An anonymous medical scribe posted an article titled “Confessions of a Medical Scribe” in which he detailed some of the positives, and pitfalls of having medical scribes. In the age of electronic medical records (EMRs), doctors were getting bogged down in data entry, so hospitals have hired scribes to shadow physicians and input all patient information into the computer. Scribes are with a physician all day, even on breaks, gaining valuable insight and training about practicing medicine. Physicians benefit because the charts are more complete and accurate. Patients benefit because the physician is able to spend more time interacting with them, and less time with a head buried in a computer. Finally, hospitals benefit because physicians are more productive, and able to see more patients.

The author, however, describes some pitfalls of the system. Charts are billed based on their completeness – the more information in a chart, the higher the billing. Most of the time, the charts are accurate, however, sometimes scribes are put in the difficult position of being instructed to include information that was never communicated during the interaction with the patient. For instance, the chart has a button that can be clicked if a patient is counseled about quitting smoking. If that button is clicked, the chart generates an additional $20-$30 in billing – a small amount in the grand scheme. Usually, the physicians do counsel the patients, and the button should be checked. However, the scribe recounted several times in which he was instructed to check the box whenever a patient was identified as a smoker, regardless of whether or not the patient was actually counseled. In another situation, the physician had preprogramed the chart to check boxes for tests performed during a physical exam. After the exam, the scribe went back and unchecked the fields for services that were not actually performed. The scribe was reprimanded by the physician, insisting that the scribe had either missed the service, or told not to worry about it.

The scribe recognized that these were small issues of fraud that likely made little difference in any patient outcomes, but still felt ethically uncomfortable. EMRs are tremendous tools, but with the new ease of editing patient charts, some physicians are skirting the ethical rules in order to maximize billing. There is the potential for fraud in any system, but the key is for someone who notices it to intercede and prevent further abuse. In the current system, it is unlikely to be the 23 year-old scribe relying, in part, on good physician recommendations to get into graduate school.

Read Kevin M.D. for more information.