Physician, Scribe, and Patient Perspectives on Clinical Scribes in Primary Care

Chen Yan, Susannah Rose, Michael B. Rothberg, Mary Beth Mercer, Kenneth Goodman, Anita D. Misra-Hebert

Extending medical assistants and nursing roles to include in-visit documentation is a recent innovation in the age of electronic health records. Despite the use of these clinical scribes, little is known regarding interactions among and perspectives of the involved parties: physicians, clinical scribes, and patients. The purpose of this project is to describe perspectives of physicians, clinical scribes, and patients regarding clinical scribes in primary care. We used qualitative content analysis, using Interpretive Description of semi-structured audio-recorded in-person and telephone interviews. Participants included 18 physicians and 17 clinical scribes from six healthcare systems, and 36 patients from one healthcare system. Despite physician concerns regarding terminology within notes, physicians, clinical scribes, and patients perceived more detailed notes because of real-time documentation by scribes. Most patients were comfortable with the scribe's presence and perceived increased attention from their physicians. Clinical scribes also performed more active roles during a patient visit, leading to formation of positive scribe-patient relationships. The resulting shift in workflow, however, led to stress. Our theoretical model for successful physician-scribe teams emphasizes the importance of interpersonal aspects such as communication, mutual respect, and adaptability, as well as system level support such as training and staffing. Both interpersonal fit between physician and scribe, and system level support including adequate training, transition time, and staffing support are necessary for successful use of clinical scribes. Future directions for research regarding clinical scribes include study of care continuity, scribe medical knowledge, and scribe burnout.