American College of Physicians: Internal Medicine — Doctors for Adults ®

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Are scribes a potential boon or bane for primary care?

From the February ACP Internist, copyright © 2012 by the American College of Physicians

Scribes are sometimes mentioned as a time-saving (and cost-saving) measure in medical practice, especially with more widespread use of electronic medical records. However, while scribes have become more common in the emergency department, there is resistance to including them as part of the primary care visit.

Many doctors feel that the presence of another person in the room will have a negative impact on the physician-patient relationship, regardless of how much time and money that person may save. For internists, especially, the idea of a scribe taking over any aspect of information gathering, particularly the medical history, may seem antithetical to their training. Charlotte Huff examines this trend and talks to physicians and experts about whether scribes will ever carve out a place in primary care.

A patient's statement of “I can't sleep” can be a frustrating presentation for an internist to untangle. The reasons behind sleep problems can be legion, ranging from physiological causes, such as obesity and sleep apnea, to psychological causes, such as stress and alcohol abuse. In addition, some patients may have sleep problems that are complicating other conditions but neglect to mention them to their physicians. This article delves into when and what to ask patients about sleep difficulties, how to fit a comprehensive assessment into the ever shorter primary care visit, and when to refer patients to specialists for further study.

On the practice management front, a new rule requiring face-to-face assessment of patients to determine eligibility for home health care has been a source of concern for many ACP members. Here is some practical advice from ACP's Center for Practice Improvement and Innovation on how to adapt the rule seamlessly into your practice.

Finally, when a doctor prescribes a drug, crucial information about dosing and side effects may not always make it to the prescription label. ACP Internist talks to Marvin M. Lipman, MD, FACP, chief medical adviser for Consumer Reports Magazine, about the scope of the problem and potential solutions.

As always, we welcome your comments on these and other issues.

Sincerely,
Jennifer Kearney-Strouse, Editor

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