Article Figures & Data
Figures
- Figure 1.
Distribution of Coded Physician Comments in each domain (n = 289).
Tables
Codes Description Teamwork/partnership Physician refers to impact of teamwork or partnership, including (but not limited to) team-based care and joy of teaching; excludes specific comments about quality of life Quality of life Physician makes direct or indirect comments related to quality of life; excludes comments related to teamwork/partnership Charting efficiency Physician makes direct or indirect comments about time spent on charting Clinic operations Physician refers to impact of clinic operations, including (but not limited to) late patients, no-shows, inefficient scheduling, and patient refusing scribe or student participation EHR Physician comments about the EHR (EPIC) Non-patient-facing work Physician refers to impact on work done outside the exam room, including (but not limited to) reviewing laboratory test results/radiology and responding to messages/calls; excludes comments related to charting efficiency Connection with patient Physician refers to impact on patient communication and connection, including (but not limited to) eye contact, patient centeredness, attention to body language, and rapport; excludes comments related to patient satisfaction Extension of scribe role Physician refers to expanded role of scribes, including (but not limited to) assisting with procedures, completing paperwork/forms, writing letters for school/work, discussing health maintenance, and engaging in health coaching Patient satisfaction Physician makes direct or indirect comments related to patient satisfaction; excludes specific comments related to connecting with patients Charting style Physician makes direct or indirect comments about charting style Charting quality/accuracy Physician makes direct or indirect comments related to the quality or accuracy of charting EHR, electronic health record; EPIC, Epic Systems Corp., Verona, WI.
Themes, by Domain Representative Physician Comments Comments, n/N (%) Positive Neutral Negative Domain 1: Clinic operations Charting efficiency “She saved me easily 15 to 20 minutes which I instead devoted to direct patient care and inbox management. What a wonderful asset!” 33/43 (76.7) 2/43 (4.7) 8/43 (18.6) “This was one of those days where the patient conversations were complex, multifaceted, and difficult to follow. Having [the scribe] there to record the details so that when it came time for me to finish my note I had to merely make sense of/organize it was a true blessing!” Clinic operations “Poorly booked clinic, ran late.” 21/60 (35.0) 8/60 (13.3) 31/60 (51.7) “Last patient was someone I haven't seen in a while so went over time because spent extra with her. Appreciate that I feel a bit less pressured in that context when alone vs with a medical student or scribe because it is only my time vs my and someone else's.” EHR “Sometimes challenging when we want to view in the same part of the chart at the same time. Leads to delays.” 0/8 (0) 1/8 (12.5) 7/8 (87.5) Extension of scribe role “[The scribe's] help was invaluable! At the end of the day she assisted me with an IUD insertion, which freed up [the medical assistant], which she was incredibly grateful for! And [the scribe] was also a huge help to me during the procedure!” 28/28 (100) 0/28 (0) 0/28 (0) “So glad [the scribe] was in clinic with me today!! Had a particularly complex patient encounter where she helped me gather support and additional resources to best care for the patient.” Non-patient-facing work “One thing I have noticed lately is that because I use my laptop to write notes usually, when I have a scribe I do not do as much in between patients in the case that I only have a minute or two—seems burdensome to log in to computer in that context vs when I have my laptop I am already logged in so can quickly review a lab or message between patients even if there is only a very short period of time available.” 3/10 (30.0) 2/10 (20.0) 5/10 (50.0) Domain 2: Joy of practice Teamwork/partnership “So fun to have a ‘partner in crime’ and to spend the day together!” 52/52 (100) 0/52 (0) 0/52 (0) “It's also important to note that it is really fun having [the scribe] to work with. She is a friend now and a colleague.” Quality of life “I just enter the day with a little a bit more positivity knowing that I'm not going to have this onslaught of all these charts to catch up on at home.” 7/12 (58.3) 1/12 (8.3) 4/12 (33.3) “I ran out of town right after clinic this morning and it is so nice to know that my notes are nearly done! I won't be able to complete them before I leave, but am happy and feel SO MUCH BETTER knowing that there will be usable content in the notes… .” Domain 3: Quality of care Charting style “… [the scribe] adapted to my A&P style, which I had been too shy to bring up to her because I am so incredibly grateful for her I don't want to appear ‘nitpicky’ but she—completely without prompting—must be reviewing my notes and made relevant changes in anticipation of what my notes end up looking like. AMAZING.” 3/5 (60.0) 0/5 (0) 2/5 (40.0) Charting quality/accuracy “Today there were a few errors that are completely understandable—confusion about medication names and indications and therefore written up incorrectly—in the notes. It's a good practice to reflect on my explanations and whether or not I am speaking/communicating as clearly as I can!” 23/42 (54.8) 2/42 (4.8) 17/42 (40.5) “[The scribe] completed the assessment and plan portions of the note based on our conversation and my conversation with the patients and for most notes I literally only changed a few words.” Domain 4: Patient experience Connection with patient “I think I have a deeper level of intimacy with patients when I'm not on the computer and I'm just connecting with them. I'm using my body language, I'm leaning in, and it's just the two of us.” 20/21 (95.2) 1/21 (4.8) 0/0 (0) “[The scribe] was so helpful with a teen with mental health issues—I could focus 100% on her and her mother with my eye contact and body language without worry about documentation. What a wonderful thing!” Patient satisfaction “I had several patients comment today on how they enjoyed visits with the scribes much more than before I had a scribe.” 6/8 (75.0) 2/8 (25.0) 0/8 (0) “[The scribe] also gave a sticker to my grown-up patient who joked he wanted it after his flu shot. It absolutely cracked him up when she did it—what great rapport and added value to the clinic experience.” EHR, electronic health record; IUD, intrauterine device.
