• Additional efficiencies are realized if the scribing technician is trained in both clinical pretesting and optical dispensing. That is the case with all technicians in my practice. This creates an excellent patient service touch, namely one staff person calls the patient into the clinic, performs all pretesting in various exam rooms, stays with the patient during the doctor portion of the exam and then carries out frame selection, contact lens training or any additional special testing. The patient is never left alone in the office and the patient and technician build a nice rapport.
• The doctor does not have to search for a technician at the end of the exam. Before I started using scribes, I spent half my life looking for a technician or optician to take over for me. I'm not sure where the staff was, but they were always busy or missing. I'd either have to start a frame selection myself (not good) or I'd have to leave the patient and hope someone would assist him. Just walking patients out to optical takes a huge amount of time. Having the tech in the room with me solves the problem.
• The scribe hears the consultation first hand. I don't have to hand off the patient to an optician and repeat everything I just discussed in the exam room; my tech hears everything and simply carries it out. The best hand off is no hand off.
• The scribe assists with contact lens fitting. Having a tech on hand makes the contact lens fitting process very streamlined. I have all the data I need at the end of the eye exam, why not just fit the patient immediately while they are still in the chair? I tell the tech what trial lenses to apply and I leave to see another patient. In the meantime, the tech puts the lenses on the patient's corneas, lets them settle, takes acuity, performs an over-refraction, educates the patient about the lenses and discusses fees. I pop back in and check the fit with the slit lamp and we are done.
• Having a tech in the room is immensely helpful when I need an instrument or supply from another room, or I need another patient record, or I want to arrange a referral appointment with another doctor, or whatever. I don't have to page anyone for help.
• Additional medical testing is carried out by the scribing tech as needed. I don't even instill eye drops very often, I just tell the tech what to use and I leave the room.
• Records are better. I used to rush and scribble when I kept the records myself. Techs have plenty of time to record everything that occurs in the exam process so the record is neater and more complete. They circle the procedure and diagnosis codes, record all instructions, indicate recall dates, enter all fees, write up all Rx copies - they do it all.
• Patients are impressed. The importance of the eye exam is elevated when a technician sits in to assist and record. Hearing the routine findings spoken out loud, even something simple like the refractive results, is educational and impressive to the patient.
• In my practice, the technician pages the doctor (on a silent vibrating pager) when the pretesting is complete and the patient is ready to be examined. Doctors don't page techs; techs page doctors.

Just do it

Of course it helps to do some planning and training before asking your techs to scribe for you, but in the end it's really much easier than you might think. Just reassure your staff that you know their skill levels and you won't embarrass them or throw very advanced terminology at them that is over their heads. You can still reach over to the record and make a drawing or jot a down few notes that you don't want to speak out loud. I found it was helpful to redesign the exam form to assist technicians with recording and to allow me to see the pretest data. It also helps if your exam routine is fairly fast.

If scribing works for you it is very likely that you will need to hire more staff members, but the increased revenue production will greatly exceed any additional payroll cost. I remember when I first tried the technique in my practice my office manager was worried that we might run short of technicians to start workups or to dispense eyewear. I didn't let that stop progress; I just told the manager that if she ever really needed a tech, she knew where she could find one - in my exam room! I said, "just knock and the door and call her out; I'll be fine by myself and I'll understand that you needed help." It was hardly ever necessary.