Technology adds spiceto reporting chores

December 1, 2008

I have severe pains in my head and my right hand that have started only recently. I wonder if I am working too hard, though my chief says that my output and efficiency can only be described as average.

I have severe pains in my head and my right hand that have started only recently. I wonder if I am working too hard, though my chief says that my output and efficiency can only be described as average. I claim that things were better in the old days, but he says that is just a fairy story. Bear with me and listen to my fairy story and see if you can understand the cause of my pains.

Once upon a time there were a radiologist and a secretary. The radiologist looked at films and thought long and hard, bringing all his experience and training to bear. He occasionally referred to large texts. The radiologist then made wise pronouncements that the secretary typed up into a report. The room was dark and cold, perhaps just a little damp, and it had a reassuring acetone-like smell of old films. The typewriter was noisy, and the ribbon often needed changing. On the rare occasions that the typist made spelling mistakes, correction fluid was used to cover the error.

The arrival of the word processor changed that special and peculiar environment. This was a big step forward. The secretary was able to type faster, mistakes were corrected onscreen, accuracy improved, and the efficiency of the radiologist and secretary was enhanced.

My secretary also alerted me when I confused left and right, organized my diary, typed my letters, responded to queries, dealt with patient inquiries, and ran the office. In essence, I had my very own personal assistant to smooth the complexities of the day. This allowed me to concentrate on what I had been trained to do: read medical images.

But progress cannot stand still. One day a wizened old woman with a crooked nose came to the office to tempt us with an Apple. (Actually it was a PC, but that fits poorly with the fairy tale theme.) What more could we wish for? With a personal computer we could ensure the accuracy of our missives, store data electronically, and recall relevant communications at the touch of a button.

But the "touch of a button," unfortunately, happened too often. Repetitive strain injury became a new term in the medical lexicon. Radiology secretaries appeared to be particularly vulnerable. Like Rumpelstiltskin's princess, the faster they worked, the more they were given to do. More and better changes came with our computing "apple." With the advent of e-mail and spellcheckers, I could respond to letters and other inquiries myself. A new immediacy took hold. Shouldn't I be able to reply at once to information that had been sent electronically? I would need my own laptop, perhaps a PDA-or maybe even a BlackBerry!

So who now types my letters, generates articles, creates PowerPoint presentations, organizes my diary, and answers the e-mails? Aha! So maybe that is why I have a sore head and pain in my right hand!

I hear your advice. What you need, Dubbins, is voice-activated transcription. You speak with clarity, you are used to dictation. You can even pace the room while you dictate, alleviating that low back pain.

Except that I already possess voice-activated transcription software. I have been trying to teach it how to write English, but things are not going well. As you may recall, it was my secretary who could spell, not me, so that part of the training is proving to be a problem. As for the pronunciation training…

The reports I wrote today have been particularly enlightening. I will choose just two examples. When describing Doppler signal for the kidneys, my statement that "The left has low peripheral resistance" became "Left lobe peripheral assistance." My favorite, though, is what will inevitably become a case report for unusual involvement by endometriosis, which extended into the "knees and rectal fascia."

I had already become accustomed to shouting at the computer when it crashed midway through a piece of work. Now I am arguing with software that thinks it knows how to report a radiological study better than I do.

So the pain in my head actually has to do with rhythmic banging against the wall. The pain in my hand? Well, it didn't hurt before my fist went through the computer screen, but it sure does hurt now!