Lost in Dictation

I didn't have to do much dictating in medical school, but now that I'm a lowly resident there isn't a day that goes by without having to participate in this dreadful ritual. How it works? You call a number, and talk to the phone about a patient. You have to do it for all consults, deliveries, and yes, the dreaded discharge summaries which get sent to the family docs so they have a clue about what's happening to their patients. It was only in my third week that I discovered the pause and rewind buttons, those poor, poor, people who have to transcribe these things! "Ummm . . . uhh . . . note to transcriber, delete that last sentence . . . uh . . . I . . . uh meant to say . . . " Then last week, I had my first official doze-off during a discharge summary which I was trying to do before going home post-call . . . I'm such a dimwit!

As my friends and family can attest, I have a mumbling problem. In regular conversation, this isn't an issue, people just look at me funny and I pause and repeat. One friend, in the middle of an animated story I was telling her, tilted her head to the side, squinted her eyes and said, "funny, sound is coming out, but your lips just aren't moving." Unfortunately, as I found out when I actually read one of the consults I dictated, it may become a more of an issue. One of my patients ended up having a 67cm abscess in her pelvis. Now, even if you're not an expert in abscesses or the pelvis, wouldn't you maybe question something the size of an exercise ball being drained through someone's vagina?!? It was actually 6-7cm of course, but reading it on the computer I laughed out loud, imagining this slim woman waddling around. I was at the nursing station and everyone promptly assumed I was on Facebook. Hehehe, nope, doesn't take much to amuse me.

It made me think of one of my classmate's attempts at getting some tips on how to dictate and googled "medical transcription tips". The results were hilarious, although I can only remember a few of them:

1) When dictating, please place the receiver as far into your armpit as possible and whisper softly.
2) If you need to cough or sneeze at any time, please remove from armpit, and do so directly into the phone receiver.
3) Please make sure to spell out uncommon names like "Brown" or "Smith" but don't waste time spelling simple names like Ghchoayeyzfhgfr.

Then some of the mistakes that have been made:

1) Because the couple is having trouble conceiving, I have referred them to a futility expert.
2) On rectal exam, the thyroid was found to be enlarged.
3) During her first visit to the emergency department, she was examined, x-rated, and discharged home.

So my new goal is to speak clearly, mostly to avoid medico-legal problems in the future, and ultimately, I sure hope those nice people at transcription have a whole lot of patience and a sense of humour (I always thank them copiously after each dictation).