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George Floyd’s life mattered. Like Ahmaud Arbery, Breonna Taylor, Tony McDade, and too many others whose names we don’t know, Floyd was stolen from friends and family members who loved him and cared about him. His murder cannot be undone, and it is our most recent reminder of the fact that white supremacy, police violence, and racism are dangerously prevalent forces in America today… Read Full Statement

How Medical Scribes Can Heal Physician Burnout

U.S. Army Maj. John Ritchie, a general surgeon assigned to Brooke Army Medical Center in San Antonio, Texas, assists his Ghanaian counterpart perform a radical prostatectomy during Medical Readiness Training Exercise 17-2 at the 37th Military Hospital in Accra, Ghana, Feb. 8, 2017. MEDRETE 17-2 includes participants from the Ghanaian government, U.S. Army Africa, Brooke Army Medical Center in San Antonio, Texas, and the North Dakota National Guard. It is the second in a series of medical readiness training exercises that USARAF is scheduled to facilitate in various countries in Africa. The mutually beneficial exercise offers opportunities for the partnered militaries to cooperate on medical specific tasks, share best practices and improve medical treatment processes. (U.S. Army Africa photo by Staff Sgt. Shejal Pulivarti)

Physician burnout—not Zika or Ebola—is the next big epidemic threatening our health care system. Doctors in the United States are more burnt out than ever before, leading to emotional exhaustion and even depression, which harms the well-being of patients and physicians alike. A 2014 survey of nearly 7,000 physicians found that 54.5 percent reported symptoms consistent with burnout—up from 45.5 percent in 2011. This increase is possibly unique to physicians; no comparable change has been reported among the general workforce during the same time period. 

Many recent changes in medical practice—including rising drug prices, pay for performance (which compensates doctors and hospitals based on patient outcomes), hospital purchases of medical groups, and mandated usage of electronic health records—have been cited as causes of the sharp increase. Of these, electronic health records (EHRs) may appear the most innocuous. However, in the years since their introduction, EHRs have quickly established themselves as tremendous time burdens to doctors, decreasing the amount and quality of patient-physician contact. In the field of medicine, thorough, comprehensive documentation is critical to ensuring the well-being of patients. As such, it is a monumental task, but one that should instead be delegated to a separate professional, namely medical scribes.

Electronic health records are specialized software used to store medical history and record details of patient encounters, and were introduced in order to modernize the health care system by replacing paper charts. The 2009 Health Information Technology for Economic and Clinical Health Act allocated $30 billion in Medicare and Medicaid incentives to hospitals and doctors who adopted certified EHRs. These subsidies aimed to bring health care into the digital age, with EHRs promising easier transfer of medical records between health care providers, chartless and more efficient medical offices, and greater availability of records from home.

Despite these good intentions, EHR adoption has introduced many challenges, arguably more numerous than its benefits. The software underlying EHR systems is difficult to learn, and it requires special training for proper use. Additionally, EHR implementation has failed to reduce the burden of charts on doctors, instead making record-keeping even more of a time sink. The flurry of EHR adoption that followed the government subsidy program locked-in underdeveloped standards, forcing physicians today to use the same obtuse, inefficient software as they were nearly a decade ago.

"Just as judges do not record their own courtroom transcripts, doctors should not have to spend obscene amounts of time documenting their patient encounters"

Physicians are currently forced to dedicate far too much time on data entry through EHRs. One cross-sectional study of family medicine residency programs found that primary care physicians spend more time working on EHRs than interacting face-to-face with patients. A substantial amount of this time is wasted cloning notes: A recent University of California, San Francisco study found that medical students, faculty, and house staff manually copied around 80 percent of their patients’ daily progress notes. In clinics, computers become physical barriers between physicians and patients, constantly demanding attention. EHRs trickle into doctors’ home lives as well, forcing many to catch up on patient data entry in what is known as “pajama time.”

The sheer time requirements necessitated by EHRs harm both patients and doctors. Physicians consistently cite EHRs as one of the top factors contributing to burnout and job dissatisfaction, which increases inattentiveness to patients and rushed interactions. In a field dedicated to helping people and caring for their health, the tedium and inhumanity of data entry in front of a screen can be particularly frustrating. Primary care physicians, who are particularly reliant on EHRs to document patient encounters, suffer from burnout at the highest rates; yet, these doctors are often the first point of contact between patients and the health care system. Furthermore, the expanding nationwide shortage of doctors is fueled in part by burnt-out physicians leaving the medical field, an effect disproportionately impacting underserved areas.

As government incentives have now entrenched EHRs into health care workflows, updating them to better fit the needs of health care providers will be no easy task. Until better solutions are developed, delegating the responsibility of filling out EHRs to medical scribes, who assist physicians by recording clinical information in real time, is a promising and long-overdue approach that would allow physicians to spend more time with their patients and less time in front of computers. Just as judges do not record their own courtroom transcripts, doctors should not have to spend obscene amounts of time documenting their patient encounters.

One recent study published in the Journal of the American Medical Association found that physicians who began using medical scribes spent less time at home working on EHRs and more time interacting with patients. Those same physicians reported increased job satisfaction and improved clinical interactions. Patients saw very real benefits as well, with a majority of those surveyed reporting that the presence of medical scribes had a positive effect on their clinical experience. Having medical scribes step in to bridge the gap between physicians and EHR documentation can produce direct, tangible benefits to both doctors and patients.

The funding that currently goes into subsidizing use of EHRs has succeeded in ensuring widespread adoption of the technology. Now, that funding may be better used to incentivize hospitals to hire medical scribes. While the costs of hiring new personnel will undoubtedly pose significant expenses to hospitals, the increased productivity afforded to doctors with fewer EHRs to work through will help to offset these costs. As for patients, having the undivided attention of their doctor will result in better clinical experiences. Better patient care and improved outcomes are certainly worth the investment.

Thorough documentation will always be a crucial part of the health care process. Utilizing medical scribes to perform this task will both improve patient outcomes and allow doctors to spend more of their time actually practicing medicine. Health care is already a stressful endeavor; reserving its monumental clerical component for trained professionals is a very feasible step towards healing physician burnout.

Photo: US Army Africa

About the Author

Jonathan Huang '20 is a Staff Writer for the US Section of the Brown Political Review. Jonathan can be reached at jonathan_huang@brown.edu

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