A Scribe's Reflection.

Deciding to become a physician is by far the greatest commitment I have ever made. At the end of it all, I will have spent over 20 years in school and several hundred thousand dollars paying for my education only to graduate and spend several more years training rigorously as a resident! Yet, for a field that demands so much from its members, it offers relatively little opportunity for prospective doctors to gain insight into what lies ahead. How many premedical students truly know what they are getting into? I certainly did not. Unlike several of my premedical peers in college, I had no physicians in my family or prior exposure to the field to guide my decision. Throughout my undergraduate career, medicine was on the backburner; I only fulfilled the prerequisites because they were required courses for my biology major. By the time graduation rolled around, however, the idea of applying to medical school started to take shape. Yet I was still not comfortable with how little insight I had into what it really meant to be a physician. Most of my non-premedical friends had spent summers or semesters interning in their respective fields and were graduating into jobs that mirrored their experiences. Yet, for obvious reasons, you cannot let an untrained premed spend a summer interning as a physician! I felt that a gap year or two would be my best option to gain experience in medicine, but I was unsure how to spend this time. Fortuitously I came across the opportunity to work as a scribe and build a new scribe program for my local emergency departments and in return, received the best preparation for medical school I could have imagined. When I started working in the Emergency Department (ED), I was the only scribe in the state of Rhode Island. To function as a scribe I needed to achieve two main goals: first, to educate myself, I needed a crash course in emergency medicine terminology and coding reimbursement standards in order to even begin to function as a scribe. Second, I hoped to convince our ED physicians that, as a scribe, I could improve the quality and efficiency of their shifts by charting on their behalf. Within a few months I had firmly decided to pursue a career in medicine, but oddly enough it was not just seeing the exciting and rewarding sides of practicing as a physician that had convinced me, but also the struggles of everyday work. Scribing is unique, not just because it gives one a front row perspective into the doctor’s daily life, but it also makes one a very active member of the team. I can vividly remember shadowing several physicians while in high school and college, and always feeling as if I was an intruder – watching the healthcare team work as I viewed from the outside in. As a scribe, you are there for it all, working side by side with a physician for eight hours, and within very little time, the walls come down. The realistic perspective I gained of the rewards and the stresses of managing and caring for sick patients was invaluable to me. I was present for exciting and inspiring shifts that showcased the breadth of medical cases managed in the ED – from gunshot wounds and strokes to motor vehicle accidents. I was constantly in awe of the knowledge and skills of the attendings and residents I worked for. One moment they could be stitching up a finger, and the next intubating a new critical patient or running a code. I looked to these physicians as role models on how to deal with my own emotional responses to what I witnessed while working as a scribe. When I first started there were novel and powerful experiences in almost every shift I worked. From the first death to the first successful resuscitation, and the first laceration repair to the first thoracotomy, the nature of emergency medicine is such that no two shifts are alike. It was not always exhilarating, however. There were also frustrating and disheartening shifts where physicians spent hours dealing with difficult and noncompliant patients, overflowing waiting rooms, conflicts within the healthcare team, and endless paperwork. I have no shame in admitting that I used to harbor a romanticized notion of what it meant to practice as a physician. If I had been asked three years ago what I thought was the greatest challenge in medicine, I would have likely have answered determining a diagnosis. My experience in the emergency department has been eye opening. I now recognize that the socioeconomic barriers to both preventative and curative patient care are an undeniable reality in modern clinical practice. Paradoxically, the more I learned about the challenges present in modern medicine, the more comfortable and confident I felt with my decision to pursue medicine. The advantages of the experience did not end after entering medical school. Even as I wrap up my first year I can still appreciate how much support and confidence my prior exposure to the field has given me. One of the most significant features has been my comfort with the seemingly impenetrable language of medicine. I remember how, when I first began to work in the ED, I would listen to conversations between the medical staff and struggle to catch every third word. Attaining fluency in medical terminology is 7 8 EN