Scribes

I initially was somewhat dismissive of scribes. I viewed them as Ancient Greek or Roman characters who would sit at the emperor’s side to transcribe every gem the great leader had. In modern times, parody takes a different turn with Dr. Glaucomflecken, whose scribe Jonathan acts unquestioningly, is supremely competent, and has lightning fast speed.

Now I have the opportunity to work with scribes at the Arlington Free Clinic. Let me tell you, it is great. I am not encumbered by having to look at my screen typing in my advanced finger pecking technique (no, I did not take a typing class in school, and yes, I know that it is life changing). I can focus more completely on the patient, which is helpful for me and them both.

The scribes I work with are college seniors or recent college graduates who are interested in going to medical school. They learn medical terms, hear physicians discuss medical problems with patients, and get a sense of the medical interaction. I also view having a scribe as a teaching opportunity. We discuss clinical correlations, medications, and the techniques involved in medical history taking. Now granted, I am a volunteer physician who has the luxury of not worrying about time. I generally speak to the scribes at the end of the patient session.

I know that the position of scribe is fast being overtaken by the machine, and that the human scribe will likely not exist in 5 or so years. But let me make a pitch for keeping the human scribe. It is a great opportunity for the medical school applicant who frequently takes a “gap year” to prepare for the Medical College Admission Test (MCAT) and makes applications to med schools. They not only learn phrases, but get a glimpse of how medicine is practiced before they enter into their pre-clinical years. And it is edifying for those clinicians who like to teach. The machine transcription has to be edited, just like the scribe’s. But it is not a social interaction, with a give and take.

Having made my pitch, I know that the admin folks will definitely get rid of the human scribes. And there are those clinicians who don’t like a crowded room. Let me tell you, though, I have seen clinicians standing at the screen, focused on filling the boxes and not seeing the patient eye to eye. It is not pretty. And, more importantly, it makes for sub-par medicine. This is especially a problem for the cognitive specialties such as Internal Medicine.

Medicine is a team sport, and learning is a continuous process. Let’s keep the “Jonathans” out there excited to learn.

Finally, I would like to note that, in honor of the State Department getting rid of the Calibri font for Times New Roman, I was going to switch to Calibri. The Calibri font is more readable for the vision impaired, which the State Department views as a “wasteful sop” to diversity. I would like to suggest a movement to go to the Calibri font in protest. Stick it to Secretary Rubio, who has no shame. Alas, Substack does not have a Calibri font. It should.