January 11, 2006

. . . Dictating a Preoperative History and Physical on Pharoomaferfloomph

Lovely, I guess I get to transcribe preops tonight. I can't stand these. Is there some med school tradition that requires future surgeons to learn how to mumble everything?

You would think speaking clearly and precisely would be more important in the business of cutting people open, wouldn't you? But you would be oh, so very wrong. Do I want to know what they sound like in the operating room? When they're further muffled by masks? I don't think that I do.

Nurse! Hand me that klaquoolfulogama!

I don't know why I bothered learning a single word of medicalese when all I really need to know how to type is the series of five underscores that indicates I have no idea what in creation this surgeon just said. Cripes. It takes a shit job like this to drive a school-o-phobe like me back to college.

Speaking of, I don't get to register until Tuesday (classes start later that week), because of oh-who-the-fuck-cares-what reason, which means next Tuesday I get to go through this all over again, only this time with lots and lots and LOTS of people half my age to go through it with me. You know what I wish? I wish I had a silver-haired wig and thick pretend glasses. I would show up to registration in the wig, the glasses, a housecoat, and my slippers. I mean, if I'm going to be old, I might as well be freaky, scary, do-you-think-she-wears-diapers, or-just-a-catheter-and-leg-bag old. I might as well be OLD old.

Um. So, that's uh, where I'm at right now. How are you?

Posted by Ilyka at January 11, 2006 09:09 PM in in praise of idleness

I think the mumbling dictation makes them feel more experienced. You know how a doctor's handwriting is sterotypically atrocious? During my time in the greens it became very apparent that the handwriting is worst for the inexperienced doctors. As they grow into the profession they write better as they realize that communication is more important than writing like a doctor. "I am a doctor and it is other peoples' responsibility to figure out my instructions" changes to "I am a doctor and it is more important for me to get my instructions across than to flaunt my authority in petty ways".

I bet dictation quality goes the same way.

Posted by: Jim at January 12, 2006 04:22 AM

I don't think Jim is implying this but just in case. Handwriting and enunciation are different animals. My handwriting, particularly my signature, has deteriorated (It was never that great but it was legible at one time) over the years mainly from lack of practice. I simply don't do it that much any more. It's a by-product of computers, paying bills online, and using a debit card all of the time. My enunciation, on the other hand, has gotten better mainly because having to repeat myself all of the time made me crazy. There are people I deal with daily that if I'm not looking at them, focused on them, and anticipating that they are going to say something, I don't understand a word they say. They mumble too low and too fast. These are people who have to repeat themselves more than I ever did. You'd think over time....................

Posted by: Rob at January 12, 2006 04:43 AM

No, I wasn't implying that they were the same, though they do have similarities. Both are intended solely to communicate and a person's attitudes toward them are generally similar as reflected by their overall attitude towards communication. In the case of the hot off the presses medicos, an attitude of hubris in communication is very common. This fades with experience as the importance of communication is learned and the professional feels more confident (and therefore finds it less necessary to play doctor by exploiting medical stereotypes).

Posted by: Jim at January 12, 2006 06:56 AM
and therefore finds it less necessary to play doctor by exploiting medical stereotypes

There is definitely something to that, except some never grow out of it. These ones who never grow out of it also tend to be the same ones who call our company re-peat-ed-ly to complain that the transcriptionist isn't transcribing what they dictated, damnit! Well, YEAH, dude. That's because the transcriptionist can't make out what you dictated.

And then there are the overcompensators who work from these premises:

1. Everyone's an idiot, except me.
2. Transcriptionists are like SUPER-IDIOTS.
3. Therefore I will dictate every item of punctuation and spell every potentially difficult or confusing term, i.e., "incision," "history," "and," "the," "if," and I will spell them all f-as-in-Frank fashion, because see item 1.

I've actually had a run of good physician-dictators this week, so I'm not surprised I hit an enormous Asshole Patch in the road last night. It's inevitable that the work will eventually sort itself out among the good, the bad, and the ugly.

There are people I deal with daily that if I'm not looking at them, focused on them, and anticipating that they are going to say something, I don't understand a word they say.

And I swear SBC hires most of them, too. Of course on the phone all you can do is beg pitifully for them to repeat themselves over and over. Fun times!

Posted by: ilyka at January 12, 2006 12:51 PM

I'm a lawyer and when I moved to my current firm I had to dictate for the first time in my life. At the first firm where I worked I didn't have a secretary so I did all my own typing, which was actually faster. I had never even seen a dictaphone when I moved to my current firm and I had no clue what to do with it. The biggest problem wasn't in figuring out how to push the buttons, etc, but in trying to compose coherent thoughts in my head and spit them out in a way that still makes sense on paper. I used to close my door when dictating because I was so embarrassed at how bad I was that I didn't want my co-workers to hear me. I don't care any more because I know they're just as bad. I often get my dictation back and think, "What, for the love of God, is this?" but I also know that the errors are most likely my fault, as it just isn't easy to say something into a machine that reads as well on paper. But medical dictation may be different-- I can't say I know as much about that.

Posted by: kitty at January 12, 2006 07:18 PM

As long as you don't sit in those Asshole Patches waiting for the Great Asshole (for entertainment purposes only) then your dictation course should flow quite nicely. Those Asshole Patches have a way of dumbing you down if you wait and stare to long. :)

Posted by: T-Steel at January 14, 2006 11:27 AM


I work as a remote transcriptionist for lawyers (instead of doctors) and I bitch about it sometimes, myself but -- and I think Ilyka will back me up on this, here -- it's not new authors (I hate the term "dictator") like yourself that are the problem. Hell, I go OUT OF MY WAY to make documents as complete as possible for them, and I know that with most, it's a learned skill that takes some time to get used to. Most lawyers have the ability to think on their feet and they will get the hang of it -- eventually.

We're all just people. You're good at what you do, and so am I.

Posted by: Margi at January 15, 2006 02:51 PM