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 By Neil B. Gailmard, OD, MBA, FAAO, Editor May 20, 2009 - Tip #380 
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The Secret Benefit of Scribes


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I've recently heard from a few optometrists who were interested in adding scribes to their clinical operations. I'm pleased about that because I've long felt that scribes are underutilized in optometry. Having a chairside assistant and scribe is quite common in ophthalmology, but I'm not sure why it hasn't gained wide acceptance in optometry. There is every good reason why it should because it's an extremely effective aspect of delegation.

I suspect most ODs feel that scribes will increase the payroll cost of the practice, but my experience is quite the contrary. There is so much efficiency gained that the practice can easily see several more patients per day and that more than makes up for any increase in staff cost.

I've written before about the benefit of scribes, but in this tip I'll concentrate on a relatively unknown factor that I feel is the biggest reason of all to use them. My system for scribes is different than the usual approach.

Some definitions and the secret revealed

Since there are many different ways to use scribes, I'll define how we do it in my practice. I use the terms chairside assistant, technician and scribe interchangeably. This employee is also a trained ophthalmic technician who performs the pretest work-up on the patient, pages the doctor when the patient is ready, and then stays in the exam room with the doctor.

Now here comes the part that is truly great: the scribing technician is also a fully trained optician! This allows the scribe to completely care for the patient from start to finish in my office. The patient is never left alone and the tech and the patient are able to form a nice bond. The customer service aspect of this system is outstanding.

We do not have one scribe per doctor, but rather several technicians who go where they are needed most in the office. These scribing-clinical-optical technicians may be paged to optical for a dispensing, repair or adjustment of eyeglasses. Or, the tech could be needed in the clinic to begin a pretest work-up. She might be paged to conduct a visual field exam or OCT. Or, the technician could be needed to instruct a first time contact lens wearer on insertion and removal.

We generally find that we need three techs per working doctor, but we can still function with two. The maximum number of doctors in our office at one time is three, so that would mean about eight or nine techs on those days. As a side point to this staffing formula, I should note that we also have two full time opticians who do not participate in clinical work, but stay on the optical floor. We also have several business office staff members, three lab technicians and an office manager.

The secret expanded

It is rare to find an office where the clinical technicians are cross-trained as opticians. It is much more common for the two groups to be separate and a handoff occurs when a patient goes from clinic to optical. But this is where the big benefit comes in: the only thing better than a good handoff is no handoff! It is extremely effective when the technician listens to the doctor-patient consultation first hand in the exam room. Nothing needs to be repeated and nothing is lost in the translation. Furthermore, the doctor does not have to walk the patient out of the clinic and no one has to search for an available optician.

I really don't find it difficult to train clinical technicians in optical dispensing; or to train opticians to do pretests. That is just the norm in my practice and we train new employees with the skills they are missing. This is also the norm in formal optometric technician programs at colleges and universities. The curriculum in these programs historically always included both aspects of eye care.

The other benefit

Let's not forget the original benefit of scribing: it saves a huge amount of doctor time. This is partly because the recording of data is delegated and partly because the technician is available to assist with any other aspect of patient care and office administration. This is very efficient in contact lens fitting and it carries through to pupil dilation, additional diagnostic testing, referrals to other doctors or other aspects of patient care. The technician can take care of all data recording, whether it is with electronic records or paper ones. She can write out all prescriptions, input recall information and complete the billing and diagnosis codes. She enters all fees, including eye wear prices, applies insurance benefits and reviews the fees with the patient. At that point, the technician says thank you and goodbye and turns the patient over to the business office for final checkout.

Once you try scribes, you'll never go back.

Tip maintenance

Most readers know, but in case you don't, here are a few facts about the Optometric Management Tip of the Week. All eye care professionals are welcome to subscribe for free; just go to www.optometric.com and enter your email address in the tip section. There is an archive at the same website that provides a link to all the tips ever written. The archive has a key word search function that lets you quickly look up any management topic you wish. If you wish to unsubscribe, just follow the link at the bottom of each article. To change addresses, just unsubscribe the old one and subscribe the new one at www.optometric.com.


Best wishes for continued success,

Read Past Tips Neil B. Gailmard, OD, MBA, FAAO
Editor, Optometric Management Tip of the Week


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Send questions and comments to neil@gailmard.com.

Dr. Gailmard offers consulting services to eye care professionals through Prima Eye Group; information is available at www.primaeyegroup.com.
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