Association of Patient Satisfaction With Medical Scribe Use in an Academic Dermatology Practice

Abstract

This survey study examines the the association of using medical scribes in an academic dermatology practice with patient satisfaction.

The introduction of medical scribes into academic practices has become more prevalent in recent years, driven largely by the intricacies and complexity of electronic medical record systems and the amount of time spent by physicians on administrative tasks. We recently demonstrated that medical scribes could be successfully integrated into an academic dermatology practice, with reduction of factors that contribute to physician burnout and an increase in both the number of patients seen and clinical revenue generated per physician. Factors impacting patient satisfaction in dermatology have been examined but patients’ perceptions of medical scribes in the field have not been assessed. We sought to characterize the impact of medical scribes in an academic dermatology practice on patient satisfaction.

Methods

In September 2017, all patients presenting to the Brigham and Women’s Hospital Department of Dermatology for medical dermatology visits during which a medical scribe was present were invited to complete an optional, anonymous, postvisit survey regarding their perceptions of medical scribes. Surveys were distributed to all 5 scribe-supported practice locations across the department and responses were scored on 5-point Likert scales. Scribes were hired from ScribeAmerica and had specific training in dermatology documentation. All scribes working in the department during the time of study were women.

Patient demographic variables including age (stratified into quartiles for analysis) and sex were collected, as well as the sex of their treating dermatologist. Data were collected and analyzed through Microsoft Excel using t tests and analyses of variance with P < .05 for threshold significance. This project was a departmental quality improvement initiative, and thus was not formally reviewed by the Brigham and Women’s Hospital institutional review board per policy.

Results

A total of 652 patients completed surveys during the initiative; 41 (71%) of 631 were women and the mean age was 56 years. Of 639 patients, 571 (89%) were return patients to the practice, and 468 (73%) of 639 patients were seen by female dermatologists.

Overall, patients reported high levels of satisfaction across multiple domains related to the presence of medical scribes (Table). Most patients agreed or strongly agreed that the presence of a scribe improved the patient-doctor experience, was a comfortable part of the encounter, and was something they would support during their dermatology visit. In addition, female patients more strongly agreed with supporting the presence of scribes than their male counterparts. Analyses by patient age, visit type, and physician gender revealed no significant differences.

Table. Patient Satisfaction Regarding Scribe Presence.

Variable	Having a Scribe in the Room Improved the Patient-Doctor Experience			I Felt Comfortable During My Visit With a Scribe Present in the Room			I Am Supportive of Having Medical Scribes Present During My Visit
	No.	Mean (SD)	P Value	No.	Mean (SD)	P Value	No.	Mean (SD)	P Value
Total	648	3.9 (0.9)		650	4.4 (0.8)		649	4.3 (0.8)
Patient sex
Male	204	3.8 (0.9)	.17	204	4.3 (0.8)	.10	204	4.1 (0.9)	.03
Female	444	3.9 (0.9)		446	4.4 (0.8)		445	4.3 (0.8)
Visit type
First visit	68	4.0 (0.8)	.09	69	4.5 (0.7)	.47	69	4.3 (0.7)	.74
Follow-up	580	3.8 (0.9)		581	4.4 (0.8)		580	4.3 (0.8)
Age, y
≤44	160	3.8 (0.8)	.23	160	4.5 (0.7)	.11	160	4.3 (0.7)	.30
45-59	166	3.8 (0.9)		167	4.3 (0.8)		166	4.2 (0.8)
60-69	151	4.0 (0.9)		151	4.5 (0.7)		151	4.4 (0.8)
≥70	157	3.9 (0.9)		158	4.4 (0.8)		158	4.2 (0.9)
Physician sex
Male	172	3.9 (0.9)	.28	173	4.4 (0.7)	.32	173	4.3 (0.8)	.43
Female	476	3.8 (0.9)		477	4.4 (0.8)		476	4.2 (0.8)

All questions were scored on a Likert Scale with 1 = strongly disagree, 2 = disagree, 3 = neutral, 4 = agree, 5 = strongly agree.

When asked to report preferences regarding scribe gender, most individuals overall (59%) reported no preference, whereas 39% preferred a female scribe (Figure). Female patients and patients seeing female dermatologists expressed the highest percentages of preference for a female scribe.

Figure. Patient Preferences of Scribe Gender in an Academic Dermatology Practice.

Most patients surveyed in an academic dermatology practice expressed no preference regarding scribe gender. Female patients and those seeing female dermatologists were most likely to specifically prefer female scribes.

Discussion

In an era of increasing administrative burden placed on physicians, medical scribes provide an important clinical adjunct for enhancing clinical care and reducing physician burnout in dermatology. One of the major concerns of scribe implementation by physicians is whether scribes would negatively impact the patient encounter. Our study suggests that patients are comfortable with and supportive of scribes, and most patients feel that the scribes actually enhanced the patient-doctor experience. Our department chose to work with only female scribes during implementation of this service. This may have impacted the female (vs male) preference we observed across our patient population.

Conclusions

Scribes were well received by patients of both sexes and all ages. Taken together with prior findings of the enhanced impact on clinical productivity and dermatologist satisfaction, patients’ strong support of the scribe experience provides valuable affirmation for this strategy of clinical care enhancement.