This article, "Cicero Teaches Dictation: Lessons From Ancient Rome", is intended for physicians, residents, interns, medical students, nurses, and physician assistants.

By Elizabeth Dearborn

My beloved Cicero (106 B.C. - 43 B.C.), the great Roman statesman and orator, said it best: "Brevity is the soul of wit." I believe this quotation has been read, in its various translations, and taken to heart by most young physicians. This is not necessarily a good thing.

Let me first explain that I'm not a doctor and I have never attended medical school. I've been a medical transcriptionist (MT) for about 20 years. I have contributed to three transcriptionists' reference books, and now, in addition to my full-time MT job, I run a reference website for transcriptionists. During my time in this business, I've noticed that the average number of words dictated per minute, especially by the younger physician, has been climbing steadily upward.

A participant on one of the MT networking websites has a son who is a third-year resident. He told her that he and the other residents enjoy holding informal dictation contests to see who can dictate the fastest. Even this wouldn't be so bad, since playback can easily be sped up or slowed down, but recently I have noticed the disturbing trend that the typical dictated report contains less and less information. The traditional Chem-7 becomes a Chem-5, with chloride and CO2 left out.

Everyone in the healthcare field is under tremendous pressures, not the least of which is cost control. The less you say, the fewer lines will need to be transcribed. Often the transcriptionist is at a remote location, cannot contact the dictator to ask questions, and knows nothing about the patient. Combined with limited information, dictated at a high rate of speed, these ingredients can form a potentially hazardous mixture.

The stated purpose of the transcribed operative report, consultation, clinic note, or discharge summary is to document patient care after the fact and to obtain reimbursement. Nevertheless, these documents are also important tools for planning patient care. If the patient is unable to provide an accurate medical history, for whatever reason, his old medical records just might save his life.

Hospital medical records departments assess penalties against doctors whose records are delinquent. One hospital has a monetary fine policy for physicians who, on the first of the month, have at least 10 charts delinquent by 30 days or more. The fine is $100, with increasing increments if they still have delinquent charts the following month(s). At another hospital, if a physician is on suspension for more than 30 days, he or she is automatically resigned from the medical staff. This facility's medical staff bylaws state that the physician must complete his records and pay a $500 application fee for reinstatement of privileges.

The chore of dictation is routinely handed off to medical residents, and increasingly to MSIIIs and IVs. If you're still a student and are assigned charts to dictate, take it as a backhanded compliment. Remember, "stressed" spelled backwards is "desserts".

A report that is erroneous or incomplete can come back at you like a dietary indiscretion. I can't guarantee that this will never happen to you; I can only show you how to minimize the chances. I know how you cherish the minutes you can call your own.

With the kind assistance of Cicero, Emperor Claudius, and the recently departed Dr. Mark Greene of ER, I'll show you how to dictate your reports most effectively in the odd moments of time you have available.

The 14-second discharge summary - a new speed record?

Not long ago I transcribed a discharge summary on a patient who came in for laparoscopic cholecystectomy. The dictation was 14 seconds in length and contained only 58 words. I've transcribed hundreds of lap chole reports, but because the dictator was speaking too fast, there was one word I couldn't get no matter how hard I tried. If not for that one blank, the report still would have contained the bare essentials of patient care documentation, and I'll give mad props to the dictator who can do that.

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