Clinical Geriatrics

Today, with decreasing reimbursements and increases in overhead expenses, there is motivation to become more efficient in our practices. One of the easiest methods of increasing volume of patients seen each day is to make use of a “scribe.” It does not make good use of physicians’ time to take a history of the present illness, do the review of systems, and ask about the patients’ past medical history. This can be effectively and accurately done by delegating this important task to someone else in your office and allow you to see more patients while this information is being obtained. I have used a scribe, a college graduate interested in the healthcare profession awaiting acceptance into medical school or obtaining a job in the pharmaceutical industry, who completes the HOPI, ROS, and PMH. The scribe then makes a 30-45–second medical student presentation to me and then she accompanies me into the exam room where I examine the patient and tell her the positive findings on the physical exam, which she records in the patient’s records. I then provide the patient with my impression and discuss the evaluation and/or procedures that I recommend. The scribe returns to the room with educational material and prescriptions and explains to the patient what the plan of action will be. If necessary, I return to the room to answer any additional questions the patient may have. We make use of an electronic medical record (EMR) with tablet PCs, and the scribe inputs all of the information into the EMR, which has been reviewed by me prior to signing or completing the encounter form. As a result of making use of the scribe technique, I am able to see an additional 6-8 patients per day. I have surveyed my patients before and after the use of the scribe and my findings reveal that patient satisfaction is excellent and there have been no complaints regarding the assistance of a scribe.