Thursday, September 1, 2011

Jack of all Tirades

Dear Friends,

The Hard Taco Song for September is called, "Jack of Any, Jack of All." Enjoy it irresponsibly.

At the University of Michigan, doctors dictate clinic notes into a phone and within a few hours a written version comes back, ready for to be signed and mailed to the referring physician.  The voice recognition software (or Trickster God) responsible for transcribing my dictations is a cruel deceiver, bent on altering the meaning of my correspondence without me noticing.  Real example:

The patient is very frustrated by the pain from her chronic unexplained illness... I will start morphine as needed.


The patient is very frustrated by the pain from her chronic unexplained dullness... I will start morphing as needed.

When I was a first year neurology resident, my friends training in ophthalmology had a small wager to see if any of them could plant the phrase, "Shiver Me Timbers" in a clinic note. This concept amused us to no end, because there is no way an eye doctor could dictate that expression inconspicuously.

Slit lamp examination shows increasing cataract peripherally in the left eye. The pressures are 22 bilaterally but... Shiver Me Timbers! There is no significant evidence of optic disk cupping!

As a neurologist, though, it's as easy as falling off a velocipede. We often have patients repeat simple phrases to assess their ability to process language. When a woman with memory complaints came to my clinic, I simply said, "Please repeat after me. Shiver Me Timbers."

"Shiver Me Timbers," the patient replied, dutifully.

The patient is a 60 year old woman with a chief complaint of forgetfulness. On examination, she was awake, alert, and [insert pirate accent] could repeat the phrase, "Shiver Me Timbers!" It is my impression that she is neurologically intact. Avastin!

Avastin is the trade name of a chemotherapy drug that was obviously developed by a scurvy-riddled buccaneer. I did not suspect a brain tumor in my patient, of course, so I had to end this dictation with:

Is not indicated at this time.

Here are some other medical terms that I always dictate with a pirate accent:
1. Aricept (A dementia drug. As in, "The patient was unable to repeat Shiver Me Timbers. I will prescribe ARRRicept.")
2. Blow the Man Down (A neurologic test that indicates a patient's balance is very poor.)
3. Pillage (The act of prescribing oral medications, such as ARRRicept)
4. Hearties ("The patient has cardiomyopathy and is now on the transplant list, in case any hearties become available.")
5. Fire in the hole (Hemorrhoids)
6. Privateer ("After delivering the bad news, I stepped out of the room so she could share a Privateer with her family.")
7. Abaft ("The patient should tape a plastic bag around her foot to keep the sutures dry when she is taking abaft.")
8. Keelhaul (What Oates will have to do if he ever wants to be the front man. Surprisingly, this phrase is not commonly used in medical dictations.)

A couple years ago, I had the opportunity to to write a chapter about the neurologic examination for the Oxford American Handbook of Neurology. You can preview this book for free on Google Books, and after reading the delicious passage on the top of page 22, turn back to page 21, where you will see the London Shiver Me Timbers Test included as part of the standard neurologic examination.  I'm bolding it not because I enjoy the time-consuming act of pushing the Ctrl key (I don't), but because it is a powerful and original idea, and I must remember to pay myself royalties for mentioning it here.(1)

There's more to this story, but I must stop here because I feel the need to start morphing at this time.

With warmest regards,

Hard Taco Homepage:

(1) I have another great idea, but I'm not sure I'm the first person to come up with this. What if we make a velocipede that has two wheels the same size rather than a ridiculously large front wheel and a ridiculously small rear wheel?