PERSPECTIVE

A SCRIBE’S STORY

By Ben Saul, Harish Thoppe, and Larry Kravitz, MD

It is hard to lay bare your personal medical practice to the eyes of another professional. As I have told every medical student on rotation with me, “You will learn from me how to practice medicine right, but you will also quietly learn how to practice medicine wrong, seeing things you will know you never want to repeat.” We are imperfect. When we are teaching medical students, we showcase our successes, but we relinquish any hope of hiding our professional flaws. You must make your own peace with that in order to teach. You must trust in the benevolence of students to see that you stepped up to the plate and volunteered to try to raise their medical skills. Medical students shadow and practice, practice and shadow. They come and go, usually for four short weeks within a family medicine rotation. But scribes come and stay; they are the ultimate shadows. Muted by the nature of their mission. Silent witness to the inner clinical sanctum. We take them on to share the exhausting intensity of our trusting patients with their challenging mortal illnesses and aging. A bond develops with your scribe, often unspoken, yet undeniably strong. I have had scribes in my family practice for six years now, each one for about a year. Four are currently in medical school, and for one deserving scribe, we are hopefully waiting on his acceptance. Most scribes are in a gap year awaiting medical school, and hiring one is more than hiring an employee; you are entrusted with hiring an apprentice. In the year you have these future doctors, in a sense, you are grooming them for medical school; and you are imprinting on them a path, a template, for their entire physician career. They are the unassigned medical students, but the ones whose future careers you may influence more than any of the students you ever see on family medicine rotations.

I want to tell their story, because scribes in family medicine are different than ER scribes, surgical scribes, or orthopedic scribes. Because family medicine is not just clinical, it’s personal. But I cannot tell their story. They have to tell it themselves.

IN THEIR WORDS:

It is true that the bond between scribe and physician is undeniably strong. As a scribe, I gained a physician mentor and a good friend. I often felt that when we entered an exam room our brains merged so I could think and understand as he did. Family medicine can be arduous, but it makes up for this by its deeply personal qualities. I was perpetually amazed by the scope and breadth of knowledge family physicians were able to provide to their patients, possessing the ability to change the hat they wore to meet the needs of the patient at hand.

While now I am only in my first year of medical school, I understand the importance of developing the skill and understanding to diagnose and manage a patient. However, after working with a physician for more than a year as a medical scribe, I now understand medical education is much more about intangible skills. These are the things that cannot be taught from “UpToDate” or “Gray’s Anatomy.” How we understand and connect with patients is what makes a great physician, and I am grateful for beginning that education with a family physician. Young and budding physicians are undifferentiated, and I believe any physician who takes a scribe will contribute much more to medicine than they anticipated.

As pre-med and medical students, we often focus too much on one thing; what do I want to be? Perhaps it’s a cardiologist, a general internist, a family medicine physician, or an orthopedic surgeon. While these thoughts are certainly important to ponder, they could never paint the whole picture. I believe the more important and meaningful question to ask oneself when considering a career as a physician is

I always wondered what it took to be a good physician. While I learned about lab and imaging interpretations, medical terminology, and what to look for when treating various medical conditions, this is not what will help me the most as a doctor in the future. It was learning about myself, my strengths and weaknesses, by comparing myself to a role model and understanding that I didn’t need to be perfect to be a good doctor.

who do you want to be rather than what. As we witness physicians’ entire practice with all the victories and failures unsheltered from our eyes, scribing with a family physician sets the scaffold to make these discoveries on one’s own. I often believed my heart was too big to bear the weight of medicine, but I now understand I can master this trait and use it to connect on a deep level with patients, and foster better quality, patient-centered health care.

I always wondered what it took to be a good physician. While I learned about lab and imaging interpretations, medical terminology, and what to look for when treating various medical conditions, this is not what will help me the most as a doctor in the future. It was learning about myself, my strengths and weaknesses, by comparing myself to a role model and understanding that I didn’t need to be perfect to be a good doctor. Pursuing a career as a physician is a life-long journey of learning and commitment to those for whom you care. My time as a scribe in family medicine both helped me understand just how fulfilling being a doctor can be and strengthened my passion for it.

After reflecting on my experience as a scribe in family medicine, I know my family physician mentor will continue to be one of the most influential figures in my medical career. In fact, even now I think about our patients often as I undergo my didactic medical school education. I remember how he spoke to patients in dire need. I remember how he spoke to patients who received terminal diagnoses. I remember how he spoke to patients who felt like they couldn’t live another day. And I know he isn’t perfect, but I do know he was devoted to his patients and that is what matters most of all. Whether they know it or not, when a physician begins taking scribes, they make a lasting impact on the medical profession with all those who work alongside them.

In a sense, pre-med and medical students are a chimera of all their mentors along the way to completing their medical education. A physician with a scribe has the opportunity to play an enormous role in the way students envision themselves as future physicians. I believe leaving a legacy for the future of medicine should always be part of any good physician’s career aspirations. While I think the training of medical students may be more tangible in the world of medical education, investing time into a scribe may have more impact than anyone could imagine. It did for me. When I become a licensed physician, I know I will always carry a piece of what I learned while working in family medicine. My advice: consider taking a scribe because you might just change the course of someone’s medical career without even realizing it.

POSTSCRIPT:

Having a scribe shortens a physician’s workday by an estimated 2.5 hours, an average physician work product equal to $450, exceeding the average scribe cost of $200 per day. That’s 2.5 hours a physician could spend with their spouse, their family, their exercise, and restoring their spirit. It can lengthen careers by unburdening the physician at the twilight of their practice when they have the most wisdom to role model for eager students. In some medical schools, former scribes make up as much as 35% of the class. Behind the eyes of a scribe is a future physician soaking up the inner essence of medicine. Unleash their future.

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This work was supported in whole or in part by a grant from the Texas Higher Education Coordinating Board (THECB). The opinions and conclusions expressed in this document are those of the author(s) and do not necessarily represent the opinions or policy of the THECB.