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Brandt’s Rants: Doctor: Be careful what you document …: Emergency Medicine News


communication, dictation, humor in EM


Communication is essential in the emergency department, not only when speaking to our colleagues and patients, but also in writing. Our documentation should clearly show what we have done and what our thought process has been. The notes must convey our reasoning and our reason for being. We’ve all heard the mantra, “Document it, or it didn’t happen.”

But we have to be careful what we document. Mistakes can happen, and we need to be vigilant not to let unintentional – and sometimes humorous, sometimes dreadful – mistakes creep into the medical record. These are concrete examples of cases where our dictation service made (ahem) slip-ups.

Doctor: At the time of discharge, the urine was still pending.

Dictation: Upon discharge, the urine was tasteless.

Doctor: Take your prescription every day until you are gone.

Dictation: Take a doctor every day with a gun.

Doctor: The peanut was removed from the patient’s nose.

Dictation: The penis was removed from the patient’s nose.

Doctor: I carefully irrigated the patient’s wound.

Dictation: I carefully urinated the patient’s wound.

Emergencies are increasingly busy. Pressure is mounting to see more patients in less time while having increased responsibilities and longer documentation requirements. Less time for more work allows mistakes to slip through the cracks.

Doctor: The cremasteric reflex was present bilaterally.

Dictation: The cremasteric reflex was pleasant bilaterally.

Doctor: The patient was sterilized and draped.

Dictation: The patient was sterilized and raped.

Doctor: After that, we consulted with the palliative care team.

Dictation: After that, we consulted with the failure team.

Doctor: The patient was punched in the face.

Dictation: The patient was punched in the face with the joints in the chest.

Doctors, always so resilient, have adapted. We used to freely dictate our interactions with patients. We have hired staff who can understand our vehement dictations and accurately translate our thoughts into cohesive documents. Sadly, time has rushed and the era of free dictation has faded with the emergence of newer and better technology.

Doctor: The patient had normal appearing male external genitalia.

Dictation: The patient had nominally attractive external male genitalia.

Doctor: No post-traumatic findings in the chest, abdomen or pelvis.

Dictation: No post-romantic findings in the chest, abdomen or pelvis.

Doctor: The patient was electrically cardioverted at 200 joules.

Dictation: The patient was sexually cardioverted at 200 joules.

Doctor: The cardiologist came to the emergency room and examined the patient.

Dictation: The cardiologist came to the emergency room and raped the patient.

Text-to-speech programs were born and we have adapted again. We have created special patterns and phrases. Billing departments were thrilled as they could nitpick the tables to make sure all the qualifiers were there. I remember receiving billing emails stating, “Only nine of the ten required systems reviews on this graph. Looks like you’re a bad doctor.

Doctor: The patient was encouraged to take antibiotics.

Dictation: The patient was encouraged to retract the buttocks.

Doctor: The patient is in the room with her husband.

Dictation: The patient is in the room with her was.

We made progress despite the difficulties. Time spent with patients has been broken down into smaller and smaller amounts to give us enough time to enter patient information and order labs, x-rays, and ECGs. We quickly documented the stories and the physical data in the graph. We finally arrived at a perfect documentation system. Where do we have?

Doctor: The baby has a circumcised penis.

Dictation: The baby has a penis the size of a circus.

Doctor: Pelvic examination performed in the presence of an attendant.

Dictation: Pelvic examination performed with a machete.

Doctor: Patient admitted to hospital with anxiety and Takotsubo.

Dictation: Patient admitted to hospital with anxiety and a bowl of taco soup.

Doctor: The patient has greatly improved after DuoNebs.

Dictation: The patient greatly improved after the donuts.

Remember to check your dictations before accepting. You might be surprised at what the dictation service heard.

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Dr Brandtis an emergency physician currently working in New Zealand (after 12 years in Michigan). Read his blog and other articles on, follow him on twitter@brandtwriting, and listen to his humorous ED podcast, “EpineFriends”, which can be found at Read his old REM columns on