From the Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, CA.
J Am Board Fam Med. 2018 Jan-Feb;31(1):49-56. doi: 10.3122/jabfm.2018.01.170314.
The immense clerical burden felt by physicians is one of the leading causes of burnout. Scribes are increasingly being used to help alleviate this burden, yet few published studies investigate how scribes affect physicians' daily work, attitudes and behaviors, and relationships with patients and the workplace.
Using a longitudinal observational design, data were collected, over 1 year, from 4 physicians working with 2 scribes at a single academic family medicine practice. Physician experience was measured by open-ended written reflections requested after each 4-hour clinic session. A data-driven codebook was generated using a constant comparative method with grounded theory approach.
A total of 361 physician reflections were completed, yielding 150 distinct excerpts; 289 codes were assigned. The 11 themes that emerged were further categorized under 4 domains. The most frequently recurring domain was clinic operations, which comprised 51.6% of the codes. Joy of practice, quality of care, and patient experience comprised 22.1%, 16.3%, and 10.0% of the codes, respectively.
Our study suggests that integrating scribes into a primary care clinic can produce positive outcomes that go beyond reducing clerical burden for physicians. Scribes may benefit patient experience, quality of care, clinic operations, and joy of practice.
医生感受到的巨大文书负担是导致倦怠的主要原因之一。书记员越来越多地被用来帮助减轻这种负担，但很少有发表的研究调查书记员如何影响医生的日常工作、态度和行为，以及他们与患者和工作场所的关系。
使用纵向观察设计，在一年的时间里，从一家学术性家庭医学实践中的 4 名医生和 2 名书记员那里收集数据。医生的经验是通过在每次 4 小时的门诊后要求他们进行开放式书面反思来衡量的。使用扎根理论方法的不断比较方法生成了一个数据驱动的代码本。
共完成了 361 份医生反思，产生了 150 个独特的摘录；分配了 289 个代码。出现的 11 个主题进一步分为 4 个领域。出现频率最高的领域是临床操作，占代码的 51.6%。实践的乐趣、护理质量和患者体验分别占代码的 22.1%、16.3%和 10.0%。
我们的研究表明，将书记员整合到初级保健诊所中可以产生超出减轻医生文书负担的积极结果。书记员可能会受益于患者体验、护理质量、临床操作和实践的乐趣。
