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

Recently, an Indian company successfully underbid the incumbent large national on the transcription contract for a prestigious New York teaching hospital. One can only hope that the patient records this offshore contractor produces will be intelligible and that confidentiality will be maintained.

Talking about talking

Marcus Tullius Cicero did not make it a practice to sit down with pen in hand, but dictated all of his writings. In the letters he wrote to his son, later compiled into the three books of De Officiis, the great Cicero prescribed:

"Now since we have the voice as the organ of speech, we should aim to secure two properties for it: that it be clear, and that it be musical. We must, of course, look to Nature for both gifts. But distinctness may be improved by practice; the musical qualities, by imitating those who speak with smooth and articulate enunciation."

Some months ago, the weekly survey question for MTs at, the Health Professions Institute website, asked which type of accent people would least rather transcribe. The "winner" was fast-talking American at 31% -- more than Indian, Latin American, British, Asian, or regional American accents.

Given the choice between an ESL dictator with a heavy accent, who is sincerely trying to be understood, and a fast-slurring native speaker of English, arrogant in the knowledge that no matter how bad his/her dictation, someone must deal with it, the vast majority of MTs would prefer to transcribe the ESL doctor.

Transcription agencies are beginning to refuse to transcribe for people who do not dictate intelligibly. I applaud this new trend wholeheartedly.

"I prefer tongue-tied knowledge to ignorant loquacity." - Cicero, book 3, De Oratore (55 B.C.)

What about voice recognition? At this writing, VR is only really useful in limited-vocabulary situations, such as pathology or the emergency room -- or the solo practice of a physician who also happens to be a computer geek, and doesn't mind spending hours training the software over and over. VR may one day replace the medical transcriptionist, but as of now it might as well be virtual reality.

I dictated the following phrases into my Lernout & Hauspie voice recognition program, which I have trained to my own voice but not completely for medical terminology.

Elizabeth said: immunocompromised host.
VR program typed: to pay a new compromise the host.

Elizabeth: status post renal transplant.
VR program: forced as bad as real transplant.

Elizabeth: hyperlipidemia.
VR program: upper lip Kenya.

Elizabeth: squamous cell carcinoma.
VR program: squid was zero cars in them.

I purchased this program for $30 at a computer show, knowing it was only a toy; I would say I've gotten more than $30 worth of entertainment from it already.

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