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Ottawa Citizen (Aug 10): Medical scribes are changing the way doctors do their work

ELIZABETH PAYNE, OTTAWA CITIZEN

“So what brings you in today?”

Dr. Bhaskar Gopalan, chief of the emergency department at Queensway Carleton Hospital, sees dozens of patients during his often-hectic shifts. Today he is seeing 68-year-old William Ellacott, who tells Gopalan he was hit by a puck while playing hockey.

Before Gopalan examines the small wound on Ellacott’s chin, he turns behind him and says a few words to a young man scribbling quietly in the corner.

“Alex, can you pass me a gauze?”

Alex Adani, 23, is a medical scribe. He takes notes during the patient exam. He has the patient’s chart and any other needed paperwork filled out for Gopalan to review and sign as soon as the exam is finished, so he can move on to his next patient. He even grabs supplies from the cupboard, when needed.

Many patients won’t even notice the medical scribe in the room. Still, Adani and his colleagues are quietly changing the way doctors like Gopalan work.

The medical scribe business has taken off in the United States in the past decade, where an estimated 17,000 are now working, but it is relatively new in Canada.

Medical Scribes of Canada, an Ottawa-based company founded by Queensway Carleton emergency physician Dr. Peter Graves, is pioneering the practice.

Like many of his colleagues, Adani is working as a medical scribe as a kind of training ground for his future career. He returns to school at the University of Ottawa in September where he is training to become a paramedic. Meanwhile, he has been recruited to work as a scribe. He says the lessons he learns are invaluable.

“Everything I have learned so far has just been phenomenal. You just absorb the information.”

Adani is one of 22 medical scribes employed by Medical Scribes of Canada, the only Canadian-based company of its kind. The scribes, who earn $15 an hour, are hired by individual doctors at the Queensway Carleton and other Ottawa hospitals. Their ranks include medical students, students planning to become nurses and psychologists, and even foreign-trained doctors trying to get into the Canadian system.

Their training is rigorous. Those going on to careers in health care are often at the top of their classes.

“To see a psychiatric patient and see how the physician takes it step by step for me was invaluable,” said scribe Rebecca Lewinson, who begins her master’s degree in September on her way to a career as a clinical psychologist. “I am sure that is mostly why I got into grad school, it gave me a unique perspective that most people don’t get to see.”

For physicians, the benefits of scribes show in increased efficiency and reduced stress.

Ten years ago, Queensway Carleton’s emergency department saw about 180 patients a day. Today, that number is 220 — and higher. Gopalan says hiring a scribe has given him more time to spend with patients, even on the busiest days.

“I am less tired after any shift when I have a scribe. I am working more efficiently and I feel more refreshed.”

Queensway Carleton supported a pilot project and study in 2015 that looked at the impact of medical scribes. It found 82 per cent of physicians who used scribes saw more patients per hour. On average, they saw 13 per cent more patients. 

Graves, who owns the company and admittedly has a conflict of interest, says using a medical scribe allows him to do what he loves as a physician — get more face time with patients.

He demonstrated that bedside manner during the examination of a young boy in the emergency department this week, who had been hit in the head with a golf club a few days earlier. The boy’s cut had not been initially stitched, but Graves thought some stitches might help it heal with a more discreet scar.

Graves joked with the boy and spoke to his father. All the time he was conducting an exam and quietly talking to Lewinson, who was taking notes in the corner.

“Let’s get you sorted out buddy,” he said to the boy.

“I have always been someone who wants to talk with my patients. I think I get a lot more information out of it and I think they appreciate the face time. The scribes enable me to do that and when I leave the room, my chart is completed so I can actually move on to the next patient fairly quickly with proper documentation.”

The rapid rise of medical scribes in the U.S. was pushed by the introduction of electronic medical records, and growing criticism that, rather than looking at patients, doctors increasingly have their faces turned toward a screen when they deal with patients.

Electronic records have not fully arrived in Canada — Queensway Carleton physicians still use paper charts, although the hospital uses a hybrid system — but they are on the way, which Graves sees as another argument in favour of medical scribes.

“I think I am able to give better attention and am able to be more effective,” he said. “And how happy are you when someone talks to you like this?” he asked, pointing his head toward his smartphone.

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