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"Under HPI..."

March 3, 2018

"Under HPI, make sure you include everything the patient just said."


*After a good 5-10 minute patient history*


"Wait, what?"


Medical scribes are a new wave and a vital aspect in patient care and workflow. Not only does it free up time for the providers to focus on the patients, it allows for great exposure and experience for the scribes themselves. But not all scribing experiences are the same. I've scribed for a handful of providers in various specialties and all of them have unique styles and expectations. I have had scribe experiences where I am with the provider essentially the whole day in their office cleaning up notes, in the exam room with them, to even transcribing remotely! I am confident in my abilities now as a scribe and how it has continued to prepare me for PA school through exposure to key medications and diagnoses, the thought process of caring for a patient and how to speak like a professional healthcare provider. But per the above anecdote... this wasn't always the case.


I was thrown into the fire of scribing for a busy orthopedic office during my early scribe experiences. I had exposure and experience in medical transcription before, just on a smaller scale. A very small scale. I was working in occupational medicine as a medical assistant/scribe and I essentially only dealt with basic S.O.A.P. (Subjective, Objective, Assessment, Plan) notes. Also, that previous EMR (electronic medical record) platform was much easier to navigate.


I consider myself to be pretty tech savvy and I type fairly quickly but just trying to put it all together while listening to what the patient was saying with regards to their history and what doctor was telling me with regards to the physical exam and catching the true assessment (and not the differential diagnoses) as well as the plan was a juggling act. I adapt quickly and I can get the hang of it, if I practice and through repetition. However, it didn't help that I was only at the orthopedic office a few days out of the week and at the occupational medicine clinic the other days. My mind was in disarray, trying to remember different providers style of medical documentation and their key tagline and phrases. On top of that, I thought I'd throw in some emergency medicine shifts as well. (Bad idea). Long story short, although I learned a lot about orthopedics, medical scribing, and how to work efficiently-- these early scribing experiences did not pan out. I decided to work full-time solely at the occupational medicine clinic, scribing and working as an MA but looking for different opportunities to grow. I decided to take my talents back home, like LeBron, except it was more to regroup and re-evaluate myself during the CASPA 2016-2017 application cycle.


Fast forward to April 2017, I had gotten the last of my rejections and was pretty bummed out. At this point, I had built up a strong foundation in terms of medical terminology, physician verbiage and a better understanding of patient workflow. I truly enjoyed being in the room with the provider, the patient and knowing the story of a patient's visit from beginning to end and just the thought process it takes to treat a patient holistically. I threw my resume and application in the air and tried to see if it'd stick somewhere, by this time I had more experience and minimal-moderate exposure in three different specialties. While helping my dad out at his clinic, BOOM! I got a call. It was a staffing agency asking if I was interested in a scribing opportunity in pediatrics.


Peds? I loved shadowing and volunteering in peds! I was thrilled and nervous at the same time. This was a great opportunity but I was traumatized by my early scribing experiences and I was concerned about my abilities. Regardless, I went in, anticipating to do my best and absorb information on how to become a better scribe and a better future PA. The experience definitely hit me like a wrecking ball though. It was also fast paced, it was detailed and extra... on a lot of different levels. The pediatrician was unlike anyone I've worked with before and it taught me a lot. It taught me how to adapt, how to tolerate various personalities and styles of practicing medicine, and how to be confident in my own work and abilities. It was an interesting experience because she was definitely behind a lot of patients often and the notes were also behind, so that's why I came in eager to get her back on track (despite this learning curve of a new style and new EMR). After the first few months, I was comfortable enough to understand the thought process, again, the tagline and key phrases. I even built up templates and used shortkeys, adjusting as needed and it really gave me more confidence in my ability to make notes sound, "more doctor-y", as I've been told before.


Although I had a system in place, the patient workflow got much better and the notes were getting completed in a timely manner. I couldn't handle it. I couldn't handle JUST being a scribe, I wanted more, I wanted to learn more and I wanted to be utilized to my full capabilities. I feel like 6-7 months in, I had peaked. I understood why certain antibiotics were used for certain bacterial infections and was familiar with dosages and immunization schedules but I knew there was much more to learn. I just wanted to learn about other aspects of medicine as well, especially as a PA, where we're seeing as the "generalists" who should be knowledgeable about various specialties. And that's when, BOOM! I got another call. From my earlier "toss my application in the air and see what sticks" days, I got a call from a cardiology practice near where my mom lived. I had already gotten accepted to PA school and the idea of spending time with my mom and little brother was the icing on the cake. Three weeks after I got the call, I had quit scribing at the pediatrics office and I began work as a cardiac electrophysiology scribe.


The first couple of weeks were tough, as expected. I had little to no experience in cardiology, however the office manager and specialist had confidence in my abilities, per my resume and interview. I did my best to meet those expectations. I looked through my EKG books, I familiarized myself with cardiology, cardiac electrophysiology, the anatomy of the heart and pharmacology associated with this specialty. I quickly learned the provider's style and adapted quickly. This time, I was navigating through another new EMR with ease and completing thorough, accurate notes with more confidence. Again, I wanted to create a system and be efficient with my notes and this time, by my 3rd-4th week there, I was on top of my game. I've learned a lot and thus far, I'm extremely comfortable with the notes aspect as a scribe, I just want to be able to expand on this knowledge as a future PA.


In essence, I went from a novice medical scribe to an efficient one. I went from having physicians look at my notes and say, "What is this? This is inaccurate" or "You missed the treatment." etc. to "Looks great. Good job!" I'm extremely grateful and thankful for the scribing opportunities that I have had, as I know I am much more prepared now for PA school as I was when I first started scribing. So regardless of how you start, it's how you bounce back and learn from the experiences of struggling and failure.

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