Do scribes compromise patient confidentiality?
The rise of medical scribes is notable, with many healthcare entities examining their role and various companies promoting their services. The exact functions, qualifications, and training of scribes remain undefined. No state licensing process exists for them. Essentially, they're ambiguous medical aides. The evolution and future of this role in healthcare remains uncertain.
Typically, medical scribes accompany healthcare providers to input data during clinical tasks. They might be present during patient history taking and physical examinations. More often, they are in the room, observing the entire process. Their emergence can be attributed to the growing demands for electronic medical records (EMR). Before the EMR era, data processors were seldom seen in examination rooms. Federal regulations have consequently introduced this new category of employees, complicating healthcare interactions and potentially driving up costs. Some establishments might expand scribe duties to include assisting with minor medical procedures and serving as chaperones, mitigating the additional costs.
Scribes' qualifications vary. Basic data entry skills, or typing speed, seem essential. Some job postings specify a high school degree or a bit of college education, while others don't mention educational prerequisites. Some training programs range from a few weeks to several months. At the advanced end, some employers prefer candidates with a background in medical terminology, especially medical or pre-med students. This is prevalent in academic settings with easy access to such students. However, most facilities can't access such qualified candidates. Scribes tend to be younger, with few viewing it as a long-term career, resulting in high turnover. Salaries can range from $8/hr to around $20-25/hr, with varying work hours.
Proponents argue that scribes enhance clinical efficiency by relieving doctors from data entry tasks, promoting patient-doctor interactions, and serving as a cost-effective measure. However, some practices remain skeptical about actual cost savings. Scribes could counter the challenges posed by EMRs, which sometimes offer questionable benefits. Privacy risks, however, are evident, though often downplayed. The extent of concern varies by specialty. For instance, few would mind an assistant hearing an ophthalmological history.
But many would be hesitant to share intimate details in the presence of an aide, especially in general medicine or internal medicine. Some practices have scribes stationed outside, potentially improving patient comfort. The presence of scribes during private examinations can be unsettling for many. A study involving urologists showed acceptance, but it had several limitations. The study setting was academic with medical students as scribes, predominantly male. A female urologist declined participation. Results might differ in non-academic urology clinics, especially if young female scribes without medical training were involved. Opposite-gender scribes might discomfort many, especially in private clinics. Emergency departments, despite having clear privacy issues, might be different as patients might prioritize treatment over privacy.
To my understanding, scribe accuracy hasn't been critically examined. Outcomes would significantly depend on the scribe's qualifications and training. It's challenging to imagine someone with minimal education and training comprehending a vast range of medical issues. Though physicians approve all records, records filled with errors become counterproductive. Employing pre-med students might improve accuracy, but high turnover remains an issue.
In conclusion, routinely using scribes in general practice poses potential accuracy and privacy challenges. The competence of scribes without medical training in understanding comprehensive medical histories is questionable. It might be more beneficial for patients to complete detailed forms, which scribes can later input, ensuring privacy. The presence of scribes during personal histories and examinations should be restricted and occur only with the patient's consent. They shouldn't act as chaperones or general medical aides without additional specialized training. Scribes might be a temporary solution to the unwieldy mandated EMR system, which brings its own set of challenges. The need for scribes underscores the excessive complexities of current EMRs, further challenging small practices and solo practitioners.
