White Coat, Black Art

A new face in your ER: Medical scribes come to Canada

Some Canadian doctors are starting to hire scribes to write up their medical charts. They say it helps them focus on the patient and improve their efficiency.

Dr. Peter Graves and his medical scribe Ryan Sandarage at the Queensway Carleton Hospital in Ottawa (Justin Wood, Queensway Carleton Hospital)

There's a new presence on the floor of the busy Queensway Carleton Hospital emergency room in Ottawa. As Dr. Peter Graves walks in to see a patient, he introduces his medical scribe Ryan Sandarage.

The scribe's job is to shadow the ER doctor and take notes while the patient is being seen The scribe fills out the chart and other paperwork for the doctor to review and sign when the visit is over. 

Graves is the person responsible for bringing this new face into the ER — he runs a company called Medical Scribes of Canada which currently employs more than 20 scribes. Its one of two companies that employ scribes in Canada. 

He says he and his colleagues who use scribes are seeing the advantages — including better communication with patients. 

"I'm able to give undivided attention to my patient. I'm not looking down at a chart or a laptop"- Dr. Peter Graves 

Graves says having a scribe also means he's a more efficient doctor.

"Because it's done concurrently and  done in a very effective manner, I don't have to take the time afterwards to write the chart up." he tells Dr. Brian Goldman, host of White Coat, Black Art. 

In 2015 Queensway Carleton Hospital ran a pilot project using scribes to see what kind of an impact they would have in the ER.  It found 82 per cent of physicians who used scribes saw more patients per hour. On average, they saw 13 per cent more patients, although Graves says that number is now closer to 20 per cent.

The scribes make about $15 per hour, and many aspire to medical careers, including Ryan Sandarage.

He sees it as a unique chance to be in the room while real medicine is being practiced. 

"Seeing it first hand, hearing from the doctors themselves, not just from the medicine side, but from the personal side -- that has pushed me forward in my career aspirations," Sandarage says. 

Graves says not all doctors want to use scribes and it can be an adjustment for patients to have another person in the room while they are being examined. 

There have been some questions raised about the qualifications and training of scribes in the United States, where they've been on the job for more than a decade. 

It's expected that there will by 100,000 scribes working in hospitals, clinics and other healthcare settings in the U.S. by 2020. Lisa Gillespie covers health and science for the NPR affiliate in Louisville Kentucky. She's wirtten about  the scribes since they were introduced — largely as a means of helping doctors cope with the switch to electronic health records. 
Lisa Gillespie, Health/Science reporter WFPL Louisville, Kentucky

She says one issue the U.S. had to address is patient privacy. Scribes are required to meet federal privacy standards and can't share information they hear during appointments. 

Part of the problem, she says, is that scribes are paid by the doctors who use them — as is the case in Canada — and that can lead to a conflict of interest. If a scribe has an issue on the job, or sees something untoward happen on the job, it's difficult for them to speak up. 

'The only way we'd really know if a scribe was being used incorrectly is if there was a whistleblower who came out. And most of these scribes are people who are trying to get into med school or be a nurse practitioner ... So why would they risk their medical career?" 

She says scribes are not licensed and as a result the training they receive is not uniform. 

"If you're a scribe at one hospital, it might not be the same at another hosptial," she says. 

Still, she points out that studies in the U.S. have pointed to improved efficiences and improvment in doctor-patient interactions when scribes are used. 

Dr. Graves says he expects the use of scribes to increase in Canada as electronic records become more common. He says his company ensures scribes are well-versed on privacy rules. And while his scribes aren't currently licensed he hopes to develop procedures to make that happen.