We appreciate Dr. Schattner’s response to our reported findings1 regarding the role of scribes in primary care. While we agree that introducing additional team members into the provision of health care delivery has the potential to adversely affect the physician–patient relationship, it could also enhance the relationship—in delegating tasks to another member of the care team, the physician has greater ability to focus on the patient. We previously reported that having medical assistant scribes in the exam room increased the amount of face-to-face time with the patient.2
In order to provide high-value care to populations of patients, team-based care is inevitable. As recently demonstrated, every hour of direct patient care generates almost 2 additional hours of documentation and other clerical work, which often spills over into the evenings.3 In the team-based care model we described, physicians generally sign their scribed notes before the end of the day, which has the potential to reduce burnout.
There is no reason to believe that removing physicians from certain tasks will lead them to abandon face-to-face physician–patient interactions altogether. The physician’s role in assimilating the gathered data and seeking clarification or further information in order to provide care for the patient is exactly where the physician’s skill is best utilized.
Dr. Schattner’s suggestion of “deserting the screen completely” during the patient narrative and examination is exactly what team care is meant to achieve. However, without the presence of scribes, if physicians do not interact directly with the electronic health record at the time of the visit, they are likely to do so many hours (if not days) later, when important details may be lost. Reviewing our own physicians’ notes, we found that scribed progress notes were equal to, if not better than, notes written by the physician alone.4
Building and maintaining the physician–patient relationship, especially in primary care, should be the focus of the physician’s daily work. As in all complex human endeavors, from military operations to aviation, success is best achieved through specialized teams where each member brings unique skills and dedication. Primary care is late in coming to this realization, but it is welcome nonetheless.
Compliance with ethical standards
Conflict of interest
The authors report no conflict of interest.
References
- 1.Yan C, Rose S, Rothberg MB, Mercer MB, Goodman K, Misra-Hebert AD. Physician, scribe, and patient perspectives on clinical scribes in primary care. J Gen Intern Med. 2016;31(9):990–995. doi: 10.1007/s11606-016-3719-x. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Misra-Hebert AD, Rabovsky A, Yan C, Hu B, Rothberg MB. A team-based model of primary care delivery and physician-patient interaction. Am J Med. 2015 doi: 10.1016/j.amjmed.2015.03.035. [DOI] [PubMed] [Google Scholar]
- 3.Sinsky C, Colligan L, Li L, et al. Allocation of physician time in ambulatory practice: a time and motion study in 4 specialties allocation of physician time in ambulatory practice. Ann Intern Med. 2016 doi: 10.7326/M16-0961. [DOI] [PubMed] [Google Scholar]
- 4.Misra-Hebert AD, Amah L, Rabovsky A, et al. Medical scribes: how do their notes stack up? J Fam Pract. 2016;65(3):155–159. [PubMed] [Google Scholar]