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Doctors are Dictators!

September 17, 2009

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!

From MT Forum

From MT Forum

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!

From Misual:

  • “…..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]

From FileSoup

  • “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.”
9 Comments leave one →
  1. September 17, 2009 6:34 pm

    Wait until you get voice recognition. You get to learn enunciation all over again.

    • September 18, 2009 7:44 am

      Thank you forrr your pa-ost.
      I do not luk for-ward to dooing that.

      Anyway…I can’t imagine our nigerian/icelandic/scottish/egyption docs having much luck with a ‘universal’ voice recog system. We’d have to have a really really fancy piece of software to learn the nuances of their accents!

  2. September 18, 2009 1:01 am

    There is also the “kayciel” that so many patients seemed to be taking. It took me a long time to realize that meant potassium.

    I love dictation. If my hospital ever gets it may spare me a horrible death from Carpel Tunnel.

    • September 18, 2009 7:41 am

      ahh that is a good one!
      Our dictation phones look like they are from the 80s. We are trying to go all EMR so I don’t know if we’ll be typing into the computers or if the dictation service will continue.

      It’s pretty great, but one thing I learned: don’t try putting the special phone between your shoulder and ear to spare both hands, because that will mash all the buttons that are at the top of the headset rendering the weirdest dictation you ever heard!

  3. Daniela permalink
    September 18, 2009 2:20 pm

    I never thought that having a doctor as a friend could be so entertaining! I thoroughly enjoy your dictation bloopers. Don’t throw them out! I see a book in the making 🙂

    • September 18, 2009 3:24 pm

      Well those aren’t MY bloopers, they are just ones I found on the web. Glad you are entertained, at any rate!


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