Comments on: How Time is Spent During an Emergency Department Shift

By: Laura Bryan

Laura Bryan — Thu, 22 Nov 2012 04:50:01 +0000

Anybody remember transcriptionists? We’ve been providing a valuable service to doctors for decades until we were deemed an “expense.” Then docs started hiring scribes (med students). there is a vast workforce already trained in the jargon and documentation styles with excellent keyboard skills, and we’re not transient. Why don’t CFOs see the irony of paying a physician to do documentation because they think paying $20/hr to an MT is too expensive?

By: SeaSpray

SeaSpray — Fri, 09 Mar 2012 17:58:12 +0000

Yes – I thought unit reps did the order entries – followup, etc. What do they do now?

By: Dr Killpatient

Dr Killpatient — Fri, 09 Mar 2012 16:38:57 +0000

Yes, I think this will likely be the case if and when we get scribes. There will be times, like when I am on the phone or doing a procedure that a scribe could get charting done for me and save time but if I am actually able to sit down to chart, I can do it pretty damn fast.

By: ThorMD

ThorMD — Fri, 09 Mar 2012 11:30:22 +0000

Our group uses scribes, but they do not save that much time. In fact, for me, I am quicker than the scribe, so don’t use them. I generally spent more time telling them what to write and editing what they did than it took me to do it myself. In our pool of 30 scribes, only 1 person actually saved me time. And, of course, everyone wants to work with him.

Most scribes are transient (applying to med school etc). Because who else would work near-mininum wage? It takes at least 3-6 months to get them to get familiar with the jargon, and more time to get familiar with the docs styles. By the time they are hitting their groove, they leave for their next job or med school. Most realize they can work as an ED tech and earn 2-3x as much money and get the same exposure to medicine that will help them get into med school.

By: ThorMD

ThorMD — Thu, 08 Mar 2012 23:29:54 +0000

Aren’t we talking about the ED though?

By federal law, I must evaluate and stabilize you before I am allowed to talk to you about money. Most patient would choose to go somewhere else if they are insured but must pay in cash. And if they inquire and we answer questions about payment methods before evaluation, we are violating federal law.

Private offices are different as most do a wallet biopsy prior to making an appointment.

By: Ted Switzer, MD, FACEP

Ted Switzer, MD, FACEP — Thu, 08 Mar 2012 14:39:00 +0000

I find it interesting that ED physicians and nurses continue to pick up the chores of the clerical staff.
Order entry and searching for medical records has traditionally been a clerical function.
Why should the advent of EMRs change that?

By: Hamhock

Hamhock — Thu, 08 Mar 2012 07:05:20 +0000

Why would you recommend EM/IM at this point?

By: Matt

Matt — Thu, 08 Mar 2012 03:07:30 +0000

I’m asking why the majority of physicians cannot reject Medicare/Medicaid and simply go to private pay? If the third party payment system is serving you so poorly, with no improvement in sight, why not reject it wholly? (with the exception of ED, which has wrinkles due to the potential inability of the patient to competently contract)

By: Matt

Matt — Thu, 08 Mar 2012 03:05:51 +0000

I think from am emergency dept perspective it is problematic because there is so much government involved in the delivery of services, from the ambulance service, often paid for with tax dollars, to the fact that the recipient of the services is not able to consent in some cases.

So I see where you’re unique. I still think you fail to recognize your power as the gatekeeper though, and that you have a stronger voice than you give yourself credit for.

I do not believe it’s unconstitutional.

By: n.gill

n.gill — Thu, 08 Mar 2012 02:30:39 +0000

One word: scribes.