[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. 

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 

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,

First post since the first of the year! And not on anything I thought I would be writing about either...

(SPOILERS GALORE)

Are even Disney movies getting more depressing and more cynical than ever before? 

I apparently didn’t get the memo that it is now a requirement that all Disney movies open with something heartbreakingly tragic. I guess it did start a while back, with Bambi’s mother getting shot relatively early on in the plot. But with each subsequent movie, tragedy seems to appear earlier and more swiftly, working its merry way from homicide (basically every Disney movie ever), to abandonment (Toy Story), to kidnapping (Tangled), with the paradigm being the opening scene in Up, where infertility, unfulfilled lifelong dreams, old age, and death of a loved one were covered in the span of five short minutes. 

(I will admit, during that bit, I teared up behind my 3D glasses. Oh, the feelings.)

Though tragedy, too, reveals itself early on in Frozen, it thankfully doesn’t pack quite as potent of a punch as Up.  I mean, watching a giant wave engulf a ship and leave nothing in its wake a mere, quiet second later, is harrowing, but a second isn’t much time to build up or fully absorb grief. I will also never be able to hear the words, “Do you want to build a snowman?,” in anything other than Kristen Bell’s sad, singing voice ever again, but it’s not going to tear me apart inside.

What I do think is more of a punch, especially to the children, is the part where the handsome prince who falls in love at first sight with our intrepid princess Anna...

We've all been there, Anna

...is in fact a greedy, murderous, conniving son-of-a-bad guy.

What an unusual twist for a Disney movie.

I definitely got suckered in.  During the early scenes, when Anna and Hans were running around, singing together, and finishing each other’s sandwiches, as Disney princesses are wont to do, the word “love” kept coming up over and over again, and I wanted to pretend-gag and/or start on a verbal diatribe but there were innocent children present and we were inside a movie theater. (no talking! cellphones on silent!)

I settled for an enormous, Liz-Lemon-type eye-roll instead. (I’m mature and jaded like that.)

But then, Disney goes and fully justified my cynicism.

Since when did Disney get as messed-up and cynical about the world as I am?

(Some would say of Disney [Walt]: from the onset)

I’m of two minds about this.

On one hand: yay, preach it, sistah. Speak the truth, early and often.

Having been OBGYN, which requires you to be at least 10% raging feminist, I have a bit of an aversion to slick, eager men; equating sexualization to liberation of women; and cutesy, soppy, ultimately insincere gestures and sayings.  And while there was still much of the above to balk at - the existence of the other eager cute guy in the movie (though arguably more klutz than slick); the “liberated” Elsa with slinky low-cut, sheer dress and crazy hip-high slit (Angelina Jolie got nothin' on her); some genuinely frilly songs and pushy match-making trolls - it was still a nice surprise, the handsome, evil prince, and the applaudable, though slightly but pleasantly predictable way that Anna saves the day.

What a great life lesson! 

Looks can be deceiving. 

Charming people may just be using you. 

Don’t marry people you have only known for 24 hours. 

Hopefully that’ll prevent a Vegas marriage or honeymoon murder or two.

Is this the face of a bad guy? YES.

On the other hand, shouldn’t it make you, as it does me, a little sad that it has come to this - that children’s entertainment feels the need to warn little girls of the dangers of handsome men who say they love you, but are total liars and just want to use you, because this happens much too sadly and too frequently in the real world?

It’s also kind of sad to see the end of innocence, no matter how little and perhaps necessary - to see children go from wide-eyed idealism to, well, me. In that instant, hearing that loss in the sharp tiny intakes of breath and small outcries of surprise of the kids all around me, it was surprisingly a bit unsettling.

But, let’s not over-analyze: in the end, Frozen is neither child-directed feminist manifesto, nor innocence-stealing succubus.

It’s just a movie. 

A Disney movie. 

A fairly thoughtful, visually appealing Disney movie about the power of sisterly love. 

It’s not perfect - the relationship between the sisters isn’t nearly as fleshed out as it should be; the music, despite Idina Menzel’s considerable talents, are not very memorable; Tangled, in both story and song, is much more entertaining - but it’s fun, it’s got a reindeer that acts like a dog, a snowman who longs for summer, and a virtual snow-covered Norway as its stunning backdrop.

And that’s pretty much all the child left in me really needs.