Doctors no longer need medical secretaries
BMJ 2013; 346 doi: https://doi.org/10.1136/bmj.f226 (Published 11 January 2013) Cite this as: BMJ 2013;346:f226All rapid responses
Rapid responses are electronic comments to the editor. They enable our users to debate issues raised in articles published on bmj.com. A rapid response is first posted online. If you need the URL (web address) of an individual response, simply click on the response headline and copy the URL from the browser window. A proportion of responses will, after editing, be published online and in the print journal as letters, which are indexed in PubMed. Rapid responses are not indexed in PubMed and they are not journal articles. The BMJ reserves the right to remove responses which are being wilfully misrepresented as published articles or when it is brought to our attention that a response spreads misinformation.
From March 2022, the word limit for rapid responses will be 600 words not including references and author details. We will no longer post responses that exceed this limit.
The word limit for letters selected from posted responses remains 300 words.
I read this article with great interest, and have equally enjoyed reading the responses to it. I like many of my undergraduate colleagues find the reluctance of the health service to embrace new technology very frustrating.
However, secretaries provide an invaluable liaison service for medical students, particularly in hospitals. Whether it's a consultant with whom some experience has been arranged, a meeting with my personal tutor or a teaching session, the secretaries are often the first port of call.
Clinicians are difficult people to pin down at the best of times, but secretaries are usually located in one office in the hospital. As well as an in depth knowledge of a doctor's diary and workload, they also know the personalities and habits of the consultants they work with. The secretaries I have encountered have always had a wise word or two about the doctor I'm looking for, which has helped calm any nerves and smooth the first meeting/phone call etc. Secretaries are now the first person I search out in order to organize anything with a senior clinician.
Despite dreaming of the day when I no longer have to trawl through paper notes on a busy ward, I for one would definitely vote to keep medical secretaries.
Competing interests: No competing interests
As ever, Des Spence is rightly being provocative in challenging status quo and stimulating a discussion about new ways of working in the era of immense technological innovations.(1).
But, as many others have pointed out, medical secretaries do more than simply type letters. Certainly consultant productivity would drop precipitously if secretarial support is removed.
Across the Atlantic, where it is quite common for physicians to be directly approachable by patients ( eg email, mobile phone ) they still have secretaries.(2). The use of medical secretaries, in a Market led health economy, provides strong evidence regarding indispensability of medical secretaries.
Another minor issue for someone who is not a native English speaker is that speech recognition software sometimes seem to have problem with
our accents and intonations. And certainly my long suffering secretary is more forgiving.
I am afraid medical secretaries are here to stay for the time being.
References:
1. Spence D. Doctors no longer need medical secretaries. BMJ 2013;346:f226
2. U.S. Bureau of Labor Statistics. Occupational Employment Statistics. 43-6013 Medical Secretaries. http://www.bls.gov/oes/current/oes436013.htm (accessed 10 feb 2013).
Competing interests: No competing interests
Poor use of doctor's clinical skills will be a consequence of this policy. It also belittles the skills and dedication of medical secretaries to safe patient care.
Medical secretaries have always been the most important member of a consultant's team. Mine were outstanding.
The demands on Dr Spence's clinical skills allow hours writing for the BMJ and doing all his own paperwork, in front of a computer or on his phone. Perhaps there are financial savings in a General Practice's expenses?
Surely a consultant or junior doctor (whose training opportunities have already shrunk) is best employed in clinical contact with patients.
A 747 Jumbo pilot can fly the plane or give out the meals. Both are important tasks for the passenger. Common sense suggests the best use of both the pilot's or in medicine the doctor's time is doing what they are specially trained to do.
To suggest that doctors desire power and status by having a reliable medical secretary is ridiculous.
Nigel Jones MS, FRCS
Competing interests: No competing interests
Des Spence is one of my heroes and what he says normally makes a lot of sense but on this occasion I have to disagree with him. As a GP I find our practice secretary invaluable. She can do a myriad things that help my working day - chase up missing follow up outpatient appointments, request discharge summaries to be faxed over while I am still seeing the patient, get through to the hospital rather than me wasting 3 minutes of my consultation doing the same, liaise with hospital secretaries ( whom she knows and has developed a good working relationship with) over the above, draft responses to complaints or letters to the PCT, solicitors etc which I can then edit which is far quicker than writing them myself from scratch. As the letters above from secondary care colleagues have emphasised a secretary is far more than just a typist.As a GP trainer I encourage my registrars to use the practice admin staff to help them with these kinds of tasks rather than getting overwhelmed trying to do everything themselves. GPs, as small business owners, often economise on admin and support staff or out of a misplaced sense of egalitarianism feel uncomfortable asking staff to do simple tasks for them. It's a false economy and recipe for burnout and stress as the volume of patient contact, administration, audit and complaints grows exponentially. Why do lawyers and other professionals have PAs or secretaries? Not primarily as a status symbol but to enable them to work more efficiently and focus on the job they were trained for rather than trying to do everything.Multitasking is not necessarily the best way to be productive - ask any housewife or read Tim Ferris' "4 hour work week". So GPs, if they don't have a secretary at their practice, or staff who act in that capacity even if called by another title ( such as practice manager) , should seriously think of getting one. It will make their life easier!
Competing interests: No competing interests
I'm not sure I'd want to dispense with these good ladies. They provided a valuable interface with the public; patients might reveal to them matters that they wouldn't otherwise say over the 'phone. 20+ years ago their pay scale was reduced cf. non-medical secretaries; I then felt that this was an attack on my communications system. My secretaries remained loyal. No real idea why; they all could have earned 50% more in the local Estate Agents.
Competing interests: No competing interests
I am a medical secretary on a Band 4 pay scale. This morning I have checked my Consultant’s data quality performance reports, reviewed the waiting list, booked outpatients appointments, input some referrals, scanned in a pile of incoming documents, responded to patients, the police, social services, our Trust business development manager, our screening team etc etc. I haven't even started on typing the dictations yet. If I didn’t pay attention to all of this, my Consultant would have spent 4 hours on admin, away from clinical work. I do agree with Dr Spence that the NHS can work more efficiently by using digital dictation / mobile working / streamlining admin systems but without competent administrators I promise you the NHS could soon deteriorate into chaos.
Competing interests: I am a medical secretary
Dr Spence's article identifies that the NHS is plagued by complexity and difficult communication. So far so reasonable (if unoriginal). He then offers a solution...
Whilst I am ignorant of the 'bling' factor he alludes to, I can comment based on experience of many frontline senior staff (assuming he includes consultants in this term). One medical secretary supports a number of consultants (six in my case) and is part of a handful of staff that deal with administering approximately 60,000 patient visits a year. My experience and research is that this is fairly typical.
The idea that secretaries are there to type letters suggests a lack of awareness of what actually goes on in secondary care in this century. The article is also demeaning in tone to our secretarial colleagues as others have pointed out. The concept of consultants having 'their secretary' went out years ago for the vast majority of hospital doctors.
What about the suggestion that their role is to act as a barrier between clinical staff and patients? Like my colleagues in primary care, many queries do not need my input. Time spent in dealing with such queries is time not doing something else for patients. The average age of patients in an eye clinic is 77, does he really think that setting aside time for answering all text messages and email is wise? The vast majority of communications to our service is by letter, or telephone call. We already spend hours dealing with emails, letters and calls as it is. The reverse analogy would be to get rid of GP's receptionists as appointments can be made online.
I strongly suspect he is in a minority if he can type as fast as he can dictate. I would suggest it is a lot easier to learn to dictate better than to improve typing (and error correction / printing etc) to the same degree. It is obvious why it is more efficient to get someone trained at typing to type, and someone trained (and paid) to be a doctor, to be a doctor.
Has Dr Spence spent time seeing how things are in secondary care recently? It might help if he did- he may than be able to discard the uninformed polemic that weakens the article.
When faced with a large and complex structure, by all means look at ways to improve it, however: think first: why get rid of the glue that holds it together?
Competing interests: I share a secretary with 6 colleagues
Just a brief response to Dr. Spence's response, I encourage the parents of my patients to ring my secretary, and do not see her as a barrier to communication, but more as access for parents. I spend a significant amount of time on the telephone to parents of my patients, these calls often taking place outside office hours in my own time. Some of my chronic patients parents have my email address and email me, although our Trust discourages this practice, and we are urged at present, to print off all emails for the patients notes. I agree we need to move foreward, with better lines of direct communication, but we must also be mindful of confidentiality and accurate documentation etc. It would be excellent if we could link up any emails relating to patients to the patients personal electronic record. Finally , my secretary doesnt just work with me but covers the work for 2 other Consultants, in fact none of the secretaries just work for one Consultant.
Competing interests: No competing interests
It's clear that the majority of respondants passionately WANT and appreciate our secretaries. Des Spence is right though to ask whether there is evidence to justify their existence. Underpaid though they may be - particularly in comparison with Legal Secretaries, who are recompensed better for their specialist skills - we do have to consider whether the resource might be better spent elsewhere in the NHS, perhaps employing more cleaners or nursing time. In my own case, typing would be the least of the problems if I were to lose secretarial help. Over the past 15 years I have seen, felt and witnessed evidence that when doctors and services have excellent, interpersonally and technically skilled secretaries, the clinical service offered is superior, team morale and staff retention improve, and efficiency is greater.
I worked for a while in a clinic with no secretary. The effects on the service - and on patients - of paying Consultant Psychiatrist rates for untrained secretarial input were dismal. My move to a service where the secretaries were poorly managed and had inadequate skills left me resolved to work henceforth only in services where secretarial input is highly valued. I recommend an RCT or at least a study with matched controls to examine whether the presence of excellent secretarial input correlates with the delivery of excellent clinical output.
Competing interests: No competing interests
Re: Doctors no longer need medical secretaries
Des Spence comments that he still finds communication poor with long delays for letters etc. with the use of secretaries and his solution is to remove secretaries and get Consultants to do their own typing!! Is it the 1st of April?? I would like to know where the evidence is that 'most consultants can type as quick as they dictate' as that is certainly not my experience. If delays are long now they will only be worse by removing secretaries and getting Consultants to do the typing.
As many have already commented a medical secretary does far more than type letters but it seems to be only Consultants who appreciate the diversity of work they perform and who recognise that they are indispensable to the smooth running of the clinical team and dare I say the NHS. One only needs to have a secretary on leave to witness how everything grinds to a halt without them. By all means use technology and make progress but getting rid of medical secretaries and have consultants do secretarial work as well as medical work is not the answer.
Competing interests: I have a medical secretary