Doctors Are Talking: EHRs Destroy the Patient Encounter

Neil Chesanow


May 22, 2014

In This Article

Would a Scribe Repair or Destroy the Doctor-Patient Bond?

Medical ethicist Art Caplan, PhD, recently taped a video arguing that medical scribes were more likely to ruin rather than improve the doctor-patient relationship. "If we want to make electronic medical records work, do we have to introduce a third party, a scribe, to arbitrate patients' complaints about what the electronic medical record is doing to their relationship with their doctor?" he asked.

He then answered his own question: "You have got to be kidding me."

This negative assessment of scribes generated a tsunami of comments, and this time, more doctors championed scribes than dissed them.

"Sorry, but this clearly misses the point of having a scribe," a dermatologist countered. "If it doesn't take an MD to do something (like entering data into an EHR), we shouldn't be doing it. In dermatology, using scribes has significantly improved the quality of our notes (and the number of patients we can see)."

"I saw an orthopedist last month," a psychiatrist recalled, commenting on the idea that a scribe in the exam room would be an intrusive presence. "A scribe was with him. I didn't even notice."

"I disagree!" another physician declared. "I use scribes in my office. This frees me and allows me to engage my patients in direct and meaningful ways. Scribes are a valuable part of my healthcare team."

An emergency physician put it like this: "Data entry is not the best use of the clinician's time. Until EHR technology evolves into an elegant and efficient tool, scribes are the best answer."

"My doctor does the same thing: head buried in the computer, no direct eye contact or even physical contact," an ophthalmologist stated, and then proclaimed, "Bring on the scribes!"

But other respondents agreed with Caplan that scribes are not a welcome development.

A large contingent, for example, felt that scribes were merely Band-Aids® for a broken healthcare system. "The issue is simple," a psychiatrist explained in a typical comment. "Obamacare needs to be repealed, and then doctors can document in the way that's best for their patients and the situation."

Several doctors questioned the ability of scribes to accurately enter information into an EHR. "A scribe would indeed further destroy the doctor-patient relationship by putting a virtually untrained, unlicensed person in charge of the key transfer of medical information between doctor and patient," one physician maintained.

The scribe as an intrusive presence in the exam room was mentioned by several commenters. "As a health professional and a patient, I know patients are reticent to share personal but important information with their PCP because of the presence of a scribe," one provider observed. "Undoubtedly this harms the doctor-patient relationship and could hinder a diagnosis."

"I certainly don't want a scribe in the room, regardless of their training," an advanced practice nurse agreed. "Some things are hard to talk about. Another person in the room, a stranger who you don't have any trust in? No, keep them out of the exam room."

Another provider deemed scribes to be superfluous. "There is no reason why the medical note needs to be written during the patient-physician encounter," he asserted. "The main purpose of the EHR is to replace the illegible, incoherent, handwritten paper note. A few handwritten reminders jotted down on paper during the history and physical should be sufficient to jog the memory of the physician when typing the note into the EHR after the visit. Hence," he concluded, "no reason for a scribe!"


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