Language Skills Worksheet #4

Many doctors dictate in a conversational, stream-of-consciousness style. This habit can result in frequent contradictions and statements which make no sense. Poor sentence structure and improper punctuation can cause further confusion.

Each one of these statements was dictated by a licensed physician. Diagnose what is wrong with the dictating doctor's statement and write your own version of what the physician failed to communicate.

"The patient is now producing a stool specimen here for analysis but most likely this is viral."

Diagnosis:

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Corrected Text:

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"The patient is a 90-year-old whitefemale who states that she was bending over today, putting in a drawer, when she felt her hip pop out."

Diagnosis:

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Corrected Text:

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"The patient came to the EmergencyRoom with a history of vague abdominal discomfort, or chest pain, or neither,or both, lasting for the last several days or not."

Diagnosis:

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Corrected Text:

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"The patient radiated to the right."

Diagnosis:

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Corrected Text:

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"Significant for high cholesterol which is controlled by medication and vasectomy."

Diagnosis:

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Corrected Text:

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"The patient was advised to not lift any heavy weight such as a box of French fries."

Diagnosis:

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Corrected Text:

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"His elevated LDL is here to be discussed."

Diagnosis:

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Corrected Text:

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"Her mother died last May after sixty years of smoking camels."

Diagnosis:

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Corrected Text:

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"A baby was born in the toilet of the Emergency Department."

Diagnosis:

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Corrected Text:

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"The patient had 10-12 diarrhea stools with no flushing."

Diagnosis:

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Corrected Text:

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"Cardiovascular system: There was no murmur noted during hospitalization and perforation was good throughout."

Diagnosis:

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Corrected Text:

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"The patient had some things in her nose and her mother and her sister do, too."

Diagnosis:

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Corrected Text:

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"The patient passed out at work and was found on the floor by his desk."

Diagnosis:

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Corrected Text:

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"The patient was recovered on the ward when she was fully awake, approximately 30 minutes after she woke up."

Diagnosis:

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Corrected Text:

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"Rectal examination was not done because they could not find any lubricant on the floor."

Diagnosis:

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Corrected Text:

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"She complains of no history of injury today or tomorrow, but she maybe sprained her left ankle about a week ago, and is now limping."

Diagnosis:

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Corrected Text:

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"She has no new acute complaints except that she feels somewhat more nauseated than old."

Diagnosis:

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Corrected Text:

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"The patient was taken to the recovery room in good disposition."

Diagnosis:

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Corrected Text:

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"Diagnosis: Questionable history of uterus and cervix."

Diagnosis:

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Corrected Text:

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"Emergency Room Course: The patient was given Maalox 30 cc p.o. with 98% pulse oxygenation on rectal exam."

Diagnosis:

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Corrected Text:

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"Because of some hypocalcemia requiring intravenous supplementation transitorially, she was in the hospital the sixth postoperative day when she was discharged on oral calcium supplements with diet and activity as tolerated."

Diagnosis:

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Corrected Text:

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"Definitely, laparoscopy would be really the only thing that could really help us to really look at this area."

Diagnosis:

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Corrected Text:

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"He had a pacemaker placed in the East Bay for unclear reasons sometime in the last few years."

Diagnosis:

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Corrected Text:

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"So even though her lactate extraction is normal and therefore she doesn't have ischemia, she certainly looks like an ischemic response to morphine and her ST segments would scare the most brave of cardiologists when these changes occur."

Diagnosis:

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Corrected Text:

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"This patient is very fart and smunny."

Diagnosis:

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Corrected Text:

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