Virtual scribes are game-changers for physicians

Virtual scribes are game-changers for physicians

Me and my “virtual” scribe — an actual person who seems to “virtually” to exist inside of a Jabra speaker on my desk and so subtlety that I forgot to mute a few times when not seeing patients. The “man” in the Jabra speaker now knows just how long of an appointment I need for my hair, and that I prioritize it over my dentist appointment.

No, doctors aren’t perfect. We can be vain — irritable, worried, tired, even sick ourselves.
It was just one day, but that person in the Jabra speaker reminded me of a genie in a lantern, like Aladdin’s or the one in the 1950’s show, Bewitched.
“Would you like me finish that note, doctor?” (Perhaps I’m twitching my nose like Elizabeth Montgomery in Bewitched without realizing it?)

“I see you didn’t add the CPT codes in the template box but in the note. Would you like me to document them in the intended box as well?”

“Yes, Genie, can I also have a pink pony?”

This person is quickly becoming the most important person — virtual or otherwise — in my life. (Note to husband: I probably won’t be dashing off with my genie, wherever he is. But on Maslow’s hierarchy of needs, my scribe’s position is higher than I would have anticipated for someone who is not intricately linked to the larger plan that has been my life.

Presumably, I never anticipated the burden of charting and the effect it would have on my joy of practicing medicine until now.

Nonetheless, despite his newly appointed rank, I don’t think he can get me a pink pony. At least I haven’t asked yet.

But perhaps the most unexpected realization to come from having my man in a Jabra speaker was that this was the only person I interacted with throughout my workday who didn’t seem to want anything from me.
And having a “witness” made me feel somehow more aware of the constant onslaught of disruptions I seem to have. Of course, I run my own busy practice, but I have experienced the same volume of queries when I belonged to larger systems. As physicians, we sure do a lot of answering of questions and problem-solving in any given day, and that’s in between the patients we are actually seeing.

Knock knock: “Just a few questions before you get really busy. Mr. X can’t find his Depakote, or maybe it’s his clozapine. He’s not sure and doesn’t know how many he took of which one … the pharmacy says Y’s insurance rejected the Vivtriol prescribed and you need to fill out a PA providing a failed alternative (how about the alternative is her third DUI and thus incarceration which ironically would allow her to receive Vivtriol without her HMO paying for it?). The TMS machine power supply will take the power out of the entire floor. What do you want to do? Oh and, Mr. X just got admitted — the ER can talk to you right now. Mrs. Z called from Florida to say that her daughter (who is 23) sounds more “tired” on the phone since you changed her medications. And your son’s camp is on the phone, he has a rash, and his eyes and lips are swollen, but they don’t think he got stung by a bee. Should they administer the Epipen? And your next two patients have been vital’ ed and are ready.”

And during the direct patient care encounters, all I could think was, I wonder what my scribe is thinking right now. “Poor Dr. Sepah? How can she convince this person that Effexor probably isn’t why she feels she has halitosis. Or will this psychotic patient punch her before they can administer the Paliperidone injection?”

Of course, I have no idea what he thought because he is a person in a Jabra speaker. Yet somehow, having him silently witness a day in my life was, well I guess it was like looking in a mirror while practicing medicine. I had forgotten what it looked like.
It seemed the opposite of intrusive. If anything, I felt less alone although I’m never really alone, yet I must feel somehow alone in carrying the burden of my responsibilities in any given day.
Kind of like that old adage about a tree falling in the forest, having someone witness my entire day, gave it a new dimension — I could hear the thump loud and clear. I am that busy and being a doctor is hard work, even this many years out.

It’s too bad that I didn’t have this the last few years when charting and administrative demands began to escalate out of portion to the time allotted to address them. A recent JAMA article found that physicians spend 52 hours a year just logging on to the EMR. That’s six and a half days a year that are not accounted for — we don’t get it back. We squeeze — just quietly compensate — like good physicians are trained to do. We squeeze more into one day — skip lunch and engage in a new routine called “pajama time” charting
— after the kids are asleep, of course, on unpaid time.
It is just now as my own clinic owner that I’ve implemented this rather basic tool that can give me back about 10 hours of my week. Well worth the cost. This is a game-changer for physicians. I don’t need a yoga retreat. I am flexible enough. What I need is to look at my patients and click less. Listen to them. Have the time to think through and complete a thought without clicking a collection of boxes or closing distracting alerts.

While well-intended, we do not need elaborate “wellness programs.” I would be more “well” with less clicking. We need basic solutions like this one that actually works.
I am not the problem. We are not the problem. I don’t need to learn how to become more efficient, resilient, relaxed, or mindful. I don’t want coaching on how to “engage better” when study after study, shows that the primary issues related to physician burnout are in the domain of the systems that wield power. The problem is not on the front lines.

I am still baffled as to why the starting point for addressing physician burnout syndrome consistently begins with the physician as the one who needs fixing/stretching/coaching/relaxing/or the opposite — toughening up. Maybe JAMA’s latest article on “coaching physicians” should have considered “coaching the hospital leadership” given what we have as physicians have been saying in survey after survey.
In the end, perfecting downward dog will not get me through my charts or Ms. Y her Vivitrol before she lands in jail again. That is what ultimately contributes to my burn out. It is that simple.
It is so rare that as physicians we “treat” ourselves in lieu of accepting more burden, that for a second — just like Aladdin and the genie — I worried that I had used up all of my wishes. Had I scared him off? Is my genie gone? Darn, it was that last patient who always yells. But then, the Jabra speaker said, “I’ll be ready when you start clinic again, Doctor.”

Torie Sepah is a psychiatrist and can be reached on Twitter @toriesepahmd.
Originally published on on 9/16/2019. To share, go to:
#scribes #physicianburnout #torangsepah #toriesepahmd #TMS #neuropsychiatry #TMSpasadena #virtualscribes

Torie Sepah, MD @ #PasadenaNeuropsychiatry Center