A med student reflects on a year as a medical scribe.
On my second shift as a medical scribe in an emergency room, I saw a handful of medical staff running into a room for an emergent intubation. In minutes, the doctor successfully intubated the patient and secured his airway. While making sure I had all the details for a procedure note, I tried to process the moment of life and death that I had witnessed.
As a recent college graduate, I began working as a medical scribe at an ER without previous experience in a hospital. At first I made mistakes every day. Doctors and nurses would point out, “You misspelled amoxicillin,” and, “That’s not an ultrasound, that’s an EKG machine.” Most scribes work during a gap year between college and graduate school, so the job has a high turnover rate.
My role was to complete a patient chart with concise patient narratives, physical exam findings dictated by the physicians, and notes on procedures done during the visit. Scribes aim to alleviate the burdens of electronic medical record charting on physicians and improve billing efficiency. I worked with a team of care providers and was privileged to hear patient stories, see physical exams, and process how doctors make differential diagnoses.
At a Level 1 trauma center, seeing a wide range of patients taught me a great deal of clinical medicine. As I became more adept at spelling medical terminology, I also became familiar with the patterns of medications, symptoms, and diagnoses associated with certain clinical presentations. In medical school, I recently learned that troponin is a protein that leaks from heart muscles during an acute heart attack. Immediately I recalled from my scribe experience that troponin is one of the first proteins tested at bedside for patients with chest pain. Connecting past scribe experience with current preclinical course material makes learning far more intuitive and rewarding.
But I have come to realize the true depth of medical practice: how it is more complex than simply interpreting lab results or prescribing medicine. Friends outside of medicine often ask, wide eyed, “Have you seen someone die?” Unfortunately, yes, I have. Patients die in the ER. Documenting resuscitations and speaking with families facing a sudden loss are difficult. Walking into a shift, I would never expect to see a child with shaken baby syndrome or a 25-year-old with an irreversible head bleed. Standing on the provider side, I thought I had to put on a façade that I am OK encountering these tragedies on a daily basis. In retrospect, I feel that scribes are not adequately trained to handle the emotional burdens of repeated exposure to trauma. As I proceed headlong into a career in medicine, I need to take a step back to reconsider the tenuous balance between empathy and professionalism.
There are nuances to medicine that can be learned only in action. Some of the most valuable lessons were taught unintentionally, merely by seeing how different physicians treated their patients. I remember a doctor who would discreetly warm her stethoscope with her palm before every cardiopulmonary exam. That simple act didn’t change the course of care, but it made one part of an ER visit less intrusive. In retrospect, not knowing what is relevant in a diagnostic process forced me to observe carefully and notice these details in patient encounters. These stories were left out of a patient chart, but were kept in my mental note for my future practice in medicine.
My year as a scribe proved to be only the beginning of my medical education. I saw patients through the lens of a care provider and learned valuable lessons that couldn’t be taught in a classroom. Caring for the ill can be emotional, and social and financial issues complicate quality of treatments. I leaped into the ER without any knowledge of health care. Now I have holistic considerations to guide me through a long journey in medicine. And I can spell the most convoluted names of antibiotics.