Thursday, September 19, 2013

The worst way to dictate

I recently saw a resident named Jimmy dictate in the worst possible way I've ever seen anyone dictate in my whole life.

Before dictating his note, Jimmy types up the HPI so that he can read it for his dictation. So for every single patient, he types the history, then dictates the entire note. Have you ever heard of something like that? You should have seen my face when he told me.

Me: "No way. You don't really do that."

Jimmy: "Yeah, I do."

Me: "No way."

Jimmy: "It's just easier for me."

Me: "Oh my god."

Jimmy: "Yeah."

Me: "You have to stop doing that!"


  1. I haven't written down a history since third year medical school. Ugh, that is an awful, awful habit.

  2. I do that, but I'm a medical student...

    1. Why would you dictate it after you've already typed it? The one purpose of dictation is to make somebody else do the work of operating a keyboard.

      If you really need to type to organize your thoughts, type it directly into the EMR and save everyone a bunch of time.

  3. He'll learn when time becomes a bigger consideration. My written history in training was 2-3 pages. Now it's a sentence or 2.

  4. That will likely be me as a resident and attending, but I think I'd rather just type everything myself rather than dictating. I have trouble gathering my thoughts and remembering important details if I try to just say it out loud without writing/typing something first. I feel really disorganized if I have to present a patient without at least some notes jotted down. Then again, I feel like I could type a note faster than I could dictate a note to begin with.

  5. Two out of the four doctors I work for just type their own. The other two change the ones I type so I have to correct them. I think the issue is the different types of learning/personalities...some people have to see it on the page. I have noticed that a lot of run-on sentences are dictated, and it would be very easy to make a mistake and divide the sentence in the wrong place. Good thing I'm paid by the hour and not on production. I work in a nursing facility so I also have access to their medical records to check if I need to.

  6. I used to type then dictate. Took ages. By the end of first year though, you realize it's a time suck and just write good notes in the chart, so it's easier to dictate after.

    I actually tried to type up a dictation I did just to see how long it takes. Turns out I speak a lot faster than I type. I was three sentences behind on my typing after like the first sentence.

    So yeah, dictating is a lot faster than typing. But it's a learned skill and takes a while.

  7. For you students the dictating will come if you facility still allows it. I do love Dragon in one hospital where I work. I end up dictating my HPI and usually then use shortcuts I was able to program in for most of the PE and A/P. Sometimes dictating part of the plan. Even as a very fast typist it's still easier to dictate certain portions, once you get the hang of it, regardless of how fast you type.

  8. I'm a senior peds resident... and if I have a complicated note to dictate I often still type out the HPI. Staff sometimes balk if they see me typing until they realize how fast I can actually type and how organized my notes are.