Talking To Myself In A Quiet Room

By John H. McCord, DPM

   Documenting chart notes has become a pain in the butt. In the good old days, I would handwrite one or two lines after rendering routine foot care. Now I have to dictate a chapter of War and Peace after trimming a few toenails. It is even worse if the patient comes in with a complex foot problem. I have to insert all the bullets to justify the billing code or go to jail for 10 years if the dreaded audit occurs.    I never wanted to buck the system so I hired a transcriptionist (one who can listen, type and keep track of office gossip all at the same time). That worked for a few years until she got burned out and we had to move her to a podiatry assistant position.    I outsourced the transcription for a few months. The typist got behind by a few weeks so I tried an online outfit. The work was prompt. Every morning we turned on the computer and downloaded the previous day’s work as an attachment in Word.    That outfit charged by the line and they really knew how to cram 10 lines into 25. It got to be very costly. My young partner was from the school of thought that says, “If a thorough note is good, a really long thorough note is better.” I needed another method of getting our chart notes on paper in a timely manner without going broke.    Voice recognition software has been around for about three decades. I first observed it when a neurologist, with whom I shared space, began sitting in a quiet room talking to himself in a slow monotone voice. I figured he was trying out for the Dustin Hoffman part in Rainman or he was forgetting to take his medication. I poked my head in the door and said, “What the hell are you doing?”    He turned, scowled and then let out a few curse words. I watched in wonder as the string of expletives streamed across his computer screen. He later explained that he had bought voice recognition software for about $3,000 and was planning to fire his typist. I calculated that at eight words a minute, he could only see four patients a week. I also promised myself that if I ever found myself in a quiet room talking to myself in a monotone voice, I was going to apply for a greeter’s job at Wal-Mart.    Well, now I sit in a quiet room talking into a microphone while the words I say dance across a computer screen. I decided to install voice recognition software. I didn’t buy the expensive medical version. I bought the cheap standard version from a “big box” office supply place for $155.    I heard horror stories about the learning curve. An internist friend spent six months learning to use the program and gave up. This was a challenge to me.    I installed the program and then read something by Dave Barry for about 10 minutes into the microphone. In less than a half-hour, I was talking and the computer was typing. I used it for all my chart notes and consults the next day.    My young partner didn’t have it quite so easy. He uses a lot of complex sentences that require commas and semi-colons. He is also Canadian and says “ay” at the end of his phrases and sentences. This caused some problems. The computer typed every “ay” and every “um” and “ah.”    I watched him struggle and finally gave him some advice. Don’t speak Canadian to the computer anymore and use simple declarative sentences. Talk to the computer like you talk to a dumb orthopod. No big words or complex thoughts. It worked like a charm. Now my partner sits in his own quiet room chattering away to the computer with one and half pages of chart notes for everything. Now we are all happy. Our transcription costs practically nothing although there have been a few complications.    Mike had the flu last week and coughing screws everything up. I had the hiccups all day once. That triggered page breaks each time I hiccuped. I had to merge the paragraphs and delete a few curse words but it all worked out.    We have developed templates and macros for operative reports and commonly used chart notes. When we say, “Macro tibial border left hallux” the computer spits out a complete operative report for the nail procedure. It is the easiest system I’ve ever used and saves lots of time.    Our former typist has turned out to be a wonderful and motivated podiatric assistant. We are going to survive the documentation crisis. Dr. McCord is a Diplomate with the American Board of Podiatric Surgery. He practices at the Centralia Medical Center in Centralia, Wash.

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