Optometric Management Tip # 113 - Wednesday, March 17, 2004
Technicians as Scribes
As optometrists look for ways to become more efficient and save time in the exam process,
I'm surprised at how often they overlook or reject the concept of using optometric technicians as exam room scribes. I adopted this technique around 1990, after observing
it in an ophthalmologist's office and I can't see ever going back. The use of chairside assistants is fairly common in ophthalmology, but still remains fairly rare in optometry.
I often recommend that doctors take one step up from their current standard of delegation.
Doing so can result in a new surge of improved patient flow and practice profitability.
If your office currently delegates many clinical procedures, like pre-testing and contact lens insertion, exam recording could be the next step up for you.
Here are the major benefits I see by using scribes.
- Tremendous time saving by not having to write in the exam record. As optometric
practice has evolved, so have our record keeping demands. Just think how much time you
spend writing in records - or if you don't, then your records are probably not as complete
as they should be. In addition to the case history and all the clinical data, there are
notations of drops used, assessments, diagnoses, recommendations, plan, recall date, fee
entry, coding, patient exam summary codes, written copies of prescriptions and more. With
chairside technicians, I don't write anything down, or have to type and click into a computer
in the exam room.
- Better records. By having a technician "take notes" while you talk to the patient,
virtually everything is recorded. And if you use paper records, the handwriting is probably
better than yours.
- Scribes can use electronic medical records software or paper records.
- Continuity of care. In my practice, one technician stays with the patient throughout the
entire visit. The tech calls the patient in for the exam, does all the pre-testing, stays
in the exam room for the doctor's exam, takes care of optical dispensing if needed, and
writes up all fees. If further testing or contact lenses were indicated, the scribe would
take care of that also. The patient is virtually never left alone, and a good relationship
develops between the technician and the patient.
- Chairside technicians can assist with dilation flow. The tech makes dilation run
smoother by instilling the drops at just the right time, performing frame selection or asking
the patient to wait, and then working him or her back into an exam room for the dilated
- I never have to search for a technician. I remember the days when I would finish an exam
and, knowing my next patient was waiting, I'd escort the current patient to optical
dispensing. Hoping to hand the patient off to a technician or optician, I'd find no one
available. I'd spend more time helping the patient to begin browsing, and I'd have to
interrupt a busy technician to tell her what I wanted her to do, when she eventually became
free. It was very inefficient.
- I don't have to repeat all the recommendations and options that were just decided upon in
the exam room to a technician. When my scribe listens to my consultation with the patient
at the end of an exam, he or she knows what to do. I just thank the patient and say goodbye
and move on to the next exam room.
- A technician is available - for whatever reason. There are hundreds of ways she can be
of assistance, such as retrieving clinical supplies from another room, entertain a child when
Mom's behind the phoroptor, rechecking the Rx on an old pair of glasses, holding an eyelid
during Goldmann tonometry, getting the record of a family member, or just being a third party
witness when a patient is emotional or unstable.
Here are some questions and concerns doctors may have when contemplating starting to utilize scribes.
- The payroll cost will go up. Well, yes, it might if scribing becomes successful for you,
but that cost would be miniscule compared to the increase in revenue you could realize by
seeing more patients per day. Using a scribe will cut your exam time considerably. If you
won't be comfortable with a shorter exam time, however, then scriibes won't work well. It is
wasteful to have a technician sitting in the corner of the room for a half hour or 45
minutes. Using scribes requires an exam philosophy that is problem focused, and assumes much
data was gathered during pre-testing.
- How will I train technicians to do it properly? It's not that hard. I recommend
designing an exam form that works as a guide for the technician and has spots to enter all
the usual data, and blank lines to write on. Besides, nothing says that the doctor can't
still reach over to the exam form and enter some data himself (or herself). If a notation is
too advanced for a specific technician, don't embarrass her, just write it yourself and
teach the tech about it later. You'll know what they can handle.
- What if I don't want the patient to hear about a finding out loud, verbally? Don't say
it - just record it yourself. Patients won't think anything unusual if you just make notes
in the chart.
- I may be uncomfortable having someone else watching me do an exam and interact with
patients. You'll get over it. It becomes natural.
- Patients may not like it. Actually, they are generally quite impressed by a doctor who
has an assistant present. It calms people and it elevates the importance of the exam
process. It will set your practice apart.
- What if we don't have enough staff to allow scribing? In the long run, if the technique
works for you, you'll want to increase your staff. But in the short term, I always tell my
office manager that if she needs a technician because the optical is really busy, or we need
to start some exams, she knows where to find one. In my exam room. Just come get her...
knock on the door, open it and say, "Mary, can I see you please?" I'll understand and can
easily go on without a tech.
Best wishes for continued success,
Neil B. Gailmard, OD, MBA, FAAO
Chief Optometric Editor, Optometric Management