologists, and Pulmonary Radiologist.

At these International Pulmonary Conferences, I had informal meetings with a large number of foreign colleagues. I first became aware of “Medical Scribes,” at a luncheon attended by Korean Pulmonologists.  They were seeing patients much faster than American doctors. While we were complaining that we could not provide optimal health care seeing 4 or 5 patients per hour, they said they saw at least 10 and at times 12 patients an hour. They had a “scribe” with them at all times. The patients were prepared and previously interviewed by a Nurse who presented the medical problem to the physician. The physician began examining the patient as the nurse was presenting. The scribe was writing down what the physician was describing about his findings and his recommendations. The physician would then sign the scribe’s notes, the prescriptions that were written, and they then moved to the next exam room. The South Korean said the large number of patients required this speed. Did he ever have a personal relationship with the patient? He said the patient was essentially nameless after this five minute encounter. He would normally not recognize this patient on a return visit unless the nurse mentioned it. He said he had no choice in caring for his patients. In fact, he said he did not even consider these patients as his patients—they were patients of the state.

I determined that there was no end point in the state control of healthcare. It really was not healthcare for the ultimate benefit of the patient. It was bureaucratic control of the patient population for the benefit of the state. The patient was merely a commodity that was sold to the lowest bidder with an acceptable mortality rate that didn’t elicit serious public concern. At least not enough to cause political damage.

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