[Ever wonder if there are aspects of medicine that TV shows, even fairly accurate ones like Scrubs, don't show on TV? Ever wonder why, despite advances in technology, some aspects of medicine still seem stuck in the 1950’s? Let’s discuss.]
As sarcastic as I can be about the field of medicine, surgery is truly something that I find enjoyable.
One of the aspects I truly dislike, though, is DICTATING.
God, what can even say about dictation? In medicine, dictating is when you regurgitate into words everything that was done during a surgery, or during a patient's hospital stay, with excruciating detail (excruciating being the operative word).
Dictating is that black menacing cloud whose specter ominously creeps across the otherwise sunny day known as a day in the operating room.
Dictating is necessary, yes, especially when there are complications, but make no mistake, it is evil.
It's not even so much the act of dictation, but the particularly incomprehensible way most hospitals still go about doing it. Even at the fairly 'fancy' hospital I work at these days (by which I mean working lights in every room), they still use an offensively inefficient and appallingly ancient system to transcribe and record operative notes.
First of all, the process involves a phone.
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| If you're a youths, and you dare ask me what this is, I'll kill myself. I swear. source |
A phone. As though time and technology had never evolved beyond Alexander Graham Bell to the development of computers, texting, Seamless, and near-total avoidance of real-time communication with other human beings, we must begin with a telephone.
Then, you dial the dictation number, where you will hear this cheery, static-ridden message:
“Welcome to the dictation system for the ____ Hospital.”
Then, you encounter an equally inaudible and particularly painful automated menu consisting of queries about:
- physician ID number
- dictation type
- hospital site
- patient medical record number
- the date of operation.
An answer is required for every single question, or
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| source |
An especially fun situation: when your menu doesn't specify which options are associated with which telephone key, but instead, ask you to read its automated mind. Making an assumption that pressing #1 will lead you down the right path may seem logical, but isn't, as logic is not to be included in the process of medical dictation; for this reason, some menus don’t even include an option #1.
Even when you know what numbers you must type to cross the River Styx, typing the answers may pose another Herculean trial. Hospital phones like to test your dexterity and ability to adjust to challenges by either:
1) having sticky keys, or
2) not registering properly unless you allow a good one-second pause between entering digits.
Patient medical record numbers are particularly entertaining, usually consisting of a string of 10+ digits, any of which, if you type incorrectly, will require you to hang up and restart the whole process once again. This means listening to the chipper and dreaded menu from hell, again. And even after the numbers are entered correctly, you face another challenge: the pound key (for the youths: that's the one that looks like hashtag). For sometimes you have to press ‘#’; sometimes you don’t.
Which adventure will you choose?
They will sometimes mercifully tell you whether ‘#’ is required.
But, sometimes, they will yell at you for pressing the pound sign.
Sometimes, they will passively aggressively hang up on you.
Sometimes, you will try not to slam your head repeatedly on the table and cry.
And then - AND THEN - you dictate! Which really means that you will parrot the exact same phrases again and again, because essentially, unless there are major complications, every case is performed in the exact same way. If you are an intern, and you have three hysteroscopy/D&Cs in a row, you will have to recite the same string of words and phrases three separate times, with increasingly angry and sloppy enunciation, for the sole reason that they must be recorded under three different medical record numbers.
(My poor beleaguered interns, if I can give you any hope about subsequent years of residency, it is this: advancing to second year will be better simply because you have more complicated cases, and thus a decreased number of dictations to do.)
At the end - OH GOD THE END - it’s of utmost importance that you jot down the “job number.” Not only is it proof that you did the dictation, but when your dictation from your cellphone doesn’t go through because, for some reason, only obsolete technology is compatible with this ancient system of record keeping, (or when your landline phone keys stick and enter in the wrong medical record number, or the wrong operation date), someone can use this number to scan through reams and reams of transcribed notes and charts to find the paragraphs that you painstakingly regurgitated into the phone so that you won’t have to go through this whole damn process again.
Dictating gets really entertaining for the transcriber at 3 am after an stat cesarean section (or two or three). During night float and call, I have definitely, and more than once, lost my train of thought or starting mumbled nonsense in addled delirium while dictating. One time, I fell asleep while talking, woke back up after an unknown amount of time, and sheepishly finished the dictation; I still wonder if the transcriptionists actually listened the whole recording and managed to find my poor dictation peering out from behind a long, long silence.
The particularly frustrating part is that there is a solution, and this solution is extraordinarily easy: computers. The nationally-required electronic medical records system. AKA just typing the damn note into the system.
The advantages:
1) typing, for many people, is faster than talking - and it’s certainly easier to go back and correct mistakes or add to the dictation
2) you can make a template for each case type, then copy/paste and alter as needed
3) you can be sure that while trying to decipher your mumbled and monotonous 500-wpm dictation, the medical transcriptionist didn’t accidentally write that a medication was given “trans broccoli” instead of transbuccally, or that Clearasil was placed at the surgical site instead of the usual Premarin.
4) when you fall asleep on the keyboard, you can always erase the rows of ggggggggghjklhjkyuiojhf without the risk of embarrassment or the wasting of your hard work.
5) in the case of discharge summary dictations, you can add to it gradually over time, rather than at discharge, which saves time and decreases inaccuracy due to impatience or lack of knowledge of the medical course of a patient who has been in hospital for 8 months, and has been passed between 10 different teams of physicians.
5) you can save money by not hiring medical transcriptionists, who probably can't hear what you're mumbling anyway.
Spread the word. Tell your local hospitals if they will listen: Computers - they EXIST! Let's use them.
Next time in Medicine from Yesterday, Today!: pagers. I mean, really,
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