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ED scribe

Medical Scribe Uses On-the-Job Experience to Develop App

Posted on Wed, Sep 28, 2016
Medical Scribe Uses On-the-Job Experience to Develop App

By Affan Farooq, M.D.

Many times I’m asked, “What do you do in the E.D. exactly?” To the layman, I say that I’m a medical scribe, which is usually followed by a blank stare followed by an extensive Q & A session. For those familiar with the world of medicine, I simplify it by saying “I work as a scribe,” which usually means that I document history, physical exams, medical orders and patient encounters at the dictation of a practitioner.

As an EmCare scribe, also known as a clinical information manager, I expedite and enhance patient care in the emergency department by accurately documenting detailed electronic medical records for patients at the direction of the physician or physician assistant. This allows providers to spend more time with patients, increases overall productivity and ensures thorough documentation. But there is more.

In addition to taking dictations from multiple providers, I shadow providers to actively take history at the bedside and ask pertinent questions related to physical exams, management and plans to ensure information is complete, properly documented and compliant with most recent established billing guidelines. Essentially, I have a very important position; acting as a liaison between the medical world, the billing world and the medico-legal world.

From Medical School to Medical Scribe

After completing medical school and intern year at a medical school in Karachi, the 7th most populous urban city in the world and the most populous city in Pakistan, I felt unsafe in a turbulent country. Practicing medicine in a third-world country on the forefront of the war against terror comes with its own experiences, which one cannot begin to explain. From terrorist attacks, gang wars, humanitarian crises, kidnappings, natural disasters as well as manmade disasters, the list only goes on.  I had had enough and was looking for a way to transition my life, my career and my passion for helping humanity by making a move back to the United States.

While studying for various advanced licensing privileges to practice medicine both internationally and in the pursuit of residency here in the United States as a scribe, I believe I was placed at a pivotal point in my life with the opportunity to see the medical field through a more objective view. Instead of being the one participating hands-on in a given acute situation, discussing diagnostics, management and future course of action, I was able to take a step back and observe. This opportunity granted me the ability to see things that I would want to implement in the way I practice medicine with a finer focus, changes that I would make to myself and learn from those around me with more experience.

By working as a scribe at Newark Beth Israel Medical Center, the medical control site for two-thirds of New Jersey, I had the opportunity to be at the bedside during numerous codes, many of them cardiac arrests. Instead of actively participating as I had been trained to as a physician, I now was standing bedside documenting, observing and thinking what I would do in this situation if I were the attending physician. I was able to learn and discuss with various physicians the importance of intra-thoracic pressure regulation as well as the importance of high-performance CPR and feedback. Being a physician in a scribe position allowed me to know what was going on and see what could be done to improve patient care in acute settings.

Turning Training into Technology

It was this experience that lead me to begin thinking about a mobile app that would help improve the delivery of CPR in the field. The idea came to me after I learned about a metronome device used as a separate add-on to transport monitors. With a background in basic programming and a keen interest in technology, I embarked on developing one of the world’s first wearable CPR feedback devices – PerfectCPR – an app exclusively for the Apple Watch.

Using the transport monitor’s accelerometer, haptic feedback and gyro-meter, PerfectCPR provides a “tap” on your wrist to indicate when a compression should be performed while simultaneously keeping count of compressions and the total time elapsed since initiation. This can be used in emergencies by anyone to provide emergent compressions during any condition in which resuscitation may be indicated.

Working as a scribe gave me a diverse perspective and exposure to emergency medicine that enabled me to meet professionals who not only encouraged and supported me, but inspired me to grow my passion for serving humanity and validated my reason for pursing medicine.  These experiences, discussions and responsibilities are something that I believe have shaped me as an individual.
Ultimately, as is everything in life, opportunities are what you make of them, and being a scribe has been an invaluable experience.

Affan Faroog

Affan Farooq, M.D., graduated from Baqai Medical University in Karachi, Pakistan. He received a gold medal in general surgery and has worked at various hospitals in Karachi. In 2015, he traveled with Red Crescent to the Hindu Kush region to provide medical relief after it was hit with an earthquake. Dr. Farooq has been a scribe with EmCare for nearly two years, working at Newton Medical Center and Newark Beth Israel Medical Center. He is currently pursuing residency.


From ED Scribe to ED Attending: Lessons I’ve Learned Along the Way

Posted on Mon, Aug 31, 2015
From ED Scribe to ED Attending: Lessons I’ve Learned Along the Way

Now an attending emergency physician, Dr. Peter Lee learned the importance of choosing "the right seat" as an ED scribe.
By Peter Q. Lee, D.O.
Parking my car in the scribe lot this summer brought back a string of memories that made me reflect on my career path thus far. Perhaps the picture on the right explains it all. While the most noticeable difference might be the SpongeBob sticker that appears on my old ID card, I assure you that I have come a long way in more than just my maturity level (Well, maybe that’s open to debate!). This side-by-side comparison shows how I started my medical career: as a scribe at Saint Barnabas Medical Center in Livingston, N.J., and now, my ID card on the right, eight years later, as an attending emergency physician.
On my first day as a scribe, I got out of my car and was unsure of what to expect. Maybe my first lesson would be to memorize medical terminology, learn where to obtain EKGs or check on labs. Surprisingly, my first lesson of the day was about something that had nothing to do with medicine at all – chairs. I quickly learned to not to take anyone’s seat in the ED. While this lesson may seem simple, it’s carried me a long way in terms of making a good first impression at many hospitals during medical school and residency. It’s made me walk into each new ED with the confidence that I would not be that guy who foolishly takes a nurse’s seat.
Speaking of confidence, my time as a scribe is what solidified my resolve and gave me the courage to pursue medical school, obtain my No. 1 residency spot at Morristown Medical Center and eventually that same practice as an attending.
The Treatment Trifecta
While school taught me certain fundamentals, I was truly able to learn and apply my knowledge when doctors and nurses involved me in their work. As a scribe, I had the advantage of seeing how medical professionals made decisions under split-second time constraints, how they dealt with the pressure and how they accommodated a variety of patient personalities and cultures. In an arena where there is a surprise behind every curtain, I learned that a simple, “How can we help today?” from a doctor adds a certain routine to the task at hand, and helps show genuine care to patients when they are feeling fearful and are in need of hope.
The beloved poet Maya Angelou once said, “I’ve learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.” When I was a scribe, I saw many doctors treat patients not just physically but mentally and emotionally. As doctors, we hope that we are fortunate enough to solve every problem, but it’s not always the reality. Hence, I always remind myself that medicine also is a “people field,” and I strive to make patients feel as comfortable as possible. Five minutes behind a curtain makes a big difference in someone’s life. It’s how we use that time – to let our light shine in all circumstances.
From seeing incredible displays of bedside manner, I have learned that there is a “treatment trifecta,” and I strongly value treating patients physically, mentally and emotionally. Not only did I see how doctors interacted with patients, but I also saw how they interacted with nurses and other staff members. In this fast-paced environment, nurses and other medical staff are your teammates, but they aren’t just teammates when in action; it’s important to develop personal friendships at work. I’m blessed to have already established the basis for many personal relationships at Saint Barnabas from my days as a scribe; returning to Saint Barnabas now is like returning home.
Doctors, pharmacists, nurses, techs and cafeteria and janitorial staff all helped me get to where I am today, and for that I am truly grateful. I have realized the kind of doctor that I want to be and can now find the right seat in the ED – and I attribute it to my experience as a scribe. I plan to help new scribes avoid sitting in someone else’s seat – literally – but also help them find their own “seats” at the table as doctors or advanced practice providers, just like others have helped me.

To learn more about clinical careers, visit the Careers section of our website.
Peter Q. Lee, D.O., is an emergency medicine attending physician at Saint Barnabas Medical Center, Livingston, N.J. Dr. Lee received his bachelor’s degree at Rutgers University-New Brunswick and his doctor of osteopathic medicine degree at Touro College of Osteopathic Medicine, New York, N.Y. He completed his residency in emergency medicine at Morristown (N.J.) Medical Center, where he served as chief resident. Dr. Lee lives in Montville, N.J., with his wife. They are expecting their first child in October.