Agnostic Asthmatics and Other Mishaps in Dictation..

I do not think that I speak only for myself when I say that interns often jump at the chance to be more doctor-like, even if it means doing something routine or trivial. Like eager puppies in a newfound backyard, we leap at the mundane and frolic in scutwork if it means signing "MD" on a chart. "You have a patient with a rectal abscess to incise and drain in the operating room? Yes ma'am...wow, thank you, ma'am for this opportunity!" "You mean I get to do this consult all by myself? Awesome..."

Perhaps it only lasts for the first 2 or 3 months of internship but for now life is pretty exciting. One of the tasks that will probably quickly become burdensome but still makes me feel more doctorly is dictating, the art of detailing into a microphone (or the telephone) a patient history/physical, procedure, or test for the purpose of archiving or sharing patient information with other involved medical professionals. I remember shadowing doctors and watching in awe as they spoke with the speed of the "Micro Machine Man" into that funny-looking dictaphone and wanting to be able to do the same one day. Well, my time has arrived and I have been catapulted into the world of dictating notes, letters, procedures, clinic visits, discharge summaries, etc. It takes me a pretty minute to complete these dictations as I get my thoughts together and wordsmith the letter or note to my liking. Last week, my attending tore through 20 dictations before I had finished my three...but practice makes perfect, right? Well hopefully for me, practice makes efficient.

We had a short session on dictating at the beginning of the year, presented by the transcribers (people who patiently type our patient recaps). I laughed as they told us to avoid some personal pet peeves of theirs like dictating while enjoying hard candy, eating, smacking lips, or mumbling to name several.

My sisters would be the first to criticize my mumbling tendencies. Aware of this vice, I have been trying to speak with good diction and articulation. Still, I have had some doozies come back (we review the typed version before it goes to medical records). Some of my favorites:

- The patient suffered an asthma exacerbation --> transcribed: The patient suffered an asthma excision (not sure what this is but it sounds painful...)

- Beta-2 "agonist" therapy (a group of medications that help dilate the bronchi in asthmatics) seems to be a tough one either for me to say or for the dictators to recognize:
1) the patient was on beta-2 anginous therapy (nope...we aren't treating any chest discomfort in this child) and even better,
2) the patient is on beta-2 agnostic therapy (we actually didn't discuss religion during this visit).

Here are some similarly funny dictation bloopers from http://www.npcentral.net/humor/blunder.subs.shtml:

- "Patient has a history of an atomic pregnancy" (as opposed to ectopic)

- "Discharge status: Alive but without permission."

-" The patient had a rash over his truck. " (trunk)

Others are hilarious because of the physician (tired or not thinking):

- "The patient's past medical history has been remarkably insignificant, with only a forty-pound weight gain in the past three days."

- "On the second day the knee was better and on the third day it had completely disappeared. "

-"The patient is tearful and crying constantly. She also appears to be depressed. "

-"The patient refused an autopsy. "

- "Patient has left his white blood cells at another hospital."

and one of my favorites...

-The patient has been depressed ever since she began seeing me in 1983. "

Such is the realm of dictation; however, I hereby strive to think through my words and speak them well...

"Sincerely,
Jordan C. Huskins...J-O-R-D-A-N....C...H-U-S-K-I-N-S"