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→ We are delighted to post this reflection by Dr. Ginny Van Duyne, faculty at Family Health Center of Worcester where she is also Education Director. Dr. Van Duyne captures what many of us are striving for in our care - more quality time - and she has found it!
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The Case for Scribes
I’m a naturally curious person. I was that kid who asked “why” a hundred times about everything. When I was in grade school, I remember riding on the bus on the way to school and peering into the cars next to us, wondering what that driver’s life was like. I wondered about their stories, what made them tick, why they did certain things, how they felt about all of it.
Fast forward several years to the third year of medical school. I had made it through the slog of pre-clinicals and finally got to be at the bedside. I hit the wards with enthusiasm and my curiosity flourished again. It led to meaningful discoveries like the true etiology of unintentional weight loss in a patient who had been stumping the team despite an exhaustive work-up. I was curious about his story, so spent extra time after rounds listening to him. He had been homeless for years during which time he had no dental care, so slowly lost all his teeth. He despised eating the soft foods he could manage without teeth, but he couldn’t afford dentures. The revelation to the team that we could do something so simple to help this patient was pivotal for this patient’s care.
...my curiosity had been given a backseat in my patient encounters.
It wasn’t until I recently started having a scribe with me in most of my clinical sessions that I realized that my curiosity had been given a backseat in my patient encounters. Through the fatigue of residency and parenthood, the anxiety of being a new physician and wanting to do a good job on everything, the constant distractions of the EHR, interruptions from staff and layers of complexity of my patients during the visit--curiosity had but little room. In the visits with a scribe, I could focus less on getting it all down so I wouldn’t have to do it later, and I could be more present with each of my patients. I could observe my patient’s presentation, my own sense of what is still unknown about their concerns and dive deeper into it without hesitation. I could feel my shoulders were more relaxed; I was not on the edge of my seat trying to cue “let’s keep things moving because I need to move onto the next patient” and my heart literally felt like it was opening. I actually had time to notice what was happening in my body and respond to it. Even better, I could allow myself to wonder why my patient thought a certain way and ask them about it without rushing.
I left the room feeling rejuvenated
I’m not the only one who noticed a difference. One of my patients who always has a laundry list of complaints with some serious underlying disease thanked the scribe profusely at the end of her most recent visit. “You should be here every time! My doctor is so much more relaxed!” I was able to give her the gift of my presence through curiosity and attention. I did not leave the room feeling harried; I left the room feeling rejuvenated, having my natural sense of curiosity satisfied and knowing I had given the kind of care I want to give.
This reflection first appeared in a weekly newsletter of the Department of Family Medicine and Community Health at UMass Chan Medical School.
