Letters

Listen to your body, mind and spirit

To the Editor:

I really enjoyed Dr. Marshall Zaslove's article, "What Your Body, Mind and Spirit Can Tell You" [September 1999, page 66]. It validated many of my recent thoughts.

When I turned 50, I decided to do some soul searching, because I didn't want stress or overwork to destroy my well-being or create resentment for my job. Even though I had begun taking more time off for family and hobbies, I knew that I also needed to modify my work environment if I wanted to remain sane for the long haul. Leaving private practice (and all the inefficiencies of institutional management) to become a self-contracted, salaried employee for the local hospital made this undertaking easier.

I began punting some of my more complex and demanding adult patients to one of the new internists and more routine care to our physician assistants. I limited my inpatient load and busy obstetrics practice. I relied more on the emergency and on-call doctors to evaluate my patients after hours, and I accepted committee appointments or teaching assignments only if they could be done during regular hours.

Despite these changes, I still maintained a relatively large and loyal following. I simply had to accept the reality that, in contrast to some of the self-destructive behaviors we acquired during medical school and residency, I couldn't and shouldn't try to be everything to everybody.

Since the first step in resolving some of these issues is merely talking about them, perhaps articles such as Dr. Zaslove's will stimulate meaningful discussion.

Bruce D. Greenberg, MD
King City, Calif.

Naturally speaking

To the Editor:

I read with interest the letter, "Until the lungs are removed ..." [October 1999, page 10], about voice-recognition systems.

After a recent demonstration of Dragon Naturally Speaking, I trained the program by reading to it for 30 minutes and then dictated some sample notes. I didn't have too many problems once I discovered that it was necessary to enunciate clearly. There were occasional errors, but no more than our transcriptionist makes.

However, the program can be fooled. I dictated the following sentence at top speed: "This is a test to see how fast I can speak to it." The transcription came out as: "This is the testicles of the CIA." No joke.

Charles E. Morris, MD, MPH
Chambersburg, Pa.

The art of dictation

To the Editor:

These remarks, in response to the letter, "Until the lungs are removed ...," are neither an endorsement nor a defense of voice-recognition software. Rather, they're a reminder that as bad as any of these systems may be, the physician's input is a key factor in the level of success.

Physicians are highly intelligent, well-educated people, but very often their writing and speaking skills don't reflect these attributes. These basic skills are a prerequisite for good records, whether those records are transcribed traditionally or by using voice-recognition software.

Too often, my transcriptionist colleagues and I must make judgment calls because a physician speaks too fast, doesn't pronounce words correctly, doesn't enunciate clearly and/or doesn't prevent background noises on the tape. Machines can't make judgment decisions, and transcriptionists shouldn't have to make them as often as they do.

Effective dictation training for physicians could prevent many problems, but I have yet to find a medical school or residency program that teaches this.

As we wait for all of the bugs to be removed from voice-recognition software, maybe medical educators can begin training physicians in the art and skill of medical record dictation as well as the nitty-gritty of the English language.

Maureen Lemek
Davenport, Iowa

Is it no wonder?

To the Editor:

With the acceptance of nudity on some beaches, provocative dress codes and X-rated movies and television channels, is it no wonder that sexual harassment is on the rise ["Preventing and Responding to Sexual Harassment," October 1999, page 32]?

Intelligence is no substitute for common sense, which appears to be lacking in our present society.

William M. Fuchs, MD
Huntington, NY

Coding reference cards

To the Editor:

The rules of thumb were very helpful for 99214 ["A Quick-Reference Card for Identifying Level-4 Visits," July/August 1999, page 32]. Do they exist for any other codes?

Karla S. Porter, RRA
Nashville, Tenn.

Editor's note:

In response to many reader requests, the author, James M. Giovino, MD, is currently working on a similar article and reference card for 99211. Look for the article in the spring of this year.

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