Dictation Therapy For Doctors: When English is a Doctor's Second Language

Physicians who speak English as their second language pose a particularly stiff challenge to medical transcriptionists.

Some of them have trouble forming a complete sentence.

Others are so nervous about having to express themselves verbally that they start each sentence anew six times.

In some cases, it is simply impossible to understand what the physician is trying to say.

One doctor, who cannot pronounce the word "period," mutters something that sounds like "pesh." A transcriptionist who is unfamiliar with this physician's style would have tremendous difficulty understanding the doctor's dictation until he came to the part in a report where the physician said:

"Pesh. Pesh. Another pesh. And a new pawagwaff."

Whereas court reporters must report what is said verbatim, medical transcriptionists must try to make sense out of dictation like the following:

"Harro, Harro, Harro! Opative leport for Johnson Ralph. Fust, we do a couple-a things, uh...we yank out his gallbladder and then we appendectomy. However, appendixicitis not found, so we poke around his stomach and find ulcer, sew up."

The medical transcriptionist working on this case eventually settled on the following interpretation:

OPERATION PERFORMED: Cholecystectomy, incidental appendectomy, oversewing of gastric ulcer.

I am deeply indebted to a fellow MT who sent me the following message:
George, if you are ever going to start a dictation school for doctors, I am willing to sponsor this guy. Have a look at one of his dictations:
"CHIEF COMPLAINT: Abdominal pin.
HISTORY OF PRESENT ILLNESS: Patient is an elderly 85 years old wide female has been suffered from constant pin in left frank and mainly in left low chest rib area and left upper quadrant, sharp, blacks to win, radiate to back. Pin has been going on for three days. She also woke up 2 o'clock today with significant pin, cough, deep inspiration also caused more pin on reft frank area. No nausea or vomiting. She had otic wall dissection before with similar pin. She came to hospital for help. No chest pin, no palpitations, no shortness of breath. At ER, patient vital sign stable. Patient pin slowly improved. When I saw patient, patient pin basically only one out of ten levels of pin.
PAST MEDICAL HISTORY: Otic aneurysm and otic dissection x2, coney arty disease, chf, hypertension, colonic afib with Coumadin, let me see ah, Lima toe arteritis and djd stapost total hip arthroplasty x2, copd, next is hypothyroidism, next is paragraph.
ALLERGIES: Mopping causes hives.
SOCIAL HISTORY: Quick smoke for several years, no alcohol use.
FAMILY HISTORY: Positive heart disease.
MEDICATIONS:
1. Synthroid 100 mcg po daily.
2. Lasix 20 mg po daily.
3. MTX 2.5 mg po weekly.
4. Dear Tizen 180 mg po daily.
5. Atenolol 50 mg po daily.
6. Benicot 40 mg po daily.
7. Coumadin 2.5 mg po daily.
8. Digoshin 125 mcg po daily.
REVIEW THE CISTERN: Remarkable for constant abdominal pin in left frank and left up quadrant radiates to back, wrecks on the wind. No nausea vomiting. No diarrhea or abdominal crampy pin. No typical chest pin. No focal weakness. No mental status change or passed out.
PHYSICAL EXAMINATION:GENERAL: Alert and oriented x3, follows commands, no respiratory distress.
VITAL SIGNS: Broad pleasure 158/99, pause 67, respiration rate 16, and temperature 97.5.
HEENT: Normocephanic atraumatic. Pupils equal, round, and reactive to night and accommodation.
NECK: Supple, no active jaguar penis distention, no active tenderness.
LONG: Clear to auscultation, no rales.
CHEST: No chest wore tenderness.
ABDOMEN: Soft, no tenderness, positive bowel sounds.
EXTREMITIES: No pity edema, 2+ pauses bilaterally.
LABORATORY STUDIES: Abdominal CT with contrast: Basically no acute change in dissection or aneurysm compared with previous CAT scan, angiogram, and CT of chest on July 3, 2005 and February 2006. EKG: Atrial fibrillation, rate controlled. CBC showed hemoglobin 13.6, WBC 7.5, platelet 253. Chem-7: Sodium 140, potassium 3.9, bicarb 29, glucose 94, BUN 19, creatinine 1.3. CPK 57, nipase 177, troponin less than 0.04. PT 20.9 and INR is 1.8.
ASSESSMENT AND PLAN: 85 years old wide female with the abdominal pin.
1. Abdominal pin, etiology unclear, resoled. This pin has not came from patient's otic aneurysm or dissection. Recommend observation rule out other sauces. Patient's pin already resoled in the ER already. We will admit patient now, observe, rule out cardiogenic sauce by EKG and cardiac enzymes. We will consult cardiologist for further evaluation. May use Tylenol if necessary.
2. History of otic aneurysm and dissection x2 appears stable. We will also obtain former radiology report of today's CT scan with contrast.
3. COPD - appears stable.
4. History of coney arty disease, CHF, hypertension, and afib. We will continue home medication.
5. Hypothyroidism. Resume medications.6. Lima toe arteritis - stable."

Now, you might think all of these misspellings were created by a voice recognition engine that substituted the wrong words for the doctor's speech. But that's not the case at all. "If I were to try to reproduce some of what voice recognition has come up with, I would be thrown out of this forum for using foul language," Harry confessed. "The way the term current medications was 'recognized' immediately comes to mind!"
Instead, what this medical transcriptionist has done is to recreate the actual sound of the doctor's dictation. "It is as verbatim and sounds almost just like what the learned physician dictated. Asian EFL, not ESL," stressed Harry. "English is a foreign language as far as he is concerned and he has the right to mangle it as much as he can. This guy was so polite that he ended the dictation with a 'Sank you.' We do his files the way we do crossword puzzles."