Hans Haydon, MD, an internal medicine physician with Austin Regional Clinic, was distressed that time-consuming EHR documentation was driving down his clinic’s patient numbers to levels that covered overhead but barely covered salaries. More importantly, it was driving up work hours and stress—part of the growing nationwide crisis of physician burnout.
“I'm no stranger to computer systems, as my father was an electrical engineer with IBM who helped develop the personal computer,” he said. “But I never expected them to intrude directly into patient examination rooms.”
As a result: “I was considering early retirement because my quality of life as a physician had deteriorated.”
Over time, Dr. Haydon had witnessed a shift in the skills demanded of physicians. “When I trained in the ‘70s, a doctor needed interpersonal skills to communicate effectively with patients, nurses, doctors, and colleagues, in addition to scientific medical knowledge to assess the information once obtained,” he says.
But with the arrival of the EHR, “Staring at a screen and typing at a keyboard began to replace the face-to-face interaction and hands-on history-taking and examination during a visit.” And the time he spent on documentation began to balloon.
Then, with the use of a scribe, Dr. Haydon restored productivity, quality interactions with patients, and work-life balance.
With a scribe documenting each patient visit, he can better focus on the diagnostic interview. “By having a scribe taking notes, I can get a better patient history,” he says. “I can read the patient’s body language and facial expressions. It also allows more time for examination and discussion with the patient about diagnostic and treatment options, so we can jointly develop a plan going forward.”
In other words: “I am doing a better exam.”
Patients have responded positively to the change. Dr. Haydon says, “Patient acceptance of scribes has been good—more than 95 percent in my experience.” More importantly, he says, “My patients come away knowing that I am concerned with their problem, not with the computer screen.”
And Dr. Haydon’s satisfaction in his work has returned: “The parts of medicine that are important and meaningful for a physician can be re-emphasized with the clerical assistance of a scribe, and the drudgery that detracts from a quality medical encounter can be minimized.”
Dr. Haydon recommends contracting with a service for trained scribes, then continuing training on site.
Four of the internists at Dr. Haydon’s practice currently use scribes, and the number is growing. While Dr. Haydon is now seeing more patients, he estimates that using a scribe frees up at least 12 hours per week—time that can be spent on family or other recreational activities.
“The patient connection I value so highly is back,” he says. “And I decided not to retire early because my quality of life has improved.”
The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider considering the circumstances of the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.