Revealing Insights from a Medical Scribe's Diary

Being a medical scribe for a reputable scribing agency brings pride, especially when I read the numerous articles detailing the advantages physicians experience when they have a scribe, especially in emergency settings. I'm passionate about my role and deeply appreciate the hands-on learning and involvement in patient care. Yet, surrounded by aspiring doctors in a tension-filled setting, the ethical implications of my job can be troubling.

Let’s delve into the foundation and logic that has propelled the success of medical scribe initiatives. The initial skepticism towards Electronic Medical Record (EMR) systems eventually subsided due to the quest for operational efficiency. The primary advantage of EMRs is evident: they bolster risk management. These systems enhance the recording of every intricate detail of patient care, greatly minimizing the chances of overlooking errors. This comprehensive documentation proves invaluable when revisiting a physician's decisions even after several months.

For instance, I once assisted a doctor summoned to testify in court regarding a patient assaulted by her boyfriend. The incident took place months prior in the emergency department. Recollecting every detail of such past events is challenging for most doctors. Hence, the testimony was entirely derived from the medical report, which I had written and the physician had verified. The EMR facilitated the recording of exhaustive details, including test outcomes, patient discussions, and law enforcement engagement.

But, the creation of such meticulous medical records demands significant time and effort. Doctors often lament turning into mere data clerks, allocating a substantial amount of their patient interaction time to digital data input. This is where scribes step in. Predominantly students or fresh graduates keen on a medical career, scribes become indispensable to physicians. The presence of a scribe has shown to remarkably reduce physician fatigue and enhance emergency department productivity. Moreover, detailed documentation facilitates accurate billing, thus increasing hospital revenues. My colleagues, working in an institution that has employed scribes for over three years, unanimously appreciate the system.

On the surface, the EMR-scribe collaboration seems perfect, leading to heightened efficiency, improved patient satisfaction scores, precise billing, and unexpectedly, increased fraudulent activities, eventually benefiting the hospital management. But did you notice the “increased fraud” aspect?

Medical billing heavily relies on documentation, which has various tiers. Level 5 charts, indicating the provision of premium care, are billed the highest. While EMRs ideally enhance the accuracy of documentation, leading to more level 5 charts, the convenience of a few clicks to amplify billing raises ethical questions.

In the popular EMR, Epic’s CareConnect, a simple click can indicate that a patient was advised to quit smoking, adding a nominal fee to the billing. Some doctors have directed me to use this feature even when the counseling didn't actually take place. When confronted, they usually dismiss it or assure me it's fine.

Likewise, doctors can set "macros" that autofill sections of the chart, like the physical examination. This ensures the required entries are made for a chart to reach level 5. Occasionally, the recorded actions aren't genuinely performed. My duty, then, is to correct any discrepancies. But at times, I'm instructed to overlook the inaccuracies, with claims that I might have missed their actions.

How am I so certain? Because I shadow them throughout the shift. My responsibility is to meticulously note their every move to draft comprehensive charts. I'm aware when certain procedures or inquiries were skipped. But with every inaccurate entry I let slide, I'm complicit in falsifying a medical record.

I empathize with the doctors. Hospital management places enormous pressure on them. If their records consistently fall below levels 4 or 5, they face repercussions and potential financial losses. Faced with the demands of numerous patients, it's temptingly easy to click a few extra buttons for a higher-tiered chart, especially given the immense debt many bear due to exorbitant medical education fees.

These might seem like trivial oversights. But these minor lapses cumulatively impact the patient. Furthermore, if such minor deceptions are unchecked, how many substantial misrepresentations remain concealed, shielded by intricate billing, vague recollections, and an opaque healthcare system?

I'll always value my tenure as a scribe, especially as I gear up for medical school applications. But the ethical dilemmas loom large. As a dedicated scribe, I'm conscious that my chart reflects the doctor's decisions. Thus, I often end up documenting what the physician instructs, even if it's ethically ambiguous.

The author wishes to remain anonymous.