Dictation is Public Enemy #1

Pete O’Toole

Healthcare is the biggest political issue in the US right now.  It’s a huge financial problem for everyone – individuals, businesses, the government and healthcare providers themselves.  It’s become so overwhelming that it has gridlocked congress.  The word “healthcare” just deflates everyone in the room each time it is uttered.  Despite all the frustration and everyone’s acceptance that “healthcare is broken,” most of us can’t name concrete problems in healthcare.  There is a vague sense that sometimes too many tests are ordered, but when it’s you who may need the tests, it’s not a problem.  Personally, I think that modern medicine is amazing, and nowhere in the world is it taught or practiced better than in the US.

I prefer to look for solutions to this crisis in places that do not take away from patient care.  For me, the first place to look is not in cutting screening for cancers – even if “only” 1 in 1000 people in a certain age range may actually test positive.  I think 1 person in 1000 is actually quite a lot to dismiss.  I realize there are excesses in the administration of healthcare — doctors who might be gaming the system, patients who might be hypochondriacs and lawyers who force doctors to practice overly defensively — and that it needs to be addressed.

The world's most powerful computer at Columbia University's Watson Lab, 1954.

There are many other places we can look to save money in healthcare.  One problem that will probably only get worse is medical transcription.  Decades ago, it made more sense for doctors to speak into a microphone and let a professional typist translate that dictation into a typed sheet of paper, than it did to try to make every doctor a professional typist.  When the first computerized medical records came out in the late 1960s, this practice naturally moved right over to support entry into these systems.  In fact, these systems were little more than glorified word processors, and many of them unfortunately have not progressed much beyond that point.  Early computer applications, although exciting, were hard to use.  Human-computer interaction as a field was barely born and would not influence the industry for a long time.  In the 1960s, this workflow made perfect sense.  Let doctors treat patients and let typists type.