Doctors are Dictators!
Last month, I was intimidated to learn that all consultation notes had to be dictated, having never had to do this before. Ok, I was downright worried! Fortunately, the hospital has a service that handles the technical side, and they even gave us Residents a little brochure with the standard headings to start us off. I clung to that yellow tri-fold of paper for dear life.
A doctor can either use a fancy dictation phone, which has convenient buttons for rewinding, listening, dictating, and most other major functions, or they can call into a number (local or toll-free if out of the region) with a regular phone. I’ve tried both systems and have to say I much prefer the special dictation phone. This is because A) it means you are getting your dictations done in the hospital and not having to think about them at home or at clinic and B) it’s easy on a telephone to hit the wrong number button, accidentally ending the dictation. This is my one pet-peeve with having a touch screen phone (iPhone). Whenever I am dictating away, and need to press a number, say 2 to rewind, I have to hover my finger over the power-saving-black screen, make the numbers appear, and then press the button. This is harder than it sounds, as it’s quite easy to press the wrong button, lose the dictation, and freak out a little about having to repeat the whole thing. As if that isn’t bad enough, a computerized voice scolds you for it: “You have an open dictation in the system. Please contact Dictation Services. Bleeeep” Sigh. I know, I’m new here!
The process has gotten faster. Initially, it probably took me 30 minutes, with incessant stops and starts. Now, I can roar through at a satisfactory pace with just a few fix-ups along the way. Pouring out one’s insight and conclusions in a thorough, yet concise manner is not so easy when the game is knew and it’s hard to tell what’s important and what would be considered fluff. I dictate on behalf of my Attending, so they get copies to proof later, and I always check in the EMR to see how badly I fared. I’ve been pleasantly surprised; kudos to the pool of medical stenographers who make even our most rambling paragraphs sound like brilliant Antonian monologue. Mostly, things have turned out well but there are sometimes serious errors, especially in the subtleties. “The patient DOES have” vs. “The patient DOESN’T have.” Annunciating clearly is important for accuracy, but proofreading often catches these. I got some really great feedback this week from an internist/intensivist preceptor who happens to be a notable Canadian author; my notes were right on the money. Phew!
Errors can be entertaining too; sometimes they are direct transcriptions, sometimes they are things misheard, mis-transcribed, or the transcriptionist has done their best to use the correct medical jargon to make a bizarre but accurate account make more sense. Some are just due to unfortunate phrasing. And some errors are just urban legends – I hope. Some of them make more sense if you’ve ever dictated and know what it’s like to lose your train of thought while doing so. Behold some bloopers!
- “…..where was I? I can’t remember where I was….. oh yeah, I was in the rectum.”
- “He is an occasional smoker, smoking ten packs of cigarettes a day for the past 19 years.”
- (dictated on a patient with schizophrenia) “The patients are alert and oriented.”
From Kelly & Kevin:
- “On arrival to the emergency room she was noted to be lethargic and was noted to have uh, um, to have, um… uh… to have uh… short-term memory loss.”
- “Oh, transcriptionist, could you sneak into that last patient’s rectum and add a scant amount of guaiac-negative stool? Thanks.”
- An even larger issue was her obesity…..”
- “Skin is, uh, skin is, oh, well, uh, just take the skin off.” [take the "Skin" section off of the transcription]
- “She states she’s been wondering whether or not the Prozac is helping her depression. I’m going to try cutting her in half and see if that makes any difference.”
From MT Forum
- “I asked Dr. O, who did her sigmoidoscopy and colonoscopy, to poke his head in and he, too, though that it did not look like a classic colon cancer.”
From Transcription Nepal
- Transcribed: “42-year-old male who was delivering girl who is at the apical factory”
- (Dictated : “42 year-old male who was delivering groceries at the pickle factory.”). [yah, apparently that was the intended phrase]
- “She has no rigors or shaking chills, but her husband states she was very hot in bed last night.”
- “The patient has no previous history of suicides.”
- “Examination of genitalia reveals that he is circus sized.”
- “The patient has been depressed since she began seeing me in 1997.”