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The Creator of Medical Scribing Is Bringing Back the Human Element

Dr. Elliott Trotter's new venture addresses physician burnout while educating the next generation of clinicians.
Courtesy: iStock

Dr. Elliott Trotter founded the country’s first medical scribe company in Fort Worth in 1994, and his newest venture wants to foster the symbiotic relationship between physician and scribe.

Trotter and Dr. John Geesbreght, both emergency department physicians, founded PhysAssist Scribes at what was then Harris Methodist Hospital in Fort Worth, recruiting pre-med TCU students to work with physicians and assist in the doctor’s note-taking. The company now has 172 employees and 3,500 scribes in 36 states, doing tens of millions in revenue. EY named Geesbreght a finalist for its Entrepreneur of the Year award in 2014.

After 15 years with PhysAssist Scribes, Trotter exited the company and continues to practice today between speaking engagements about burnout and work-life balance. Despite the development of artificial intelligence software that threatens to replace the need for scribes, he founded ScribeNest last year because he saw the opportunity for students, physicians, and facilities to collaborate here in Dallas-Fort Worth. The company now has partnerships with 21 hospitals in DFW, including several Texas Health and Methodist hospitals.

Dr. Elliott Trotter Courtesy: ScribeNest

When a student pairs with a physician to assist them with their note-taking, they benefit, as does the physician. With AI, no one is being prepared to be a better future physician. A 2013 Johns Hopkins study found that new physicians especially need help with bedside manner. The study followed first-year residents as they interacted with the patient and found that just 4 percent of the time, they did all five of these steps: introduce themselves to patients, explain their role, touch the patient, sit down with the patient for a conversation, and asked an open-ended question like “How are you?”

The scribe-physician relationship can help improve that statistic. Having a scribe lighten the documentation load allows the doctor to focus on the patient. Additionally, the scribe learns from an experienced physician about best practices in patient interaction.

“It’s supposed to be a great symbiotic relationship. Scribes can be educated and learn about medicine and an opportunity to learn from several different positions,” he says. “For the physicians, we get help documenting and being organized while walking through the emergency department. That takes things that are non-doctoring off of the physician so that they are able to be a physician.”

In addition to bedside manner, the scribe can see how abstract academic learning in pre-med classes plays out in a hospital or physician’s office. Before formal medical schools, this apprenticeship model was how people learned medicine. Combining it with formal education has produces impressive results, Trotter says. “I had call from the dean of the Emory University Medical School and he said, ‘We have a student here she’s your former scribe, and she knows more than a second year resident.’ By the time these students get to get to medical, PA, or nursing school, they run circles around their competition because they already know what it’s supposed to look like.”

A study from BMC Health Services research found that medical scribes lead to quicker appointments with a more complete medical history, and the added efficiency can be a massive factor for a profession plagued by burnout often connected to navigating the electronic health record. Helping overworked physicians has long been a point of passion for Trotter, who studies and speaks on how work-life balance, mentorship, and other life habits can impact physician burnout. ScribesNest is a way for him to unite an old passion with a pressing need for his profession.

Trotter welcomes the increased use of artificial intelligence in clinical settings and recognizes that some of a scribe’s duties may be more efficiently done by AI in the future. But right now, many options are either too expensive or not functional enough. He says it will free up the scribes to do other tasks that a physician could delegate and be an option when there aren’t enough scribes to go around.

ScribesNest focuses on undergraduate sophomores through seniors who are looking to be physicians, nurses, and physician assistants. Part of the onboarding process includes team building and simulation labs to prepare them for the role and interacting with physicians, nurses, staff, and patients.

“Scribes work with 20 or 30 different physicians and take the best of all the communication methods, ” Trotter says. “They learn from firsthand knowledge and see best practices.”


Will Maddox

Will Maddox

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Will is the senior writer for D CEO magazine and the editor of D CEO Healthcare. He's written about healthcare…