Horse On A Mattress

We found the lost continent of Atlantis, though

2012-02-13T23:52:00.002-05:00

"CT scan of thehead isnegative ... There is noevidence ofMalaysia."

(Dictated: "... no encephalomalacia.")

Desperate doctors

2012-02-12T23:23:00.001-05:00

Thepatient wasdiscussed with Dr Hospitalist,who isin agreement tosuicide."

("... agreement with the plan" was dictated. No clue where Speech Wreck got "suicide"... maybe it's emo).

Best. Speech WRx. Evar.

2012-02-12T23:16:00.002-05:00

... at least, until the next best one:

"Sphincteroid."

(Dictated: Synthroid. Thanks to T.J. for this lovely Wreck!).

Night shift in the Department of Redundancy Department

2012-02-02T21:32:00.000-05:00

"She had a frontal headache in the front."

Prescription and capsule criticism all in one!

2012-02-01T20:30:00.000-05:00

"Spuriousinhalation 1 q.a.m."

("Spiriva inhaler" was dictated.)

Which one of you surgeons rolled this poor guy up?

2012-01-31T19:13:00.000-05:00

"The patient will unroll in cardiac rehab."

Cat control in the OR: A slippery problem

2012-01-30T20:32:00.001-05:00

(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

2012-01-30T20:26:00.000-05:00

"He drinks a wineglass every night."

(Mmmm, crunchy.)

Yep, boys, she's got it all

2012-01-30T01:10:00.000-05:00

"...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?

2012-01-30T00:16:00.003-05:00

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

2012-01-24T22:35:00.002-05:00

"... 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?

2012-01-22T17:37:00.000-05:00

"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

2012-01-04T23:17:00.000-05:00

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

("... a tubeless enteroclysis").

This cost-cutting is out of control

2012-01-04T19:27:00.000-05:00

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

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

2012-01-02T16:05:00.002-05:00

"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

2011-12-27T00:11:00.001-05:00

...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

2011-12-21T15:52:00.001-05:00

"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

2011-12-21T15:27:00.001-05:00

"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

2011-11-21T03:18:00.000-05:00

"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

2011-11-21T03:06:00.000-05:00

"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

2011-10-16T16:38:00.000-04:00

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

(Dictated: "garlic...")

Dr Obvious: He knows more than you do

2011-10-16T15:59:00.001-04:00

"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

2011-10-11T22:43:00.000-04:00

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

I'm not as think as you drunk I am

2011-10-02T20:56:00.000-04:00

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

There might be a problem with this EEG

2011-09-27T15:21:00.001-04:00

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

We're gonna need a bigger brace

2011-09-21T20:23:00.002-04:00

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

2011-09-19T18:11:00.000-04:00

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

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

Dr Obvious attends to detail

2011-09-13T21:44:00.000-04:00

"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

2011-09-04T20:21:00.000-04:00

"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!

2011-08-18T18:39:00.001-04:00

"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

2011-08-14T17:03:00.000-04:00

"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

2011-08-07T22:53:00.000-04:00

"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

2011-08-05T03:01:00.000-04:00

"POSTOPERATIVE DIAGNOSIS: Dinosaurs caries."

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

If that's your chief complaint, geddouttahere

2011-08-03T19:17:00.000-04:00

"She is widowed and is tired."

Gone fishin'

2011-08-02T21:03:00.001-04:00

"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

2011-07-31T23:35:00.000-04:00

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.

2011-07-28T16:23:00.002-04:00

"She has a burning IUD in place."

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

Twittering

2011-07-28T02:17:00.001-04:00

... 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

2011-07-28T01:08:00.000-04:00

"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

2011-07-27T16:33:00.002-04:00

"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

2011-07-26T19:47:00.003-04:00

"...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.

2011-07-25T23:19:00.000-04:00

"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

2011-07-19T21:50:00.003-04:00

"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

2011-07-19T01:34:00.003-04:00

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

2011-07-17T23:28:00.001-04:00

"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!.

Blah, blah, blah... (yawn), blah... wait, WTF?

2011-06-12T23:46:00.001-04:00

"Hypokalemia may be mediated by her hydrochlorothiazide. I would expect her lisinopril to kill her."

(Dictated was "expect her lisinopril to counter...")

Dr Obvious is in the house

2011-06-09T23:34:00.000-04:00

... or maybe it was just too soon after watching Hitchcock's "Psycho":

"Social history: The patient takes care of his mother.

* * *

Family history: The patient's mother is still living."

Not a speech wreck. Just to keep you on your toes.

Yeah, we've got an outbreak of that here, too

2011-06-02T04:07:00.000-04:00

"Patient also has a diagnosis of ringed nose phenomenon."

(Approaching pandemic? ... Thanks to V.R. for this one!)

Doc has a gift for understatement

2011-06-01T02:57:00.000-04:00

"The arm and wrist were removed and there was noted to be stability of the joint."

In Soviet Russia, speech wrecks you!

2011-06-01T02:53:00.000-04:00

"Mr. Xxxxovich is a pleasant elderly male from unbearable Russia."

It could be worse. I think.

2011-05-31T01:03:00.000-04:00

"He lives with his wife, who is still living, but who also has some health problems."

Fun With Names, It's Been Too Long edition

2011-05-31T00:58:00.001-04:00

Yeah, it has been a long time, hasn't it?

Dr Bronco Rhonchi

Dr. Rub Steroid

Dr. Scatterbrain

Dr. Is Not In

CONSULTING PHYSICIANS: Dr. Are Not, Dr. Already Well

...and we have found just the right facility for all these guys:

Failure Medical Center

tough love

2011-05-25T20:11:00.002-04:00

"The patient will be kicked in the chest pain observation unit overnight."

Umm... might want to try a different specialist

2011-05-23T16:15:00.000-04:00

"He had no response of his wide-complex tachycardia to a dentist in the emergency department."

(Dictated: "... to adenosine...")

It's probably not contagious

2011-05-23T16:10:00.000-04:00

... Culture positive for gram-positive cockeye.

Mrs Gingrich, the lawyer will see you now

2011-03-01T17:09:00.002-05:00

"Further care pending divorce in the hospital."

(Oh, dear, that was kind of political, wasn't it. How naughty.)

And he wan't amused either.

(Dictated: "...pending course in the hospital.")

Coming soon: The Skeletina diet

2011-03-01T17:09:00.000-05:00

"CHIEF COMPLAINT

"I want to lose weight. I want to be faxed."

(Dictated: "... I want to be back [to my old self].")

Thanks to SO for this one!

Docs versus Zombies!

2011-02-18T04:11:00.000-05:00

"He is, of course, at risk of acute decomposition."

(Dictated: "...of acute decompensation")

Speech Wreck: Valentine's edition

2011-02-14T01:49:00.002-05:00

Speech Wreck has a sentimental side, and what better day for a glimpse of it.

"Plan:
Check an echocardiogram.
Sputum culture.
A little tenderness."

Being the jaded old cynics we are, we happily observe that Speech doesn't neglect the, er... friskier side of things, either:

"Again, special note, I discussed this patient in bed with Dr. Attending."

(Dictated: "...I discussed this patient in depth with Dr. Attending." Thanks to the eagle eye of JW for this one.)

New diagnosis

2011-02-03T23:37:00.000-05:00

The patient has a "history of chronic NERD."

Dunno about you, but I'm guilty as charged.

Hold the lox

2011-01-02T15:15:00.004-05:00

"The patient is a pedestrian struck by a bagel tonight."

Happy New Year, everyone, and watch out for giant bagels in the streets.

("... struck by a vehicle..." And thanks to S.O. for this one!)

There's no surgery for that

2010-12-16T16:41:00.000-05:00

"The patient reports a bulging desk."

And don't call me Shirley!

2010-12-02T20:25:00.000-05:00

Speech Wreck inadvertently served up a timely little memorial to Leslie Nielsen today:

"Shirley. The patient has had a prodrome of diarrhea for weeks, but more concerning is the onset of fever and epigastric pain..."

(Dictated was, "Surely, the patient has had...")

(R.I.P., Mr Nielsen, and thanks for so many laughs...)

Hurry, or you'll never catch them!

2010-11-29T17:36:00.000-05:00

"She has IV fluid running at 125 miles an hour."

It sucks to be him

2010-11-22T15:33:00.000-05:00

"He is allergic to diltiazem, oxygen, and prednisone."

Fun With Names, Thanksgiving Edition

2010-11-18T01:19:00.003-05:00

--This actually has nothing to do with Thanksgiving, but it sounds cozy, doesn't it?

Dr. Might Go Walls (orthopedic surgery)

Dr Brake Lining (nephrology)

Mr. Clinic Head

Dr. Sputum Coming

Dr Serene

Okay, one CT, you want fries with that?

2010-11-11T22:45:00.001-05:00

"We will have the CT scan from McDonald's sent to us for review."

Times are hard and funds are short

2010-11-01T22:39:00.001-04:00

... so hospitals are exploring creative staffing options.

". . . .She suffered a fracture that was treated with closed reduction by the horse OPA in the emergency room."

We don't know what level of certification "OPA" represents, but we have full confidence in horses around here, so we're sure he did a pretty good job.

(Okay, okay, it was actually "...by the ortho PA." Spoilsport.)

No one can accuse this doc of not spending enough time with his patients

2010-10-19T17:37:00.001-04:00

"Time spent preparing this patient for discharge has now been 41 months."

Caring, you know? It's all about the caring.

2010-10-17T23:06:00.004-04:00

"He is critically ill. His prognosis is discarded."

Dangers of the passive voice and slippery articles

2010-10-07T21:27:00.002-04:00

"The patient recently had a husband die."

This painfully passive-voice remark with it's odd use of "a" was thought about by me, and it was wanted by me to be finished in an interesting way, such as:

"... but the patient still has two husbands who are not dead, so she is having her garbage taken out by one and having her lawn mowed by the other."

(In case it can't be noticed by you, the passive voice is much utilized by medical professionals but is detested here at Horse HQ.)

That's the third one this week; the rounding team keeps tripping over them

2010-09-28T15:55:00.001-04:00

"The patient stated that the pain was like stabbing. He was killed over on the floor."

(Dictated: "... he was keeled over on the floor...")

With friends like this you don't need enemies...

2010-09-23T22:17:00.001-04:00

(... but you might need psych meds).

"He is currently living with his skull friend."

("living with his girl friend" was dictated, sort of).

Speech Wreck knows more than you do

2010-09-23T20:37:00.000-04:00

"Pneumovax is not safe."

My goodness. I'll just send this important news out over the Internets, and we'll all be safer soon. Thanks, Speech Wreck!

Voice Recognition, Scottish style

2010-09-19T16:13:00.011-04:00

A hilarious take on the horrors of letting Speech Wreck take charge of an elevator. (Mildly NSFW due to one slightly naughty outburst... --oh, and there's an irritating laugh track, too.)

In other developments...

2010-09-16T17:28:00.002-04:00

"He then developed the development of leukocytosis."

Speech Wreck and found poetry

2010-09-16T17:00:00.003-04:00

See, what happened is, this resident was dictating and hung up, somehow, but what he had actually done was put himself on hold. And, as also happens from time to time, the institution's recorded on-hold marketing spiel took over the call. Which was being sent to the Speech Wreck server.

For 36 minutes. Well, there was a little music, too. But mostly spiel. Over and over.

Speech Wreck didn't know quite what to do with the repetitive marketing spiel, so it created from it a rather fine postmodern existential poem. (I helped it with the formatting, 'cause poetry is important). The poem is about tongues, and Illinois (please note: The facility is not in Illinois), but that's just the surface stuff. Mostly it's about goals. And about being oriented.

After you read this your goal will be to become oriented in Illinois. This is my dream.

00000 time a at
in the oriented goals
UA he time is a 0 lingual
and really in the oriented goals
outlined U the 90 he time and the lingual and is lingula
in the oriented goals
lying in the a UI time the OU but lingual and Illinois
in the oriented goals
MI in the UAUI spine strain use the O, but lingual and Illinois
oriented bolus
outlined in the AU she I spine strain use the ULO sublingual
at goals
and U she is in a UIO spine strain the ULO lingual
and in the or goals
and UAUI this time use the ULO lingual and
he U oriented goals
and EAU she IO this time.
She the O lingual and, I,
Illinois
or
goals

Who knew it was so dangerous?

2010-09-09T17:40:00.001-04:00

".... Will continue high risk oxygen and vancomycin."

Might want to call the lawyer first. Just sayin'. (Dictated was "hyperbaric oxygen").

Today is Dada-Day

2010-09-07T18:56:00.001-04:00

(Every day should be Dada-day, really. Anyway:)

Dictating on the roof of the heart. She can generate thank you changes in her states. Cups to do what we have to the medics; research the discretion of the disk. Nature to see him out. Platelets of 290,000 with a normal death. Share in a crack boot for antiquite ill, Asian ambulating in my catheter. Pulmonary movements are slow and low. Except the patient does have a bad crack.

Another strange obsession

2010-09-02T20:22:00.002-04:00

... sometimes it's beer. This time it's a whimsical interest in the name "Michael." And bilingual, too!

"I closed it with Michael in the subcu."

"Chest x-ray reveals evidence of Miguel abnormalities."

She's asymptomatic, but I have a headache now

2010-08-31T21:10:00.000-04:00

"I told her she is having asymptomatic symptoms."

Thanks for clearing that up.

Are you a good witch, or a bad witch?

2010-08-30T16:37:00.003-04:00

"I am going to send her home with Glinda."

Oh, man, I hope the ruby slippers are still in the patient-belongings plastic bag thingie.

("There's no place like home... no place like home... " BTW, he dictated the silly doc-invented non-word "clinda," so he got what he deserved).

Colonoscopy is teh awesome!

2010-08-26T16:19:00.001-04:00

"Total cool endoscopy to the cecum and terminal ileum."

Only Speech Wreck would think it's cool to have a medical instrument shoved up your... oh, never mind.

Don't leave home without it

2010-08-25T01:47:00.001-04:00

"She has her husband and her gallbladder at her bedside to offer support."

(Dictated: "... adult daughter...) Thanks to LG for this awesome Wreck.

Pleasant patient is pleasant!

2010-08-24T18:39:00.001-04:00

"Mr Oldguy is a pleasant gentleman who appears somewhat confused but pleasant."

Monday is Fun-Day

2010-08-23T18:04:00.003-04:00

Fun With Names, that is. Let's see what we've got today:

Pity the poor fellow whose name, apparently, is "Robert Underwear Fluids."

"Dr. might go walls" of orthopedic surgery.

"Dr Bender Clot."

... And, oh dear, there's so much that could be said about a guy named. . . "All-terrain Johnson."

(Like, if only, instead, the poor guy had an all-terrain brain...)

This patient should really get out more

2010-08-19T16:59:00.001-04:00

"The patient is seen today in the context of an outpatient fever and no ladies and jaundice."

(..."elevated LFTs and jaundice," but how boring is that).

You think maybe he should go with just the VapoRub?

2010-08-18T15:06:00.000-04:00

(Patient with cold symptoms, etc.) "He has tried toxin and VapoRub OTC."

Elitist bacteria

2010-08-17T17:33:00.001-04:00

"...Esoteric coli sepsis."

Not for us common folk! (Thanks to T.J. for both wreck and caption).

Dr Obvious is in the house again, reminding us that gravity is still the law

2010-08-16T18:39:00.001-04:00

"This gentleman fell 20 feet off a scaffolding on a construction project earlier today. He landed below."

That's odd; usually they have the opposite problem

2010-08-15T21:58:00.001-04:00

"She has noted feeling sad and anatomic."

p.s. If you, too, think this hoodie is pretty cool, go here.

(Dictated: "... sad and anhedonic...")

Dr Obvious is in the house

2010-08-11T22:48:00.000-04:00

"Chief complaint: Motor vehicle accident prior to arrival."

TMI

2010-08-11T20:21:00.000-04:00

(In social history): "He rubs with his wife."

It's good to know he doesn't rub alone; that would be weird.

(Dictated: "He arrives with his wife").

Speech WRx--The All-Inhaler Edition!

2010-08-11T01:02:00.003-04:00

1. Format motor humor
2. Forward a little bit Carol Weiser**

3. T-max twisting

4. Spy Reeve

1. formoterol fumarate

2. Foradil Aerolizer

3. Asmanex Twisthaler

4. Spiriva

** (note: This "name" came along as part of the random speech wreck; nothing to do with a real patient's name!)

Optimism is overrated

2010-08-09T19:10:00.002-04:00

"He may return to the emergency department on an as-needed basis, versus not survive."

He presents accompanied by guacamole

2010-08-08T19:35:00.000-04:00

"The patient also states that he is chili all the time."

Can you have too much of a good thing?

2010-08-05T21:59:00.000-04:00

". . .generous general endotracheal anesthesia."

Poor Speech is a Nerf-ous wreck

2010-08-04T17:28:00.001-04:00

"The patient will also be on amitriptyline for insomnia, but also for Nerf modulating effects. . ."

Poor thing. Nerf stuff used to be sorta innocuous and squishy,

But now? Now Nerf has gone all weaponized and paramilitary. Note the kid's expression. No wonder she needs help sleeping.

So much depends. . .

2010-08-03T16:56:00.001-04:00

(Let's see if anybody gets it. The pic is a clue...)

"...Possible barrow reflex failure."

(Dictated: "... possible baroreflex failure")

She can't hear well and it's pissing her off

2010-08-02T19:48:00.000-04:00

"... decreased hearing in the right kidney."