Top 10 Funny Dictation Errors

I count down my top 10 funny dictation errors.

The worse part of my job is paperwork. One of the ways I get around the time consuming activity of record keeping is through dictation.  I use a medical version of Dragon dictation software which works relatively well… except when it doesn’t.  Certain proper names and newer medications are not readily recognized by the system and make for some entertaining and often funny statements within patient’s official records.  I catch most of these but unfortunately some do slip through.  Below I count down my top 10 funny dictation errors for your entertainment.

1. “She saw her cardiologist and these are relatively low was stopped”

Strangely, this one phonetically sounds pretty close. The medication is called Xarelto which was stopped.

2. “Your ratio of going to bed cholesterol is in a good range”

Wait!  You haven’t heard about that “going to bed” cholesterol?  This is cutting edge research on the cholesterol that increases when you head hits the pillow. Just kidding, this should actually be “ratio of good to bad cholesterol.”

3. “She completed the doctor Franklin yesterday”

Yeah, Dr. Franklin is a jerk.  I’m done with him too.  Actually, I stated the patient completed the “nitrofurantoin” (an antibiotic) yesterday. Yeah, that's not even close.

4. “She has avoided smoking and oral cultures except as because of this.”

Oral cultures? There must be something weird growing in there to want to avoid any cultures.  What this should say is “oral contraceptives."

5. “He would like to see Dr. ziploc” 

This one is not even close.  The doctor’s name is Des Pois, and while it is a nice french name, it’s not ziploc.  And I’m pretty sure ziplock is not french.

6. “The prescription was sent into his optimal Rx male service pharmacy.”

I am not sure the patient wanted any “male service,” but I guess I could be wrong. Well, at least it’s an “optimal” service. What this should say is Optum Rx mail service pharmacy.

7. “He fell asleep against a teacher.”

Man that must have been a boring lecture. Or there was something more suspicious going on.  The patient actually fell asleep against a heater.

8. “CT images reviewed indecently as well and discussed with patient.”

No, I am not turned on by CT scans and was not looking at it in an inappropriate manner.  I was actually reviewing it “independently.”

9. “He has not seen Dr. genitalia”

Fortunately our nurse caught this one.  While there is not a doctor named genitalia, this almost does fit.  The doctor I was referring to is named Dr. Janiga, and coincidently he is a urologist.

10. “He decided to try to see Alice for his erectile dysfunction.”

I don’t know who Alice is, but if she can cure ED she must be something. I figure I can’t be the only one who’s ran into this with a medication called “Cialis” on the market.

I hope you enjoyed these and got a laugh out of them like I did.  While I can laugh about these, I have an underlying queasiness knowing that there are probably just as many or more lurking in other patient’s charts that I have missed.   I’m sure years down the line I’ll look back and read some of these and be able to enjoy the mistakes.  For now, enjoy these as an early Christmas gift to you.

If you enjoyed this funny post, you may also like my post on vasectomies here.

How to Become a Doctor: Part 3

The conclusion to my journey becoming a doctor.

As with every good story, there needs to be a trilogy.  So this is the third installment of my story and how to become a doctor.  You can get caught up on the first two posts here: Part 1 and Part 2.  Last post ended as I graduated medical school, but this one starts before that.  At the end of the 3rd year of medical school, every medical student sets up an ERAS account. ERAS stands for Electronic Residency Application Service.  This is where we were able to start the application process for residency.

Prior to applying for any residencies, I had to decide on a specialty.  I decided to become a family physician and applied to only Family Medicine Residencies.  The experiences of other students applying to surgical specialties or the most competitive residencies such as dermatology, ENT or ophthalmology were much different than mine.  I can only relay my experience.  Family Medicine is traditionally considered a less competitive specialty, but I chose it because it was what I wanted to pursue, not because it was easy.

In September through December of the 4th year of medical school, I traveled to the residencies which had offered an interview based on my application.  Having grown up in Northern California I knew I wanted to move back. So I interviewed at the UC Davis Family Medicine Residency Network (a network of 7 family medicine residencies from as far north as Redding down to Merced in the central valley), Loma Linda (mostly as practice as I knew I didn’t want to stay is So Cal), Reno and a few others in the Bay Area and Sacramento.

In January after all of the interviews are completed, all students make a ranked list through ERAS of the residencies they would like to attend.  The Residencies all make a similar list on their end.  The ERAS program then takes all of this data and matches up students to residencies using a complex algorithm.  In March, the results of this program are revealed on Match Day.  If a student didn’t match (which does happen, especially in the more competitive residencies), they find out 2 days before Match Day. The next day is then spent literally calling residencies looking a position (sometimes out of the residency of their choice) in a process called scramble day.  This is a complex process which is extremely stressful that I thankfully avoided and do not have insight into.

My match day was an exciting and nerve racking day.  The results of the match are released to every medical student across the country at the same time.  At Loma Linda there is a banquet where they pass out the results.  Waiting my turn felt like forever. Finally, my name was called and I went up and got my envelope.  I went back to my seat, sat next to my wife and slowly opened the envelope.  In small 12 point font were the words, “Mercy Medical Center, Redding.” This was second on my list. I was excited. We were moving back north but had overshot Sacramento! The next few months were spent setting up some housing and getting settled in before residency officially started on July 1.

Residency for family practice is a 3 year program. The first year, or intern year is the most grueling but it improves through years 2 and 3.  For family practice I wanted want to go to an “unopposed” program to get the best education.  This means that there were no residents from other specialties at the hospital.  This was ideal because I was not competing with the other specialties for procedures or patient contact.  Mercy Redding is an unopposed program where we residents had full reign and could do just about anything as long as we could find an attending to follow.

Residency was similar to the 3rd and 4th year in medical school in that I had rotations through different specialties to gain experience.  Since family practice is a specialty that encompasses so many different areas of medicine, we rotated through just about every specialty.  There was a focus on internal medicine, pediatrics and Obstetrics-Gynecolgy.  

Learning through residency was mostly done while treating patients under the supervision of an attending.  “Pimping” was still prevalent during rounding. Every lunch time was also a didactic period spent listening to a lecture on different topics.  Repetition was the key so we were exposed to patients as much as possible.  This included taking call and working long hours.  Luckily, we had a “night float” for internal medicine.  Night float is where one resident works nights for a week or two to cover the overnight shift.  Unfortunately, we did not have night float for pediatrics and OB-GYN so we took call about every 4th night.  I was again blessed to be a “white cloud” but still had a few rough nights.  

At the time I was in residency, laws were in place to make sure residents were not overworked.  When on call we could only work for 30 continuous hours.  So typically we would show up at 7 AM the day we were on call and work through the night until 1 PM the next day. There was also a law that residents could “only” work a max of 80 hours.  Fortunately it was very rare that I hit that number.  It was not unusual to work 60 or more hours though when on an inpatient rotation.

At a point in the intern year every intern takes the last test in the USMLE (United States Medical Licensing Exam) series called “Step 3.”  This one allows a resident to get his or her state license.  Once this and a year of residency were completed, I was able to apply for my state licence after completing a bunch of paperwork. I did this and halfway into my second year I got my license.  Once this was obtained, I was able to “moonlight.”  This is where a resident can work at local clinics or urgent cares under his or her licence and make some extra money.  I took advantage of this a few times a week at about two and a half to four hours at a time.  The extra cash was nice because I really didn’t get paid much while I was a resident.

Things got easier as I became a second and third year resident.  Call became less frequent and rotations moved more into the outpatient setting with a typical 8 to 5 schedule. As a family practice resident I had my own patient panel in our resident clinic.  This was what I enjoyed the most because I was able to form relationships over the course of 3 years.  I was also required to follow at least 10 pregnant women through their pregnancies and deliver the babies.  I then followed the babies as they grew.  This was such a rewarding experience.  The only downside was that I had to be on call essentially all the time to be able to attend these deliveries. (You probably get the notion that I don’t like taking call.  You would be correct.  That is why I am so blessed to only have to take phone call at my current job.)

Late in my second year of residency I was encouraged to place my name on the ballot for one of the two chief resident positions.  I agreed and was voted the first chief resident of my class.  This came with many responsibilities and a few perks.  I had the onerous task of managing the residents with any interpersonal problems that arose.  Unfortunately, these did come up and I had to mediate a few conflicts.  I also made the rotation and call schedule.  By doing this I was able to create the schedule  with all the days I wanted off and make sure my rotations were exactly what I wanted.  

After three years I had my last graduation.  This was another amazing experience. I had the honor of receiving a plaque for being chief resident and I was also voted resident teacher of the year.  This was an award for the best teacher as voted by my fellow residents.  Again, my family, close friends and mentor, my uncle were present.  Each resident was given time to speak and I thanked all who had helped me get to where I was.  I also had a message for my son, who was just 7 months old at the time.

That’s where I want to leave this post and this series.  Shortly after this I took my boards and passed, becoming a board certified family physician.  I landed a job locally where I had been moonlightling and worked there for the next 2 years before moving to where I am now.  I have had an amazing experience leading me in my current position.  I look back and see that after inspiration struck from my uncle, I locked onto my dreams and pursued them vigilantly.  There were a few times where it almost didn’t happen including almost not being able to afford going to college and going down to the wire before getting accepted to Medical School.

So I’ll end this with the same thing I told my son.  “You can do anything you put your mind to.  Don’t let anything stand in your way.  In the future you will have dreams.  Grab on to these and don’t let go.  Shoot for the stars and when life gets in the way or puts up an obstacle, look for a way through or around because it will be there.”  I wish this for you as well.

How to Become a Doctor: Part 2

This post will take you through my medical school journey.

The last post led you on my journey through my initial interest in becoming a doctor up to being accepted into medical school. If you have not read it yet, you can click here to catch up. This post will take you through my medical school journey. Again, it tells my story, but can also be used as a quick roadmap for anyone considering becoming a doctor and what it entails.  You should know what you’re getting into before committing to such a great profession.

Medical School is a completely different beast than high school or college. Through high school and college I felt that I skated through and still got good grades. This was not the case in medical school. Through the first few weeks, medical school is described like trying to drink water from a fire hose. This analogy is spot on because you are being fed so much information it is impossible to remember it all. You open your mind wide and try to “drink” any and all information your brain can handle. Needless to say, I could no longer cram for tests. I studied every day.

In the beginning of medical school I was dating my future wife and would take the weekends off. I would drive to San Diego (about 2 hours from Loma Linda) on most Fridays and return on Sundays. Other than that I studied. Here was my life: I’d wake up and go to class which was typically 8 AM to noon. I would have lunch. Then I would either have a lab (such as anatomy cadaver dissection) in the afternoon or study until dinner time. I would have dinner then return to studying for another few hours before turning in for the night. This was going to be my profession and I dove in headfirst.

When I was going through medical school at Loma Linda, we still had a very traditional curriculum. The first two years were didactic with learning in the classroom. The 3rd and 4th years were hospital rotations where you get exposure to all the major specialties. Throughout the first two years you go through multiple tests to make sure you are learning appropriately. At the end of the second year there is a big test called “Step 1.” This is the culmination of all you have learned in these first 2 years and is almost as intense as the MCAT. I remember that I did fairly well on this test (ie. a little above average).

At one point during the 1st and 2nd years, we had to shadow an internal medicine doctor for a few days to get acquainted with a typical day in a doctor’s office. I remember waking up in the morning and knowing I was going to be on my feet the whole day. Up to this point I had been in the classroom and studying just about all of the time which was spent on my duff. I had only one pair of dress shoes and did not wear them much so they weren’t broken in. I decided to wear my comfortable New Balance running shoes. I showed up with slacks, a button down collared shirt with a tie and… running shoes. I was ridiculed the whole day, but I was comfortable!

The third and fourth years are where it starts to get fun. You get to essentially learn through “on the job” training. The major rotations include Internal medicine, Surgery, Obstetrics-Gynecology, Neurology, Psychiatry, Pediatrics and Family Medicine. Each of these has it’s own test that you must pass to complete the rotation. I found that as I rotated through each of these specialties, there were elements that I enjoyed in each one. This eventually led to my decision to choose a family medicine residency which in my opinion has characteristics of each of these specialties in one.

I don’t have room to jot down all of the great experiences and stories from my clinical years here and will need to have a blog post dedicated to that in the future. I had a bunch of great experiences outside of school as well and was privileged to have my wife supporting me through these last two years. We became very involved in a local church and helped with the youth group. A part of our heart was left in that church when we moved away.

During these clinical years, medical students essentially shadow the residents and are considered part of the team. A common practice during rounding (when visiting patients in the hospital) is “pimping.” This is when the attending doctor will “pimp” the medical students and residents by asking them questions about the patient, illness or pretty much anything else related to medicine. Some attendings do this just to humiliate the medical student or resident, but others were truly interested in education and teaching.

My evenings during these clinicals were spent studying about the particular patients I was following and the the medical problems they had. This would make me more prepared for rounds and the “pimping.” It was a great feeling when I was able to answer these questions. At the end of each rotation there would be a big test on the specialty. Grades would be based on this test and reviews from your attendings.

We also have the “fun” experience of taking inhouse call during our clinical years. I had the fortunate experience of being a “white cloud.” This means that I typically had easy calls and got to sleep on most nights I was on. My friends who were “black clouds” and doomed to be up all night every time they were on call were very jealous. One night, the resident I was working with was being nice and actually sent me home in the middle of the night! This was great until I got home and was met with my wife wielding an aluminum baseball bat thinking I was an intruder. Fortunately, a subdural hematoma was averted when she realized it was me.

In the 4th year of medical school you take another big test called Step 2. This has 2 components: A clinical knowledge portion which is a paper test and a clinical skills portion where you see test “patients” and are graded on your interaction with them. These test patients judge how well you ask appropriate questions, do an appropriate exam and document your findings. I again did well on these tests and passed all of my rotations with flying colors. I was set up to graduate!

Prior to graduating, in the 4th year of medical school, every medical student needs to make a decision about what specialty they want to pursue and start sending out applications to residency programs. I will save my story of this process and some residency stories for my next post, part 3 of this series. For now I will leave this post with one of the greatest days of my life, my medical school graduation.

Medical school graduation was an awesome experience. My family was present as was my inspiration for this whole process, my uncle (pictured at the top of this post). The culmination of all my efforts over the past 4 years was finally realized in the form of a 15 3/4″ x 22″ piece of paper with the words “Doctor of Medicine” written under my name. I had done it! I would thenceforth be known as a doctor. This was a great bookend to my educational experience but was actually just the beginning of my medical career.


How to Become a Doctor: My Story

Recently, I was doing some cleaning and came across two VHS videos that changed my life when I first saw them. It’s 2 part Nova series on PBS called “So you want to be a doctor.” When I was in Junior High, my uncle who was going through Medical School brought these videos home and showed them to me.  I remember from that moment I was hooked.  This combined with a relative in high school asking me about all it takes to become a doctor made me decide to write this article on my journey to get to where I am today.  The following is my experience, but it can also be used as a roadmap for those interested in becoming a doctor as well.

As I said above, it started in junior high.  I knew that going into high school I would need to work hard and get good grades to get into a good undergraduate school.  High school came easy to me.  First, I am by no means a genius.  I did work hard, but I was able to cram for most tests and get good grades. I did not graduate a valedictorian.  I missed it by 2 B+’s from my US History class.  My love for the sciences got me a few scholarships to college including a half-ride to my eventual choice, Point Loma Nazarene University. The decision to go to Point Loma was easy because it was where I got the most scholarships.  I eventually graduated undergrad free of any debt (that would come later in Medical School).

In college, I decided to major in both chemistry and biology as a joint major. Classes continued to be fairly easy but I did study more.  Even though PLNU is located in beautiful San Diego, I was unable to enjoy the beach life as much as my friends due to studying and labs.  I was again able to cram for most tests and still get good grades.  I came out with a 3.9 GPA as I did get a few B’s along the way.  

In your junior year of college, when you decide you want to go to Medical School, you have to take a test called the MCAT.  This stands for Medical College Admission Test and it is a beast.  Most of my friends decided to take a Kaplan study course to help prepare but I decided to study on my own.  I bought a study book and studied weeks for the test.  The scoring of the MCAT has changed in recent years but when I took it you would get a number between 3-45, wherein students in the 50th percentile received a score of approximately 25 along with a verbal score given by a letter ranging from J to T.  I got a 28-O: a very average score. I was devastated but did not want to take the test again and decided to apply.

The application process for medical school is a daunting task.  When I applied, it was in the early years of the process being online.  Essentially here is the process: you first send out an initial application to all of the schools you are interested in (and of course each of these applications cost money).  The schools that are interested will then send you a secondary application.  You complete and send these back and then the schools still interested will invite you for an interview.

I sent out 14 initial applications, essentially every allopathic school in California, UNR, Creighton in Nebraska and Saint Louis UNiversity.  Six schools returned wanting secondary applications including USC, UC Irvine, Nevada- Reno, Loma Linda, Creighton and Saint Louis University. Of these, three wanted interviews.  Only three!  I was placing my future career in few hands.  I completed the interviews which included Creighton, Saint Louis University and Loma Linda University.  Of these, Loma Linda University was my first choice since I wanted to stay in California close to my future wife whom I was dating at the time.  

The interviews are stressful but fun at the same time.  You get to go to the campus and see what the Medical School is like.  You typically will get a tour from a Medical Student where you check out all of the didactic areas and hospitals.  You then sit down for an interview where you get asked questions such as “Why do you want to become a doctor ?” and ‘What are your greatest strengths and weaknesses?”  Here is where you need to come up with an answer that will set you apart and make the interviewer remember you.  I used the story you’re reading combined with some anecdotes through my life about my doctor to answer the questions.  After all of the interviews are done… you wait.

Waiting is always the hard part.  When you receive a reply from a medical school, it is one of three answers: yes, no or we’re placing you on a waitlist. Being waitlisted means that you are on a list that the school will go down as those accepted drop off if they decide to go to another school.  I was denied at Creighton and waitlisted at SLU and Loma Linda.  This killed me!  The school year ended. I graduated and went home.  I still had not heard anything.

I had no contingency plan.  May came and went and halfway into June, I decided I needed to get a real job in anticipation that I would not be going to medical school. I applied and started interviewing for science related professions but none of them excited me.  July came and I had still heard nothing.  Loma Linda and SLU had start dates in early August, time was slipping away.  Late in the afternoon on July 20th I finally got an answer.

I remember the day vividly, I was at my grandparents house doing some work around their house to pick up some extra money.  My grandma came running out stating I had a phone call.  This was weird because I didn’t live with my grandparents and if somebody had called them, they were really trying to get ahold of me. I timidly took the phone and had a conversation that changed my life.  It was the admissions office at Loma Linda University stating a spot had opened up and asking if I wanted it.  They had called my parents house and were directed to my grandparents because this was urgent news.  I screamed “yes,” and finished the conversation maintaining my composure.  I lost it after I hung up and cried.  It was going to happen!  I was going to be a doctor!

For the second part and to continue the story click here.

Shooting myself up with a needle

I pressed on the plunger to release the substance.  A strange warm sensation radiated up my arm…

I sat there.  My left forearm exposed and spread out on the table.  My right hand held a syringe with the needle unsheathed.  It carried a clear liquid with some white milky fluid stirring around it in. I had disinfected the area with alcohol and was ready to do it.  I was going to give myself an injection.  It was a Saturday and nobody was in the clinic. I was tired of the pain and needed the sweet relief that could only be found behind the needle dangling from my fingers. I took a deep breath and pointed the needle at my wrist.  The tip of the needle vibrated exposing my shaking hand from the nerves.  

I couldn’t stop.  I had to do this. I pressed on and felt the tiny prick of the needle as it pierced the skin.  “That wasn’t so bad,” I thought.  But the needle had to go deeper and I put a little more pressure.  The razor sharp needle slid easily through fascia and subcutaneous tissue diving down to the area I needed it to be.  I gently drew back the plunger to make sure I was in the right place.  I was and then I pressed on the plunger to release the substance.  A strange warm sensation radiated up my arm.  It took a couple seconds to completely evacuate the syringe. I quickly withdrew the needle and threw on a bandaid.

I waited there wondering when it would take effect.  Two minutes passed.  I started to sweat wondering it it was all for nothing. Finally, the sweet sensation of relief enveloped my left wrist and thumb. It had worked! I quickly cleaned up all of the paraphernalia.  I locked up as I left and went home.  

While drug use and self injection of addictive substances by physicians is a known problem, that was not this case.  The area I injected was my left wrist over the distal radius at the base of the thumb. The medication that was an injection was a combination of lidocaine (a numbing medication) and depo medrol (a steroid). I had what is called de Quervain’s tenosynovitis, a condition of severe inflammation over the tendons to the thumb as they pass through a canal over thumb side of the wrist.

This condition is very common in new mothers as they hold their baby on their hip with their arm wrapped around and wrist flexed stressing the tendons. The condition was caused by my second son who was a tank.  I would always hold him on my left hip and try to get my chores done around the house with the right hand.  I was well acquainted with the condition because, not only had I treated it and done injections on my patients, I had the condition 2 years earlier with my firstborn (who was also “of ample proportions”). At that time I had received an injection from an orthopedic surgeon who was a friend of mine.

This time I did not have access to a colleague to do the injection so I took action myself.  I was surprised how easy it was to do the procedure.  It worked well and the steroid cleared up the inflammation.  In the future I don’t think I’d do it again. Often as doctors we think we can self treat but we don’t always make the best decisions when treating ourselves.  (I’ll have to have Dr. Mark Vaughan talk about his friend who was going to do his own vasectomy on his youtube channel).  Fortunately now I have a partner physician I can run things by.

Perhaps this transfers to non-medical life as well.  Going solo can have dire consequences.  In making delicate, tough or important decisions in your life, I hope you consult a trusted friend.  Recently my wife and I have had to make a big decision and I am so glad we made it jointly and are going through the transition we decided together. In Ecclesiastes 4:9-10 it says: Two are better than one, because they have a good return for their labor: If either of them falls down, one can help the other up. But pity anyone who falls and has no one to help them up.”  Find that trusted person in your life and be that person for someone as well.  It mostly comes down to truely caring for and having compassion for those around you. This will open you to some vulnerability but when you have that special person who looks out for your interests as much (or more) than you do, it is a wonderful thing.  Thank that person in your life this week.

If you enjoyed this, check out some of my other medical stories here.