Which one of you surgeons rolled this poor guy up?

"The patient will unroll in cardiac rehab." 

Cat control in the OR: A slippery problem

(In an op note) "... 25% increased difficulty secondary to large cat." 




You have to wonder: Does the size of the cat really matter? I mean, it's a  frigging cat. How you gonna code that?  

Sometimes he even puts wine in it

"He drinks a wineglass every night."





(Mmmm, crunchy.)

Yep, boys, she's got it all

"...Her mother is age 54 and has her entire apparatus."

(I don't want to say anything further to spoil the beauty of this wreck. It just cries out for a semi-naughty picture of Mae West, though, doesn't it? Even though I doubt ole Mae was ever a mother. As such.)

And if they found him, then what?

The patient had x-rays of his foot to evaluate for Osceola.

(dictated was "... for osteo," obviously. 

I can't make this stuff up, folks. 

But Speech Wreck can!)

I just met a graft named Maria

"... autologous bone graft harvested from the hip using Maria."


..."and suddenly this pain
will never be the same
to meeee...." 
Sorry. I've said it before: Sometimes I can't help myself. 

(Dictated was, "...using the RIA..."  easier than using a character from a half-century old musical. Probably.)

Why? What did they do?

"She had exoneration of her frontal sinuses."

(Yes, I know that technically, it should be, "what were they accused of?" Shoo, grammar Nazis! Shoo!)

That's a strange expression, Bruce

"She also had a tuberous to loosen her Cleese."

("... a tubeless enteroclysis"). 

This cost-cutting is out of control

"Labs drawn at a truck mechanic hospital..."

He's not any good, but at least he's cheap

"The patient sees Bill Localguy, failure practitioner, for primary care."

(Dictated: "... family nurse practitioner...")

If you are a medical provider and you do this, we hate you

...Dropping the humor mask for a moment, folks. Please take a look at the following post over on the excellent Dr Grumpy's blog: http://drgrumpyinthehouse.blogspot.com/2011/12/beware-of-dragon.html


It seems providers using front-end speech recognition--sending the dictated drafts straight to the chart without proofreading or editing--have finally been forced to unhappily recognize what we at Horse HQ have been illustrating for a while now: Despite the urgings of VR vendors waving fistfuls of dollars in sweet cost savings, VR's vaunted low error percentage is nowhere near what's advertised; the much-touted learning algorithms are not all that, either.  (At my hospital, e.g., VR software remains unable to recognize the word "gout," after over two years and literally thousands of corrections. But I digress). 


So some medical providers now must recognize that there are errors in the speech-recognized reports on their charts. Oh, dear. What do they do? Do they decide to take  time out to proofread each report, or have an experienced professional do it for them, or have someone, anyone do it for them? 

No. That might increase costs. Can't do that. Instead, they make the obvious choice: A magical solution. They accept the errors; nay, they embrace them, for  powerful magic exists that can make mistakes disappear: A disclaimer!  Who cares if bizarre VR errors make a well-educated medical professional appear sloppy and careless at best, and at worst, compromise patient care? There's a disclaimer!  Right there on every report! Powerful juju against disrespect, bafflement, expanding confusion, and lawyers! All they need to do is be up-front about it: Tell the world their reports are generated by speech recognition, and then... any errors or omissions are not their fault.  


It will be interesting to see how this disclaimer thing plays out...sure, technologic change is a juggernaut that can't be stopped, but even so, reason must step in, here. Magic, not so much. 

Self-control during the holidays... often a problem

"Ms. Patient sustained a mechanical fall last night. She reports she was getting up from a binge at a restaurant."

("... getting up from a bench...")

Where there's smoke there's... oh, wait

"Discharge diagnosis: Tobacco habitation."

You know how there's "green" housing? Well, I think we can safely say this is the opposite of that. (It was "tobacco habituation," BTW).

A unifying diagnosis will be challenging

"He has had 2 prior stents and no sex."

Maybe they're trying a new type of cardiac rehab. You never know.

Those darn patients, always with the drama

"This elderly female has dramatic heart disease." 

(Dictated was "rheumatic heart disease"... much less dramatic)

This might raise a few eyebrows over at the pharmacy

In med list: "Narcotic 800 mg q.d."


(Dictated: "garlic...")

Dr Obvious: He knows more than you do

"The patient was born in Localtown, to her biological parents." 

Glad we cleared that up. Because sometimes, people are born to... wait, never mind. 

Department of Dental Redundancy Department

"ASSESSMENT: 1) Toothache. 2) Dental pain."

I'm not as think as you drunk I am

"The patient had ultrasound used to guide the placement of her wine." 

There might be a problem with this EEG

"The background consisted of 20 to 40 microvolts, to death." 

We're gonna need a bigger brace

This just in: Healthcare benefits extended to tall buildings!


"The patient wears elastic braces on his 28th floor."

(Dictated: "...braces on his knees for....")

The doctor will see you now, Mrs Bass

"This is a very pleasant 62-year-old widemouth female."

(Dictated: "...white female...")

Dr Obvious attends to detail

"The patient lives in Nearby County with his wife, who is still living, and is currently present in the room."

(It's good that she is still living, as zombies aren't yet included in the hospital's Infection Control plan.)  

Oh, speech wreck, you so silly

"FAMILY HISTORY: Gore."

Dictated: "Family history noncontributory." Perfectly clear dictation. Why did "gore" appear instead? We are not to know, my friend.

No bacon for you!

"The patient states he had no more hogs or problems since the early 80s."

(Dictated: "...no more heart problems...")

Don't be the problem, be the solution

"The patient is a normally dissolved female who is currently resting in the bed."

(Or is she the precipitate? Yes, Horse is still a science geek at heart.  Dictated was: ..."normally developed...)

You'll find it in the last place you look, you know

"MRI of the brain was performed to relocate this patient's brain."

(Dictate was "re-look at," which makes me grind my teeth, but never mind).

I think we're gonna need a bigger drill

"POSTOPERATIVE DIAGNOSIS: Dinosaurs caries."

(From a Peds. dentistry note--"early childhood caries").

If that's your chief complaint, geddouttahere

"She is widowed and is tired."

Gone fishin'

"The patient confirms some piscatory preoccupation and delusional thinking." 

(For fishermen, aren't those two the same thing? . . . Dictated was "persecutory preoccupation...")

Sunday Speech WRx

Latest batch of Speech WRx. They all appeared in draft medication lists, just as you see them below. See if you can guess 'em all. The last one is pretty obscure, so you should just give up.

1. Back to now

2. for a valid 

3. awoke again

4. clipped a real 

5. climbs up 

6. travels first  

7. Pus drained 

8. than the mouth pain 

ANSWERS

1. Actonel

2. chlorthalidone

3. amlodipine

4. clopidogrel

5. clonazepam

6. travoprost

7. Fosrenol

8. bendamustine

Ow. Ow. Ow. Ow.

"She has a burning IUD in place."

(Dictated: "... a Mirena IUD in place.")

Twittering

... Yeah, so I've caved . . . Never one to be hasty, I've given in after a mere year and a half of horsing around here and gone on Twitter. Why? I have no idea. The blue birdie button's over in the right-hand column somewhere. It's mostly going to be posts from this blog; not sure if I'll be adding anything more... you never know.  But feel free to, you know, retweet, or whatever people do. 

  

Taking 'sympathy pain' too far

"The patient and his wife were both resting comfortably following Dilaudid."

(Thanks to VR for this one. Finally got around to it).

I'd be uncomfortable too

"A very uncomfortable female. She looks like a kidney stone." 

(See, what happened was, while I was looking for a normal boring image of a kidney stone, I found this picture of a kidney stone with William Shatner's face. This is much better, don't you think? No, I'm not going to explain it; you'll have to google that yourself.)

Baron Munchausen, the doctor will see you now

"...the latter diagnosis is less likely, as the patient is not exhibiting the full consolation of symptoms." 

(Dictated: "...constellation of symptoms."

I'm feeling bad because I totally missed International Munchausen Day, but at least it provided us with this awesomely bizarre illustration).

Beer. It's what's for dinner.

"The patient underwent paracentesis with 2 beers taken off."

(... 2 liters taken off. Of course, the procedure was for alcohol-related cirrhosis, so we can squeeze a few more snickers out of it. We're pathetic). 

Teacher teacher I declare

"Eye movements are conjugate and full, with some psychotic intrusions on her student." 

(Dictated: "...with some saccadic intrusions in pursuit...")

Of Speech Wreck, Censorship and iPhones

There's a whole world of speech recognition software and hardware and apps and stuff going on out there, in case you weary delvers in the medical dungeons hadn't noticed. 


So I thought I'd share this delightful blog post with you; though not new, this matter of the Dragon iPhone app censoring its users was new to me, which is just as good. And the post is funny and well-written (and despite the subject matter, completely SFW, not that you'd be reading this at work, you scoundrel). 

Plumber, heal thyself

"He has worked as a plumber but is currently unable to void."

(Dictated: He has worked as a plumber but is currently unemployed.)


Thanks to the ever-helpful JP for both the wreck and the caption!.