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As the doctor examines a patient, medical scribe Connie Gayton records the visit using a microhone tethered to her laptop. (Brandon Thibodeaux for NPR)

Scribes Are Back, Helping Doctors Tackle Electronic Medical Records

by Lauren Silverman
Apr 21, 2014

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Medical scribe Connie Gayton keeps the electronic records allowing Orthodpedic surgeon Devesh Ramnath to focus on his patients.

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Like many other doctors across the country, Dr. Devesh Ramnath, a Dallas orthopedic surgeon, recently made the switch from paper to electronic medical records. This meant he no longer had to just take notes when he was examining a patient — he also had to put those notes into the computer as a permanent record.

"I was really focused on just trying to get the information in, and not really focusing on the patient anymore," Ramnath says.

In fact, he found he was spending an extra two to three hours every clinic just on electronic records. So he hired medical scribe Connie Gaylan. Acting a bit like a court reporter, Gaylan shadows Ramnath at every appointment. As the doctor examines a patient, Gaylan sits quietly in the corner, typing notes and speaking into a hand held microphone. Once she's finished with the records, she gives them to Ramnath to check and approve, saving him hours of administrative work and allowing him to concentrate on his patients.

"I would more than happily sacrifice a significant chunk of my income for the improved quality of life I have," Ramnath says.

Medical scribes are in high demand nationally. Any doctor who doesn't make the switch from paper to electronic records by 2015 will face Medicare penalties and this deadline is fueling the demand.

PhysAssist, the country's first scribe staffing company, is on the second expansion of its Fort Worth headquarters and has opened another office in Chicago. Alex Geesbreght, the company's CEO, says the firm is growing by 46 to 50 percent every year. In 2008, PhysAssist had 35 scribes; now they have 1,400. The other big scribing companies — Medical Scribe Systems and Scribe America — each have thousands more, and the demand keeps growing.

PhysAssist trains scribes from across the country every week in its Fort Worth mock emergency department, where instructor Brandon Torres shows students the right way to fill out an electronic medical record. There are thousands of record systems, and scribes need to know how to put in the right billing codes and medical terminology at lightning speed. Torres says it's important to not just be able to multi-task, but to be able to listen to multiple things at the same time.

"You're listening to the physician, you're listening to the nurse, you're listening to the patient," Torres says. "And you're gathering all that information and presenting it back to the physician."

That last part's crucial. The physician has to approve the scribe's notes because ultimately the doctor is responsible for the record.

A medical scribe makes about $8 to $16 an hour. Many of them are medical students, who say they find it an invaluable experience. But it's not clear that scribes make things better for patients. Dr. Ann O'Malley with Mathematica Policy Research in Washington, D.C., points to one study done in an Emergency Department in New Jersey that found that doctors with scribes were able to see more patients, on average - which means more money for the institution. But that same study found that the amount of time a patient spent in the emergency department didn't decrease. Medical scribing also raises some privacy concerns, O'Malley says. Some patients may not like having an extra person in the exam room.

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Prosecutor Max Huntsman delivers his closing arguments in the corruption trial of Angela Spaccia, the former city manager of Bell, Calif., in November. Huntsman's new challenge is to monitor the scandal-ridden LA County Sheriff's Department. (Getty Images)

LA County's New Watchdog May Not Have Much Bite

Apr 21, 2014

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The Los Angeles County Sheriff's Department is one of the nation's most troubled law enforcement agencies.

Eighteen current and former deputies are facing felony charges as part of a federal probe into allegations of widespread prisoner abuse in county jails. The federal government is also investigating alleged cases of deputies on patrol using excessive force during routine traffic stops, and targeting blacks and Latinos.

Max Huntsman's job — in the newly created role of watchdog — is to help clean up the department. The only problem is, he doesn't have any real power.

Promises Of Cooperation — So Far

In a sign perhaps, of how unglamorous his new job will be, Huntsman's new digs are a cramped collection of dark offices and cubicles, two floors above the famous food stalls of LA's Grand Central Market.

On a recent visit, he had just one employee — a receptionist — but soon a team of 30 lawyers, auditors and retired law enforcement officers will be in place here. They'll help Huntsman set up a system to monitor the Sheriff's Department — namely its jails.

Just blocks from here, at the Men's Central Jail, deputies are accused of beating and choking inmates without provocation, harassing visitors, then conspiring to cover it all up. In the indictments last fall, federal prosecutors portrayed a "culture of corruption" inside the agency.

"The bottom line is, I think you need to have people looking over your shoulder, and knowing what you're doing in order to make sure those cliques don't develop, that you don't get a group of people in the jail who think of themselves more as a gang than as deputy sheriffs," says Huntsman. "That's when you don't have that light shining that that happens."

That "light" is really the only tool that Huntsman will have. Unlike a police chief in a big city who answers to the mayor or a civilian commission, LA's sheriff is elected and enjoys a lot of autonomy. Huntsman can only present his findings and recommend reforms.

So far he's gotten a warm welcome and promises of cooperation — but it's early.

"They really, really want to respond to all these problems," says Huntsman, "as they should. I mean, there are federal indictments on the table, there's talk of a federal consent decree, or a memorandum of understanding."

Just after those indictments were announced, Sheriff Lee Baca, who had held the post since 1998, abruptly retired. There is currently an interim sheriff, and for the first time in decades, there's also a competitive campaign for his replacement. The race routinely makes headlines. Huntsman says all this publicity is to his advantage — this is the moment to start changing things.

He, too, is no stranger to the TV cameras. While deputy district attorney here, he built his career on high-profile public corruption trials, including prosecuting town leaders in Bell, Calif.

"Every single political corruption case I've ever done has been fundamentally a problem of the public not knowing what's going on, and not being engaged," he says.

But remember, Huntsman can't prosecute anyone in his new role. And another challenge? The Los Angeles County Sheriff's Department is a massive bureaucracy. It runs the largest municipal jail system in the U.S., and has 20,000 employees, including 10,000 sworn deputies.

"I think it'd be a mistake to say: Can Mr. Huntsman be the silver bullet to reform the sheriff's department? I don't think anybody, or any entity, can," says Peter Eliasberg, legal director of the ACLU of Southern California. His group wrote a damning report in 2011 that first detailed widespread corruption and civil rights abuses inside the jails. He says that for too long, problems festering within the department were ignored, not just by higher-ups in the sheriff's department, but also by county leaders.

"And as a result we have a national embarrassment for the county of Los Angeles that's costing the taxpayers tens of millions of dollars a year in verdicts against the Sheriff's Department; it's got the Department of Justice breathing down the sheriff department's neck," Eliasberg says.

There have been calls for the creation of an independent commission in addition to the new inspector general to oversee the sheriff. Observers like Eliasberg say that if Max Huntsman is the man for now, his success will depend on how aggressive he is.

For his part, Huntsman is reluctant to point fingers, and he's taking the long view. He says the federal indictments will help weed out a few bad apples, but constant monitoring over the long haul is the only way to bring about true reforms.

"If we think we can fix this problem and walk away, and a year from now just ignore how things operate, we're going to end up with the same problems again down the road."

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Brian Blade & The Fellowship Band's new album, Landmarks, comes out April 29. (Courtesy of the artist)

First Listen: Brian Blade & The Fellowship Band, 'Landmarks'

by Patrick Jarenwattananon
Apr 20, 2014

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Patrick Jarenwattananon

He's widely acknowledged as one of the best jazz drummers in the world. But he's also a singer-songwriter; a session man for Bob Dylan and Joni Mitchell; the son of a singing preacher man from Louisiana. And though a man of such experiences is, as you might expect, quite busy, he's also keeps his own signature band: the Brian Blade Fellowship.

In the way that a jazzman's life often goes into his music, you might expect that a Brian-Blade-led band would reflect and merge all of his overlapping vocabularies. You'd be right, but — this is crucial — not in the overwrought, kitchen sink, jam band kind of way. His is music beloved by the jazz community, distilled to high potency, executed by a frontline (Myron Walden and Melvin Butler on woodwinds) which has committed for well over 15 years and a rhythm section (Chris Thomas, bass and Jon Cowherd, piano) that dates back to college, over two decades ago.

Landmarks is the Fellowship Band's new album, the fourth in its catalog. To the extent that the Fellowship has a characteristic aesthetic, you might call it rural, and this is no deviation. There are trademark slow-moving pastoral dirges, with faux-naive rhythms which bloom into ecstatic saxophone testifyin' and firecracker drum fills. There's the signifying twang of country and folk music cadences, note inflections and guitar overtones (courtesy of Jeff Parker or Marvin Sewell). There are melodies that surge and ebb, harmonium drones and dark bass clarinet lines. It's music tinged by juke joints and black churches, but better placed in wind-swept open fields and porch sits on summer evenings. One 11-minute swell of a song is even called "Ark.La.Tex." as in the three Southern states — exactly.

You hear a lot of "growers" from the Fellowship, songs that build to climaxes, and when you have a drummer like Brian Blade, who can break off a brilliant kinetic flash at just about any moment, the tension is delicious. But it's also telling that he takes "Ark.La.Tex" right into an arrangement of "Shenandoah," the American folk song. Blade lays out almost entirely, and the band offers it up as a chorale, an act of secular worship. It's under two minutes, all devastating. And it's one of many ways he knows how to make a song stick.

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The Ghost Of A Saber Tooth Tiger's new album, Midnight Sun, comes out April 29. (Courtesy of the artist)

First Listen: The Ghost Of A Saber Tooth Tiger, 'Midnight Sun'

by Peter Macia
Apr 20, 2014

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The Ghost of a Saber Tooth Tiger is Sean Lennon and Charlotte Kemp Muhl. Lennon, as you may know, is the only child of John Lennon and Yoko Ono. Muhl is a successful fashion model and Lennon's significant other of eight years. Midnight Sun is their second proper album together.

Try this while listening: Imagine what your opinion would be if you didn't know these basic facts - if it was just another band on the Internet with a strange name. You might think it was some kindred spirit of Tame Impala or the Flaming Lips, soft psychedelia made for sunny summer weekends. Not so druggy that it erases the day, yet weird enough to start conversations about the kidnapping of John Paul Getty III.

Now, listen again, and imagine what it must be like for John Lennon's son to make music. With his girlfriend, no less. This has been the younger Lennon's greatest obstacle since his debut, 1998's Into the Sun - the prejudice against genetic good fortune and the presumption that he sounds, and maybe acts, like his famous father because it's the easiest way to his own fame. In the past, he hasn't done himself any favors by sometimes sounding eerily like the legendary Beatle, but that seems an unfair measurement. If people are willing to believe that "there's something in the water" in any given music scene, then surely the same allowance can be made for actual shared DNA. What son is not heavily influenced by his father, even one he may have only known for a short while?

Midnight Sun should go some way in dispelling those presumptions and prejudices. In places, it still sounds fairly Beatles-esque, but no more than many other bands of the last half century, and much less than Sean Lennon has before. Muhl's influence and contribution pulls him out of his own history and to places that he did not go in previous solo work, like the gloomy "Last Call" or twee "Johannesburg." The two have a natural and obvious chemistry, especially on the songs where her honeyed voice gives direction to his nasal searching.

So, although it may have taken him thirty-nine years to do it, Sean Lennon may finally be moving on with his music. He has always made a fairly valiant effort to carry his legacy forward in interesting ways, to explore his very personal relationship with his near-mythical father in a very public manner. But Midnight Sun is his own musical statement, in his own voice, and one of the best recordings he's ever made.

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Rodrigo y Gabriela's new album, 9 Dead Alive, comes out April 29. (Courtesy of the artist)

First Listen: Rodrigo y Gabriela, '9 Dead Alive'

by Jasmine Garsd
Apr 20, 2014

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Jasmine Garsd

In their newest album, 9 Dead Alive, Rodrigo y Gabriela return to their roots, reminding listeners why they fell in love with the Mexican duo in the first place. The album finds them at the peak of their musical flexibility, dexterously weaving elements of heavy metal with flamenco.

These Mexico City natives are an if-at-first-you-don't-succeed parable. As heavy metal musicians, Rodrigo Sanchez and Gabriela Quintero had trouble launching their careers. Making it in one of the biggest music scenes in the Spanish speaking world is as pivotal as it is nightmarish: if you break through in Mexico, you've made it in Latin America, but succeeding in an environment that is frequently reluctant to take risks can also be an impossible task. So they picked up to go busk in Ireland, where they perfected the guitar licks that have made them famous.

The band has a loyal fan base that has followed them as they experiment with more orchestral and cinematic sounds (they famously put music to Shrek, Pirates of the Caribbean and Puss In Boots.) But this new album is extremely stripped down and minimalistic, a treat both for those who've been following the duo since the beginning, and also for those who recently discovered them: letting listeners eavesdrop on a private conversation spoken between two friends, in the universal language of the guitar.

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