Hilarious Medical Transcription Snafus: My Faves and Yours

This is my 100th blog posting, so it seemed like a good time to get a bit frivolous. The NY Times recently ran a front page story about websites that collect user-submitted triviata – such as “Pets Who Want to Kill Themselves” (pictures of bulldogs wearing bunny ears or cocker spaniels in Yoda costumes) – and are later repurposed into bestselling books. Just as I was thinking about that, I happened upon a medical chart with one of the funniest dictation snafus I’d ever seen, and I got to thinking…

Every doc knows that transcripts of medical dictations can be glitchy. After all, we do them in the car, or with Colbert on in the background, or frantically between patient encounters. We talk a mile-a-minute, and our word salad is chock-full of obscure medical terms. The transcriptionists charged with making sense of it all vary in skill and experience; these days, many are based in other countries. So it should not be surprising that little errors crop up all the time. But every now and then, we see a real doozy.

With that as background, here’s the deal: I’ll give you my two favorite medical transcription faux pas, and we’ll see if we can generate a boffo list of all-time favorites from all of you. Who knows, maybe there’s a book in it.

Here’s the one I just saw recently. A patient of Middle-Eastern descent suffered an acute respiratory deterioration. The covering physician came to see the patient stat, and later dictated that he found the patient in extremis (a fairly common medical term-of-art, it’s Latin for “at the point of death”).

Pretty scary situation, but not as scary as the transcriptionist made it out to be:

“…on my arrival to the ICU I found the patient to be an extremist.”

I kid you not.

As good as that one is, it doesn’t quite take the cake. That honor belongs to a dictation I did as a resident, of a hospitalization of a gay man suffering from AIDS and pneumocystis pneumonia. (Parenthetically, this area soon became my first research focus, such as here and here). The patient did reasonably well, but remained a bit hypoxic at the time of discharge. In describing the discharge plan, I mentioned that “The patient was discharged with home O2” – shorthand for home oxygen.

But the transcriptionist apparently thought I was commenting on the patient’s lifestyle and escort rather than his medical equipment. The final dictation read:

“The patient was discharged with Homo Two.”

OK, your turn. Any favorites out there?

34 Responses to “Hilarious Medical Transcription Snafus: My Faves and Yours”

  1. blackwhitereadallover April 21, 2009 at 7:48 pm #

    Bob,
    Thank you for a delightful stress reliever and congrats on your 100th posting! Each post a pearl before, um, readers, I’m sure…
    SH

  2. Ryan April 21, 2009 at 11:30 pm #

    I think my favorite was my patient who had a “paint and frame valley”.

    Or make that a patent foramen ovale.

  3. erietran April 21, 2009 at 11:30 pm #

    Here are two of my favorites:

    Cancer of the breath.
    The patient is to take her medication with her foot.

    Erietran

  4. Dan Varga April 22, 2009 at 2:57 am #

    It is not really a mistransciption, but still amazing that anyone actually agreed to transcribe it. A disgruntled surgeon who was asked to redictate a discharge summary because of a transcription snafu dictated:

    “Patient entered hospital with gall bladder and left without it.”

  5. rsm2800 April 22, 2009 at 6:23 am #

    Bob, I was also a resident at UCSF/SFGH in the mid-80’s and had the same “homo two” typo on some of my dictations. A variant was “The patient was sent home with homo, too.” I still call it The Greatest Typo Of All Time.

    Enjoy your blog.

  6. rwdrwd April 22, 2009 at 7:03 pm #

    Medical transcriptionists are unfamiliar with the term *in extremis*. I had a similar thing happen. After dictating the vital signs I said “the patient is in extremis” and it was transcribed as “the patinet is an extremist.”

    On another occasion many years ago a patient presented to the ER with ruprured abdominal aortic aneurysm. Despite heroic efforts the patient did not survive. I must have really been mumbling when I dictated my narrative summary. I said the patient was given massive IV fluids. The transcription read “the patient was given *measly* IV fluids.

    On more than one occasion, usually when dictating a narrative about a patient with alcohol related metabolic problems, my mention of “divalent cations” got transcribed as “dive in with cations.”

    There’s no limit to the ways transcriptionists can distort your words.

  7. dotdoc April 22, 2009 at 9:38 pm #

    I’ve been amused by the transcription snafus from voice recognition software. I was fiddling with an earlier version of a popular program several years ago, describing a clinic visit with a patient who had symptoms of bladder outlet obstruction. An empiric trial of “prazosin” was aptly transcribed as “praises ascend!”

  8. jcc April 23, 2009 at 3:13 am #

    Can’t blame the transcriptionist…

    Tend to mumble as the night goes on.

    Dictated under family hx: Mother had history of “peripheral vascular disease”.

    Dragon Naturally Speaking transcribed: Mother had history of “purple *** disease”.

    Signed H&P without proof reading.

    Oops!

  9. mma April 23, 2009 at 3:22 am #

    I work in spine, and instead of getting “degenerative disc disease,” I got “degenerative dick disease.” Didn’t know such a disease existed…

  10. Rich Davis April 23, 2009 at 3:31 am #

    A memorable case of creative listening/spelling was from the intended:
    “The urine ultimately grew Klebsiella.”
    into:
    “The urine ultimately grew Clubs Yella.”

    Can’t be too careful when it comes to community acquired Clubs Yella …

  11. doc1220 April 24, 2009 at 4:04 pm #

    From the first line from a procedure note in a chart:

    “The patient was prepped and raped in a sterile fashion….”

    Oy.

  12. mgraban April 26, 2009 at 8:51 pm #

    Instead of blaming the transcriptionists, why not question the practice of doing them “in the car, or with Colbert on in the background, or frantically between patient encounters. ”

    If one of the root causes of the inaccurate transcriptions is background noise, wouldn’t it be more responsible to do this in a quiet office?

  13. just a patient April 27, 2009 at 4:49 am #

    Hmm. If that’s what the transcriptionist hears, I wonder what the patient hears….

  14. harriseve April 27, 2009 at 9:31 pm #

    Found this moments ago in Proceedings of the International Consensus Conference on Breast Cancer Risk, Genetics, & Risk Management, April, 2007

    “… the panel endorsed bilateral total mastectomy…The major question was timing, i.e., at the time the mutation was confirmed or at some time in the future, the date to be chosen by the patient. Most panelists felt that surgery was best performed in the late 1930s, and should not be delayed past mid-1950s…”

    Are surgeons getting worse as decades go by?

  15. Bob Wachter April 28, 2009 at 4:53 pm #

    Folks — you may have wondered about a few of the comments that have a key word deleted, replaced by “***” (see the comments by “jcc” and “mma”, above). The censor in the blog software was set too stringently (a setting that wasn’t, but should have been, called “Maximum Prudishness”), so that even anatomic terms like “breast” were blocked.  We have given the Nanny a metaphorical Ativan, and so reasonable but slightly naughty words should now make it through. To readers jcc and mma, if you’d like to email me the actual word you intended, I can add it back to your posts (click on “email Bob”). Sorry for the glitch.

    Here’s another good one from a colleague — not a transcription error but a typo in a cardiology note:

    “–for CHF, will cont to monitor exam and dose home med lasix 20 mg today (daily PORN for weight gain >2 lb)…. will also cont digoxin, spironolactone, statin, captopril, ASA”

    Although the daily PORN might have worked, the intent was that Lasix be given “PRN.”

    Thanks to all for your exuberant responses to my Request for Typos.

  16. shmulek April 28, 2009 at 6:03 pm #

    a practising oncologist, I signed a dictation that my patient was receiving chemotherapy with “five a few” infusions and was doing well…

    [Editor’s Note for the non-clinicians:  The actual chemotherapy is 5 fluorouracil, commonly known as “5-FU”]

  17. lnicholson May 17, 2009 at 3:33 pm #

    Early in my attending career, part of the care plan for a few of my CHF patients was to “follow the eyes and nose.”

    (Instead of I/O’s for the fluid in’s and out’s — seemed so obvious at the time.)

  18. Maxine May 22, 2009 at 4:41 pm #

    I work in oncology and palliative care and like to visit this blog when I need a chuckle. Given my specialty, that’s fairly often.

    Here’s one from a recent note: “the patient’s neuropathy was due to a perennial plastic syndrome”.

    I’ll add that to the etiology of paraneoplastic syndrome!

  19. noname June 6, 2009 at 7:14 am #

    on an assessment and plan for a patient with CHF admitted for diuresis: “monitor eyes and nose….” (I’s and O’s…)

  20. MIngrahamMD June 18, 2009 at 11:02 pm #

    This is probably a variant of dication and transcription error. In my life prior to hospital medicine as an outpatient doc, I sent one of my 70-something year-old male patients off to the urologist for a consultation about a prostate nodule and an elevated psa. I was alarmed when a couple weeks later the consultation note came back with my name on the note as the patient, and my name scattered throughout the note with graphic descriptions and comments about my concerning prostate nodule and my elevated psa. I also read on with great concern that my virility was not quite up to par. Furthermore, unbeknownst to me, I was already scheduled for prostate surgery – at age 32! And the kicker, the note was cc’d to me.

  21. Bob Wachter July 16, 2009 at 1:50 pm #

    Veering slightly off transcriptions into malapropisms: I recently cared for a patient with cirrhosis and hepatic encephalopathy. I met him on the morning after admission, and he was already moderately improved with treatment. When I asked him why he thought that his thinking had deteriorated prior to the hospitalization, he said, “I didn’t take my lactulose, so I got encephalo-pathetic.”

  22. Mary Schultz August 13, 2009 at 4:24 pm #

    Another malapropism…a med student, presenting an 18 month old patient at Morning Report:

    “…for diet, the patient was taking table scraps….”

  23. Record Reviewer August 14, 2009 at 3:08 pm #

    My 3 favorites:

    1. Patient was alexic and agraphic
    (a doctor showing off his latin? for unable to read/write)
    2. Patient attempted to commit suicide by bride-jumping
    (apparently meant “bridge” jumping)
    3. In the H&P for a guy who had been admitted because of putting a foreign object inside himself:
    Impressions: Phillips Head

  24. Bob Wachter September 5, 2009 at 10:04 pm #

    A new one, just sent to me by a colleague…

    From a recent head CT scan report:

    “Soft tissue densities are seen in the bilateral external auditory canals which may represent cerumen. Correlation with colonoscopic examination would be helpful.”

    That would have to be one long colonoscope!

  25. Gabrielle November 14, 2009 at 12:27 am #

    Interesting and amusing article. As a medical transcriptionist for 8 years, I’d like to submit my input from the other viewpoint.

    I concede there are quite a few MTs whose knowledge of medical terminology is substandard to what is considered to be required in my industry, but the majority of MTs I know are quite familiar with “obscure medical terms” and actually more medical terms than the average physician. We, after all, must be versed in terminology in all medical disciplines, not just one or a handful as is the average physician. I routinely have physicians mispronouncing even common medications, equipment, or procedures not in their field and it is part of my job to make sure these are corrected.

    Physicians also use non-medical terms in the wrong context; for example, I had a physician who meant the term “Occam’s razor,” pronounced it “Hoakum’s razor,” and utilized it in such a convoluted way out of a sheer desire to sound sophisticated it was painfully obvious he didn’t know what it meant, ironically going against the very meaning of the term itself. It is also a substantial part of my job to correct and clean up grammar; obviously, physicians are busy people with an awesome responsibility and their dictation is generally made on the fly. Perfectly understandable, but it makes for quite a challenge.

    May I offer some tips to physicians so that MTs can perhaps be more accurate? First and foremost, SPEAK CLEARLY. If I had a nickle for every dictation done through a mouthful of food, coughing (loudly) into my ear (there WILL BE a person on the other side, after all), or mumbling into a handheld at their home with their children yelling in the background, I could afford to go to medical school. :-) If you are an ESL (English Second Language) it is even more important that you enunciate and slow down a bit. Everything you dictate is going to be heard by another person, who will put it into word format, which will affect your patient’s quality of care. If the MT’s convenience is not a concern, the patient’s care should be.

    Please do not let us sit and wait while you flirt with your assistant, take a long personal call, or, as I had today, get caught up in a TV show (in this case, “The Breakfast Club—great movie, but I’ve seen it, thanks). I have a physician who routinely turns out 45-minute reports with less than 5 minutes of dictation on them because he is searching his notes with no preparedness beforehand. We are paid by the line and when we are forced to sit and do nothing while the physician is doing something besides dictation it is costing us our living; we don’t take kindly to that. A physician should understand, if anyone could, the value of time.

    There are other things, but if physicians could just get down the SPEAK CLEARLY part, you would be surprised at how much your end result will improve. This does not excuse substandard transcription at all; we have a level of quality to produce and those who cannot should not be in this field. I take my job seriously. I am well aware that the quality of my work affects the patient’s quality of care and that the physician relies on me to make him look good. All I ask is that you do not throw unnecessary roadblocks in my way.

    Thank you for your time.

  26. Better Late than Never December 29, 2009 at 8:57 pm #

    I’ve QA’d things such as “driving erotically” – umm, how about we change that to “erratically”?? There was also the report had where the patient was “sitting ________ on the floor …” the blank was “Indian style.” and, you got it, the blank was generated by an Indian transcriptionist. That one made me laugh for days!

  27. Marshall Maglothin January 20, 2011 at 10:21 am #

    @ dotdoc RE “There’s no limit to the ways transcriptionists can distort your words.”

    Yes, they can exponentially increase the humor gibberish with voice recognition.  I have found having transcriptionists use prior dictation and corrected transcription to “teach” voice recognition user files improves the final result.

  28. Sheila March 9, 2011 at 11:57 pm #

    My all-time favourite was spotted on an Emergency Department admission form. Apparently the patient was seen for complications of a “baloney amputation”. Perhaps “below-knee” would have made more sense??

    Another whimsical favourite: “The patient choked on a doughnut and her eyes were glazed.” Oddly appropriate.

    As a medical transcriptionist, I would like to thank Gabrielle for speaking out for our profession!

  29. Pippa May 11, 2011 at 8:18 pm #

    My favourite was from a vascular surgeon who had seen a patient with a sloughy venous leg ulcer: “Thank you for your referral for this lady. The sloth is still on her leg, but it is getting better”.

    I am a nurse practitioner and often am asked by a MT I work with to decipher what is said on dictation tapes, and it can be a challenge: MTs everywhere, I salute you!

    As for what patients hear – I had a chap who said the doctor told him he had “very close veins” in his legs.

  30. cs August 20, 2011 at 11:27 am #

    I know this is an old thread, but here is our favorite voice recognition snafu now permanently embedded in the memory of Dragon Dictate – patient received prophylaxis for deep penis and Moses. (DVT)

  31. Patil SS August 23, 2011 at 11:08 am #

    I am a proof reader in a transcription company. This is one of my favourites typed by a transcriptionist.

    T: I offered the patient oral pregnancy done as an inpatient.
    D: I offered the patient oral prednisolone as an inpatient.

  32. mike smith September 5, 2011 at 5:17 pm #

    Thanks Bob for your humor. Can we ever forget the patient whose scrotum was placed in a support and sent home. I hope the patient went with it.

  33. Verma January 30, 2012 at 10:43 pm #

    A recent one with me:

    I think the likely etiology of pancytopenia is likely ‘delusion’ when I meant dilution!

  34. Pat April 26, 2013 at 3:49 pm #

    Is it too late to add my fave? Doc dictated, “The patient denies suicide.”

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