They more than earn their keep — they boost the bottom line.

We talk about saving time and saving money, two limited resources in virtually all practices. One way to save more of both is by employing a scribe or personal assistant — a talented multitasker who is adroit at inputting information into your EMR.

For those out there who despise electronic medical records, a likely common factor is the absence of a scribe in your exam room. If you had a scribe, EMR hatred might turn into tolerance, even acceptance. In the complex medical environment of 2017, not having a scribe/personal assistant is becoming untenable.

I like my EMR, not because of a particular software that is the be-all end-all, but because the EMR led to our practice absolutely requiring a scribe for every doctor at every visit. Scribes have changed the provider’s life for the better. Now, trying to see patients without a scribe is akin to functioning without a receptionist, accounts manager, optician, check-out staff, and so on. In truth, my scribe is the one team member I need the most from minute to minute. And sometimes two scribes per provider are required when we have hit high gear.

INDISPENSABLE NEEDS

Top-tier technicians perform as scribes for all providers during all visits. We are a team.

With a scribe I can pay attention to the patient; and the patient can get what he or she wants, which is my attention! And from our vantage point, our eyes and ears are free to focus on how the patient looks and to what the patient is saying. For me, listening to the patient while looking him or her in the eyes is priceless.

The beauty of a scribe is that he or she assists in more ways than just documenting the spoken word. Scribes play an essential role in allowing us to see the volume of patients necessary, and to provide an excellent experience and the best medical care.

TEN REASONS SCRIBES ARE SO NECESSARY

Scribes are invaluable for these reasons:

1. Scribes provide excellent documentation; the best ones get it all down, verbatim.
2. Scribes should be well-trained ophthalmic technicians and natural multitaskers. They react quickly and anticipate your needs. “I see you have some lashes rubbing your right eye, Mrs. Johnson. Do you feel like something is in your right eye?” Before Mrs. Johnson can answer, clean jewelers forceps are appearing within arms-reach almost like you are in the OR.
3. Scribes use their brains. Once you just finished removing lashes, diagnosing wet AMD and explaining cataracts and blepharitis, Katrina (our scribe) quietly mentions, “Doctor, we were following Mrs. Johnson for glaucoma suspect and it has been 18 months since her last visual field. Did you want to get a field on her follow-up visit?” “Oh, yes, thank you Katrina.” Or, “Katrina, is Mrs. Johnson allergic to antibiotics? I’m considering starting her on doxycycline.” And Katrina would reply: “No, sir, no known drug allergies,” or “Yes sir, she is allergic to tetracycline.”
4. Scribes are natural attendants who play witness to the exam room’s proceedings. Unprofessional behavior can and does occur. In clinical practice, a chaperone can provide third-party observation of closed-door behavior.
5. Scribes can educate. Scribes provide written handouts, pre-op packets describing available surgical strategies, and verbal instructions to patients. Some patients are insistent with their need to know, ask and re-ask until they have extracted every last penny of Medicare value (from your hide). When this occurs, you can gently transfer authority to the scribe — then, if you’re smart, give her a raise.
6. Scribes load and unload: gear, people, water bottles, purses, hats, suitcases, oxygen bottles. Humans carry things, so the loading and unloading can be very helpful to move the appointment along.
7. Scribes, bless them all, can assist in coding. Our scribes have taken ICD-10 courses and remind us about modifiers, postop periods and ancillary testing so we do not miss proper documentation and payment. Scribes also fill in interpretations, based on our analysis, under special testing tabs so the physician’s task is minimized. This ‘git-’er-done’ in real time helps reduce audit work later when the information is not as fresh in our minds. Efficiencies will skyrocket when processes and administrative tasks are done right the first time and as soon as possible.
8. Scribes can escort patients to optical, checkout, the dilating area and special testing. Additionally, they can relay information between appropriate staff members.
9. Scribes e-prescribe. Our scribes do very well getting patients’ latest pharmacy, recording special instructions on refills, and cross-checking medication dosages and allergies. While our scribes are always under the direct control of the physician when handling this information, it is still a huge time-saver for the physicians. If our scribes have a question, they always speak up.
10. Scribes increase the bottom line by increasing efficiency and allowing increased throughput. One common, empty argument against having a scribe is that the scribe’s salary will negatively impact the practice profitability. Few falsehoods are farther from their truth: Scribes increase revenue for the practice while reducing physician stress.

If you see one or two more patients per four-hour session with the help of a scribe, this increases annual revenue by $120,000 (Figure 1). The reduced stress, the practice building and the joy of patient interaction will be well worth it.

The following was written in 1998, in the Journal of Ophthalmic Nursing & Technology¹: “Although scribing has been used in ophthalmology for many years, the real benefits could not be realized until the entry of managed care into medicine in the United States. Everyone benefits in an office that uses scribes. The patient and the physician benefit by having a record that is much closer to being complete. The technician benefits as a result of becoming a pivotal reference for every patient encounter.”

Scribes (who make excellent choices for floor manager) escort patients from the dilating area, allowing the physician time to review charts. (The physician should also be under the authority of the floor manager, coming and going at his or her direction to avoid wasted time.)

If you are a wise physician, you will be gentle and kind to the scribe. You will soon realize two beautiful realities: your training has made your scribe both knowledgeable and very efficient, and your practice, and you, the beneficiaries of a very smart move. OM

REFERENCE

1. Slavens RL. The dictated examination in ophthalmology. J Ophth Nurs & Techn. 1998;17:99-101.

Trevor Elmquist, DO, MBA, established a general ophthalmology practice in Ft. Myers, Fla. in 1990 after eight years of active duty in the United States Air Force. Elmquist Eye Group is an integrated eye-care practice that includes two ophthalmologists, two optometrists, four opticians and a staff of 20. Contact Dr. Elmquist at trevor@elmquist.com.

Financial Disclosure: Dr. Elmquist has no financial relationship with any service or product mentioned in this article.