Do Dermatologists Need Scribes for Full Body Skin Exams?

The debate surrounding the role of scribes during full body skin exams has gained significant traction. While some dermatologists employ scribes to improve efficiency, many patients are uncomfortable with this practice due to a lack of privacy. Ensuring a patient's dignity and comfort is paramount during such exams. Here, we explore the implications of using scribes, the varying practices across facilities, and the importance of advocating for your rights as a patient.

The Shift Towards Efficiency and Speed

Professionalism and ethical standards among dermatologists have traditionally emphasized a private, patient-centered approach during consultations. However, the ethics and economics of the healthcare industry have significantly evolved. Presently, there is a strong emphasis on moving patients through quickly to maximize efficiency, often at the expense of patient comfort. The introduction of scribes to document the exam can be seen as a strategy to streamline the process, despite patient dissatisfaction and discomfort.

Despite the importance dermatologists place on regular full body skin exams to prevent skin cancer, their practices inadvertently discourage patients. The awkwardness and exposure involved in these exams often make patients feel uncomfortable, leading to a decline in attendance. Since dermatologists might not encounter the patients who choose to abstain from these exams, they may fail to fully grasp the impact of their actions.

Experiences and Patient Voices

One patient's experience with a fully gown exam highlights the discomfort many feel. In the United States, it is common to be examined in a gown with underwear still on. During their exam, the scribe did not look at them and was positioned at a desk, facing the wall. The gown was adjusted but not removed unless the patient chose to do so. The doctor examined areas away from the scribe's view, ensuring patient privacy.

Another facility in Tennessee provides a more comprehensive approach to privacy and comfort. Here, scribes are required to be nurses and take turns between scribing and nursing duties. This model ensures that patients are continuously monitored, enhancing their comfort and privacy throughout the exam.

Challenges and Solutions

The need for scribes in dermatology raises several ethical and practical challenges. Firstly, the scribe's presence can be off-putting, creating an uncomfortable atmosphere that may discourage patients from seeking necessary care. Secondly, the privacy concerns related to scribe involvement can be significant, especially in more extensive exams.

Patients have the right to express their concerns and voice their discomfort to their dermatologists. Advocating for patient privacy and dignity, even if it means insisting on the removal of a scribe, can lead to more personalized and comfortable exam experiences. Healthcare providers can also reassess their practices to ensure that patient comfort and privacy remain a priority.

Conclusion

The role of scribes during full body skin exams is a contentious issue in dermatology. While efficiency and economy play a role, the fundamental duty of a healthcare provider is to ensure the comfort and dignity of the patient. By recognizing and addressing these concerns, dermatologists can provide more positive and effective care.